Active living Flashcards
how much exercise if needed for children 1-4yrs?
180 min of structured or unstructured
how much screen time should 2-4 year olds have?
< one hour , not recommended for less than 2yrs
how is screen time related to obesity
if watch greater than 2 hours - 2X likely to be overweight
worse if low SES
if TV in bedroom
How much time should 5 yr old and on be spending on screen time?
2 hours
if athlete has temp or symptoms below the neck, when can they return to play?
until symptoms have resolved for period of 7-14 days
if diagnosed with mono, when can pt return to play?
min 3 weeks - highest risk of spleen rupture
no symptoms
normal BW
no splenomegaly - if possible on US, if not, wait another 1-2 weeks
resolution of any complications - fatigue, hepatitis…
then can return to 50% of pre illness sports
what is spondolysis and how does it present?
stress fracture of pars interarticularis
Worse with impact activity
PE: hyperlordosis, paraspinal muscle spasm, hamstring tightness
what is posterior element overuse syndrome
mechanical/muscular back pain
CP: focal tenderness at lumbar spine and paraspinal muscles, extension related pain
MGNT: Ice and NSAIDS and PT, +/- brace
PT for 4-8 weeks
what is vertebral apophyseal fracture?
repetitive flexion/extension that injures the ring apophysis
volleyball, gym, wgt lifting
need CT if think displaced
3-6 mo
what is the definition of concussion?
complex path process affecting the brain, induced by biomechanical forces and results in rapid onset of short lived impairment of neuro fct that resolves spontaneously
what are symptoms and signs of a concussion
headache N/V dizziness LOC phonophobia photophobia visual disturbances amnesia poor coordination decreased playin abilities
what are behavioural changes associated with a concussion
irritable emotional labile sad anxious inappropriate
what are cognitive impairments associated with concussion
slow reaction poor concentration memory issues confusion feeling dazed or in a fog
what are sleeping disturbances associated with a concussion
drowsiness
trouble falling asleep
sleeping more or less than usual
who is at risk of prolonged recovery from a concussion
Hx of head/face injuries and/or concussion ADHD or learning disabilities migraines or family Hx Psych issues sleeping difficulties
what are the gratduated return to learn steps (5)
- cognitive rest and limited screen. no school
- light congnitive act lasting 15-20 min
- start school - half day, avoid gym, music, shop
- try full days, unlimited time for test
- Back to full
what are the 6 steps to return to play
- no activity
- light aerobics
- sports specific exercise
- non contact training
- full contact practice
- return to play
what are common post concussion symptoms?
HA neck pain dizziness sleep issues depression or anxiety
what are complications of smoking during pregnancy?
inc # perinatal death placental problem preterm fetal growth retardation gastroschisis SIDS misscarriage learning disability
what are postnatal complications due to 2nd hand smoking?
inc rate of LRTI decreased lung growth inc otitis media inc risk of SIDS inc risk of asthma
what are the 5 steps for smoking cessation?
gt ready get support learn new skills and behaviour get meds and use them correctly be prepared for relapse and difficult situation
how do you assess if pt is ready to quit smoking
5 A's Ask about tobacco use Advise to quit Assess willingness Assist Arrange FU
How do you diagnose exercise induced bronchospasm?
10-15% drop in FEV1 from baseline following vigorous exercise at 6-8 min and a response to beta 2 agonist
for athletes - ned eucapnic voluntary hyperventilation technique
what are physical signs of insulin resistance?
PCOS acanthosis nigricans HTN dyslipidemia steatohepatitis
who should get type 2 DM screening?
if aboriginal AND
BMI > 85% AND
> 10 years
and >=1 : sedentary GDM FHX of type 2 - first or second degree acanthosis dyslipidemia HTN PCOS
what are the screening methods for type 2 DM
fasting NG > 7
random BG > 11.1
OGTT may be considered
what are the 6 Es of injury prevention
education empowerment enabling engineering enforcement employment
what are the effects of exercise on the immune system
“open Window” - brief immunosuppression post intense exercise:
- increase neutrophils
- increase lymphocytes
- Increase NK cell activity
- Ratio of CD4/CD8 decrease - ? leads to infection
- Decrease in salivary IgA levels
- decreased chemotaxis of neutrophils - high endurance
- Decreased phagocytosis - high endurance
what is the relationship between exercise and risk of infection?
