Transcript Special Olympics Healthy Athletes Data WG2013

Matt Holder, MD, MBA
Global Medical Advisor - Special Olympics, Inc.
Chairman of the Board - Special Olympics Kentucky
Special Olympics
4 million athletes
50,000 competitions
136 competitions hosted each day
1 million coaches and volunteers
32 Olympic-type
more than 170 countries
7 Global Regional Offices
Every two years, the world transcends the
boundaries of geography, nationality, political
philosophy, culture and religion to come together for
the Special Olympics World Games. