scholarly journals Essentials for Best Practice: Treatment Approaches for Athletes With Eating Disorders

2018 ◽  
Vol 12 (4) ◽  
pp. 495-507 ◽  
Author(s):  
Jenny H. Conviser ◽  
Amanda Schlitzer Tierney ◽  
Riley Nickols
Keyword(s):  
Eating Disorders ◽  
Emotional Regulation ◽  
Best Practice ◽  
Sport Participation ◽  
Emotional Health ◽  
Multidisciplinary Treatment ◽  
Return To Sport ◽  
Multidisciplinary Care ◽  
Return To Play ◽  
Treatment Team

Eating disorders (EDs) and disordered-eating behaviors (DEBs), pose a high risk of morbidity and mortality, threatening physical health, emotional health, and overall quality of life. Unfortunately, among athletes, prevalence rates continue to increase. This document summarizes the challenges of establishing and navigating the multidisciplinary care needed to effectively treat EDs and DEBs among athletes. The benefits of timely and frequent communication within the multidisciplinary treatment team (MDTT) are emphasized and discussed. Authors advise who should be selected as members of the MDTT and suggest that all personnel, including athletic coaches, athletic trainers, physical therapists, and certified fitness professionals be ED-informed and ED-sensitive. Vital components of care are noted including use of a variety of evidence-based psychotherapeutic modalities, interventions which target emotional regulation, and prioritize values based compassionate care. Authors caution that performance decrements and medical/physiological changes are not always easily observable in individuals with EDs and DEBs and therefore, attuned, consistent, and ongoing monitoring is needed. Consensus regarding previously established parameters for return to play and careful titration of physical activity throughout the ED recovery process are suggested as important for preserving health, preventing re-injury, or relapse and facilitating successful return to sport participation.

Clinical Management of Feeding and Eating Disorders

2018 ◽  
Author(s):  
Patricia Westmoreland ◽  
Anne Marie O’Melia
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Medication Management ◽  
Multidisciplinary Treatment ◽  
Psychiatric Medication ◽  
Novel Therapies ◽  
Treatment Team ◽  
Behavioral Management ◽  
Feeding And Eating Disorders

Eating disorders are diverse in etiology and presentation and are best treated by a multidisciplinary treatment team (physicians, nurses, dietitians, and psychotherapists). Effective treatment includes combinations of behavioral management, psychotherapy, and psychiatric medication. Pica and rumination disorder are typically treated with behavioral management. Treatment of avoidant/restrictive food intake disorder and restricting or binge/purge anorexia nervosa usually requires nutritional and medical management before patients are able to benefit from psychotherapy or psychiatric medication management. There are currently only two medications FDA approved for treatment in eating disorders. Fluoxetine is FDA approved for the treatment of bulimia. Lisdexamfetamine was recently approved for the treatment of binge eating disorder. Novel therapies, such as deep brain stimulation, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation, are being studied for the treatment of severe and enduring forms of anorexia nervosa. This review contains 5 tables and 58 references  Key words: behavioral management, diversity, FDA approval, fluoxetine, lisdexamfetamine, multidisciplinary team, novel therapies, psychotherapy, psychotropics

Clinical Management of Feeding and Eating Disorders

2018 ◽  
Author(s):  
Patricia Westmoreland ◽  
Anne Marie O’Melia
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Medication Management ◽  
Multidisciplinary Treatment ◽  
Psychiatric Medication ◽  
Novel Therapies ◽  
Treatment Team ◽  
Behavioral Management ◽  
Feeding And Eating Disorders

Eating disorders are diverse in etiology and presentation and are best treated by a multidisciplinary treatment team (physicians, nurses, dietitians, and psychotherapists). Effective treatment includes combinations of behavioral management, psychotherapy, and psychiatric medication. Pica and rumination disorder are typically treated with behavioral management. Treatment of avoidant/restrictive food intake disorder and restricting or binge/purge anorexia nervosa usually requires nutritional and medical management before patients are able to benefit from psychotherapy or psychiatric medication management. There are currently only two medications FDA approved for treatment in eating disorders. Fluoxetine is FDA approved for the treatment of bulimia. Lisdexamfetamine was recently approved for the treatment of binge eating disorder. Novel therapies, such as deep brain stimulation, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation, are being studied for the treatment of severe and enduring forms of anorexia nervosa. This review contains 5 tables and 58 references  Key words: behavioral management, diversity, FDA approval, fluoxetine, lisdexamfetamine, multidisciplinary team, novel therapies, psychotherapy, psychotropics

scholarly journals Symptom free return to sport following supervised exercise and a return to play progression

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S10.2-S10
Author(s):  
Matthew T. Lorincz ◽  
Melvin Darwin ◽  
Andrea Almeida ◽  
Andrew R. Sas
Keyword(s):  
Sport Participation ◽  
Clinical Care ◽  
Secondary Analysis ◽  
Return To Sport ◽  
Sports Participation ◽  
Return To Play ◽  
Return To Sports ◽  
Supervised Exercise ◽  
Institutional Review ◽  
Data Elements

ObjectiveTo determine if completion of a symptom free return to play progression (RTPP) was associated with a symptom free return to sport. A secondary analysis investigated symptom free return to sports participation following supervised exercise.BackgroundThe current consensus statement on concussion in sport recommends a graded return-to-sport strategy but there is limited data on the utility of this approach.Methods200 sequential clinic patients with physician-diagnosed concussion sustained during sport participation were contacted by phone following completion of care from a University-associated Sports Neurology clinic. A survey about their success in returning to their sport was administered. Standardized data elements were extracted from the medical records and analyzed. The study was approved by the university of Michigan Institutional Review Board.ResultsThe survey was completed on 61 (31%) patients. Of these, 57 (93%) returned to sport participation without symptom reoccurrence. Of those who returned to sport 41 (80%) returned to sport without symptom reoccurrence within 2 weeks of completed clinical care. 53 (87%) completed a RTPP and 49 (92%) of those completing a RTPP returned to sport without symptom reoccurrence. Completing a RTPP, compared to those not completing a RTPP, was significantly associated with return to sport participation without symptom reoccurrence (p = 0.0000001). Of those surveyed, 32 (52%) underwent supervised exercise (SE) as part of their clinical care. Completing SE, as compared to those not undergoing SE, was significantly associated with return to sport participation without symptom reoccurrence (p = 0.017).ConclusionsOur results support recommendations for utilizing graded return-to-sport strategy demonstrating that 92% of those completing a RTPP successfully returned to sport. Our data also suggest that completion of SE was a predictor of symptom free return to sport and can be incorporated in to return to play decision making.

scholarly journals Return to Play after Open Repair for Achilles Rupture in Recreational Athletes

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0032
Author(s):  
Hong S. Lee ◽  
Kiwon Young ◽  
Tae-Hoon Park ◽  
Hong Seop Lee
Keyword(s):  
Achilles Tendon ◽  
Sport Participation ◽  
Open Repair ◽  
Return To Sport ◽  
Return To Play ◽  
Return To Sports ◽  
Personal Reason ◽  
Recreational Athletes ◽  
General Weakness ◽  
The Mean

Category: Sports Introduction/Purpose: The management of Achilles tendon ruptures in recreational athletes can be challenging. This study assessed the average time to return to sport after open repair for Achilles rupture in recreational athletes. Methods: Twenty one recreational athletes with prodromal tendinous problems sustained an acute tear of the AT and surgical repair with Krachow method from June 2013 to April 2017. Their average age was 39.7 years, and the average follow-up time was 53.2 months. Each patient was evaluated for postoperative ATRS (Achilles Tendon Total Rupture Score), complication and time to return to sports. Results: The mean postoperative ATRS was 85.1. The mean length of time to return to sports was 8 months. Eighteen patients of 21 athletes returned to full sport participation. Eleven athletes returned to the original sports. Seven athletes changed their sports due to fear of re-rupture (four athletes), discomfort during running or jumping (one athlete), general weakness (one athlete), dissuade of family (one athlete). Three athletes didn’t return to sport participation due to thickening of Achilles tendon (two athletes) and personal reason (one athlete). Conclusion: The return to play was 85 % at 8 months postoperatively. The results provide reference data for sports physician in evaluation surgical results and informing athletes about expectations after surgery in terms of timing of return to sports in recreational athletes.

Evidence based management of sports related concussion

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Brent Pickett ◽  
Jeffrey R. Bytomski ◽  
Ross D. Zafonte
Keyword(s):  
Practice Guidelines ◽  
Healthcare Professionals ◽  
Multidisciplinary Treatment ◽  
Management Plan ◽  
Return To Play ◽  
Evidence Based ◽  
Treatment Team ◽  
Common Condition ◽  
Young Athletes ◽  
Expert Recommendations

Abstract Sports related concussion (SRC) is a common condition evaluated by healthcare professionals. In an article entitled “Return to Play After Concussion: Clinical Guidelines for Young Athletes” published in the December 2019 issue of the Journal of the American Osteopathic Association, guidelines for the management of SRC were presented to assist healthcare professionals in the management of patients with SRC. However, much of the information presented in that article is contradicted by current expert recommendations and evidence based practice guidelines. The management of SRC has evolved to a nuanced, domain driven diagnosis requiring a multidisciplinary treatment team and a customized management plan for each patient to ensure competent treatment of patients with SRC. As such, this Commentary summarizes current recommendations for diagnosis and management of SRC.

scholarly journals Detection of Persisting Concussion Effects on Measures of Neuromechanical Responsiveness

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Chad J Prusmack
Keyword(s):  
Reaction Time ◽  
Dual Task ◽  
Predictive Value ◽  
Sport Participation ◽  
Elite Athletes ◽  
Recursive Partitioning ◽  
Critical Role ◽  
Return To Sport ◽  
Return To Play ◽  
Whole Body

Abstract INTRODUCTION Numerous investigations have documented elevated risk for musculoskeletal injury following sport-related concussion, which suggests that an unrecognized vulnerability persists beyond the resolution of symptoms and return to sport participation. Improved clinical testing methods are needed to better assess the interrelated neurocognitive and neuromuscular capabilities of athletes who may have elevated susceptibility to MSK injury, and possible risk for long- term alterations in brain function, despite resolution of overt concussion symptoms. The term “neuromechanics” refers to the study of interactions between neural, biomechanical, and environmental dynamics We use the term “neuromechanical responsiveness” (NMR) to designate the ability to optimally integrate neurocognitive and neuromuscular processes during participation in sport-related activities. NMR testing may play an critical role in optimizing safe return to play circumstances. METHODS A cohort of 48 elite athletes (34 males: 23.8 ± 4.4 yr; 14 females: 25.4 ± 4.5 yr) performed visuomotor reaction time (VMRT) tests involving rapid manual contact with illuminated target buttons that included 2 dual-task conditions: 1) simultaneous oral recitation of scrolling text (VMRT + ST) and 2) simultaneous verbal responses to identify the right or left direction indicated by the center arrow of the Eriksen flanker test (VMRT + FT). A whole-body reactive agility (WBRA) test requiring side-shuffle movements in response to visual targets was used to assess reaction time, speed, acceleration, and deceleration. RESULTS Concussion occurrence at 2.0 ± 2.3 yr prior to testing was reported by 21 athletes. Strong univariable associations were found for VMRT + FT left minus right difference = 15 ms (OR = 7.14), VMRT + ST outer 2-ring to inner 3-ring ratio = 1.28 (OR = 4.58), and WBRA speed asymmetry = 7.7% (OR = 4.67). A large VMRT + FT X VMRT + ST interaction effect was identified (OR = 25.00). Recursive partitioning identified a 3-way VMRT + FT X VMRT + ST X WBRA interaction that had 100% positive predictive value for identification of athletes with concussion history, whereas negative status on all 3 factors provided 90% negative predictive value. CONCLUSION Performance on dual-task VMRT tests and the WBRA test identified NMR deficiencies among elite athletes who reported a history of concussion.

scholarly journals Assessment of Athletes With Eating Disorders: Essentials for Best Practice

2018 ◽  
Vol 12 (4) ◽  
pp. 480-494 ◽  
Author(s):  
Jenny H. Conviser ◽  
Amanda Schlitzer Tierney ◽  
Riley Nickols
Keyword(s):  
Eating Disorders ◽  
Early Detection ◽  
Best Practice ◽  
Eating Behaviors ◽  
Sport Participation ◽  
Well Being ◽  
The United States ◽  
Self Report ◽  
Disordered Eating Behaviors ◽  
And Performance

It is estimated that 1.6 million people in the United States are currently diagnosed with an eating disorder. Eating disorders (EDs) have high rates of morbidity and mortality and remain the most severe mental illness. Unfortunately, rates of EDs and disordered eating behaviors (DEBs) among athletes appear to be increasing. In this study, authors summarize ED-related risks that pose compromises in psychological and social functioning, medical health, and overall quality of life. The importance of early detection and formal evaluation in preserving the athlete’s health, well-being and sustaining successful sport participation, and performance are highlighted. Athlete-specific factors, which challenge the ease and accuracy of ED detection and assessment, are noted. The recommended components of effective ED assessment are identified, including use of self-report measures and clinical interviews conducted by ED certified and licensed professionals. The importance of being well informed in tenets of ED awareness, prevention and supporting early detection, and referral for formal ED assessment are noted. Conclusions reflect the vital roles that both the multidisciplinary sport personnel and the sport environment/culture play in reducing the serious health risks of DEBs and EDs. Each is needed to protect an athlete’s well-being while fostering safe and successful sport participation.

Clinical Management of Feeding and Eating Disorders

2018 ◽  
Author(s):  
Patricia Westmoreland ◽  
Anne Marie O’Melia
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Medication Management ◽  
Multidisciplinary Treatment ◽  
Psychiatric Medication ◽  
Novel Therapies ◽  
Treatment Team ◽  
Behavioral Management ◽  
Feeding And Eating Disorders

Eating disorders are diverse in etiology and presentation and are best treated by a multidisciplinary treatment team (physicians, nurses, dietitians, and psychotherapists). Effective treatment includes combinations of behavioral management, psychotherapy, and psychiatric medication. Pica and rumination disorder are typically treated with behavioral management. Treatment of avoidant/restrictive food intake disorder and restricting or binge/purge anorexia nervosa usually requires nutritional and medical management before patients are able to benefit from psychotherapy or psychiatric medication management. There are currently only two medications FDA approved for treatment in eating disorders. Fluoxetine is FDA approved for the treatment of bulimia. Lisdexamfetamine was recently approved for the treatment of binge eating disorder. Novel therapies, such as deep brain stimulation, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation, are being studied for the treatment of severe and enduring forms of anorexia nervosa. This review contains 5 tables and 58 references  Key words: behavioral management, diversity, FDA approval, fluoxetine, lisdexamfetamine, multidisciplinary team, novel therapies, psychotherapy, psychotropics

Stomatologic complications of eating disorders

2012 ◽  
Vol 153 (45) ◽  
pp. 1779-1786 ◽  
Author(s):  
Mária Resch ◽  
Ágnes Nagy
Keyword(s):  
Eating Disorders ◽  
Oral Cavity ◽  
Oral Hygiene ◽  
Early Stage ◽  
Multidisciplinary Treatment ◽  
Young Generation ◽  
Systemic Diseases ◽  
Root Cause ◽  
Multidisciplinary Nature ◽  
International Experts

Since the 1990s numerous international experts have reported about the somatic complications of eating disorders including those having a dental and stomatological nature. Several reports emphasised that deformations in the oral cavity resulting from this grave nutritional disease typical of the young generation could already appear in the early stage and, therefore, dentists are among the first to diagnose them. Dentists are still often unaware of the importance of their role in multidisciplinary treatment. Even if they knew what the disease was about and recognised it on the basis of deformations in the oral cavity in time, their advice that their patients should brush their teeth more often would fail to eliminate the root cause of the problem. Not only the earliest possible treatment of the complications of the bingeing-purging mechanism and the maintenance of oral hygiene are important, but controlling and curing pathological habits with active participation of psychiatrists are also required to ensure full recovery. Due to the multidisciplinary nature of the disease, manifold communication is required. For this reason, publishing the dental ramifications of organic and systemic diseases at dental conferences and in technical journals, as well as providing information about oral complications of eating disorders for general practitioners and specialists are particularly important. Orv. Hetil., 2012, 153, 1779–1786.

scholarly journals Outcomes of Multidisciplinary Care for Pediatric Post-Concussive Symptoms

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S18.1-S18
Author(s):  
Jillian O’Neil ◽  
Sean Rose ◽  
Ashley Davidson ◽  
Kathleen Shiplett ◽  
Anthony Castillo ◽  
...  
Keyword(s):  
Aerobic Exercise ◽  
Psychological Intervention ◽  
Multidisciplinary Treatment ◽  
Symptom Burden ◽  
Multidisciplinary Care ◽  
Exercise Session ◽  
Symptom Improvement ◽  
Final Visit ◽  
Post Injury ◽  
History Of

ObjectiveTo evaluate the effectiveness of a multidisciplinary treatment approach for adolescents experiencing prolonged recovery from concussion.BackgroundAlthough most youth recover from a concussion within 2–4 weeks, an estimated 14% of those injured remain symptomatic at 3 months post-injury. For those experiencing protracted recovery, the 2017 Berlin Concussion in Sport Group Consensus Statement recommends multidisciplinary collaborative care. While recent research utilizing progressive aerobic exercise among adolescents with concussion has shown promise for reduction in symptom burden, limited evidence exists for multidisciplinary care.Design/MethodsParticipants included 39 adolescents (77% female, 87% Caucasian) referred to the Nationwide Children’s Hospital Complex Concussion Clinic. All patients included had persistent (≥30 days post-injury) post-concussion symptoms (SCAT-5 symptom score ≥10). The sample ranged in age from 11-20 years (mean = 15.0, SD = 2.0) and median days since injury was 60 (range = 30–161). 31% of participants had a history of one or more previous concussions, 54% had a history of anxiety or depression, and 26% had a history of ADHD or a learning disorder. The multidisciplinary treatment included sessions with Neurology (mean number of sessions = 2.5), Neuropsychology (mean = 2.1), Physical Therapy (mean = 3.6), and Athletic Training sessions involving graded physical exercise (mean = 4.0), with an average treatment duration of 57.4 days. SCAT-5 symptom rating scales were completed at each visit.ResultsSymptom burden among participants significantly decreased between their initial visit (mean = 49.6, SD = 19.2) and final exercise session (mean = 12.8, SD = 14.1); p < 0.001. Gender did not predict symptom ratings at treatment onset, though males (mean = 5.6) had significantly lower symptom scores than females (mean = 15.0) at their final visit (p < 0.05). Demographic factors and premorbid psychological history did not predict rate of symptom improvement.ConclusionsHigh rates of premorbid psychological problems are evident in children referred for treatment of PCS. Multidisciplinary care involving graded aerobic exercise and psychological intervention shows promise, though specific factors associated with treatment response remain to be elucidated.

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