J curve
some exercise may help prevent URTI
but high endurance athletes tend to have more URTI
when can an athlete return to play
- “neck check” - if above the neck, can try for 10-15 min but if worsen, must stop
if an athlete had temp, myalgia and diarrhea, when can they return to play?
no sports until symptoms resolve
gradual reintroduction back to play
what is the most important complication of mono
splenic rupture
usually spontaneous
highest risk - d4-21
when should an athlete with mono return to play?
not for a min of 3 weeks then resume low impact non contact at 50% pre-illness level IF: - resolution of symp - normalization of labs - resolution of splenomegaly - resolution of any complication
what are useful tips for athletes to prevent illness
eat well get sleep avoid over training allow recovery time avoid sick contavcts wash hands frequently do not share water bottles get proper vaccinations
what type of exercise can a child with JIA do?
aquatic and land based weight bearing exercise
what are potential benefits of exercise for a child with JIA
- better muscle strength and fct
- decreased disease activity
- improves self efficacy
improves energy level and QOL
reduces pain and med use
what are recommendations regarding exercise for a pt with hemophilia?
- need apporpriate factor prophylaxis to reduce risk
- careful assessment before being allowed to participate in contact sports
- needs written strategies to prevent and treat bleed for coach…
- need protective wear
- if get a bleed, must wait until pain and swelling fully resolved
during exercise, when does excercise induced asthma usually present
after 8-15 min
resolves within 60 min
how do you Dx exercised induced bronchospasm
Exercise challenge:
A drop of 10% to 15% in forced expiratory volume (FEV1) from baseline, following vigorous exercise for approximately 6 min to 8 min, is diagnostic of EIB.
AND
a positive response to beta2 agonist
how is exercise good for asthmatics
swimming decreases asthma morbidity
improved areobic abilities
decrease EIB severity
NO CHANGE IN PFTs!!!!!!!!!!!!!
who is not allowed to scuba dive?
asthmatics with symptoms
asthmatic with abnormal PFTs
CF
what are the benefits of exercise for pt with CF?
slower deterioration in lung fct greater survival rate enhanced mucus clearance strength training inc mass and muscle strength improved FEV1
what are potential risks of exercise in CF
if severe disease, exercise may effect oxygenation and ventilation
increased bronchospasm
inc risk of hyponatremic dehydration
avoid contact if organomegaly
why are teens predisposed to back injury?
inflexibility
muscle imbalance
improper training
structural differences of the spine
what are 2 causes of back pain worse with extension?
spondylolysis
posterior element overuse
what are 2 causes of back pain worse with flexion?
vertebral avulsion fracture
disc herniation
how do you Dx spondylolysis?
Xray - scottie dog
bonse scan - uptake
how do you manage spondylolisis
avoid painful mov
abdo strengthening
hip flexor and hamstring stretches
antilordotic exercises with physio
if brace - 4-8 wks and weaned over a few months
if no brace - restrict act for 3 - 6month or until pain free
who gets avulsion fractures
volleyball
gymnastics
wgt lift
how does a vertebral avulsion fracture present?
acute flexion related lumbar pain
limitation of flex/ext
paraspinal muscle spasm
NEED CT for Dx
how do you manage a vertebral avulsion #
rest for 3-6 month!
heat
NSAIDS
how does a disc herniation present?
acute flexion related hamstring tightness butt pain PE: decreased flexion, + straight leg raise, may have decreased rflx and strength of lower limbs
how do you Dx and treat disc herniation
MRI
rest
PT for 3-6 mo
Sx if bad
what are red flags for back pain?
fever night pain weight loss neuro abn malaise
when should an athlete consider retiring or switching to a less contact sport
if concussion occurs with less forcer
if results are more severe
if pt has learning disability
if due to pt playing style
if pt has persistent HA post concussion, what are possible treatment options
lifestyle - hydration, sleep
avoid Tylenol/advil overuse
prophylactic treatment if magaines
neurology referral
what can protect an athlete from concussion
not much
Helmets … only protect against other head injuries - skull fracture
hypoglycemia symp at school
SHort term: affects concentration thought porcess behaviour May take 45v min for intellectual fct to return
hyperglycemia symptoms at school
cognitive slowing
increased error
slow responses
what are CPS recommendations for schools with Pt with DM
- schools need at least 2 trained personale to provide support
- each school should be provided with info on mgnt of theses pt
- kids should be provided with clean/convenient and safe area
- need individual care plan
- designated staff to monitor meal
- Do not leave them alone if hypo
- teach what hypo looks like to staff
- if low during test - gets 30-60 min extra
- allow for Dr appointments
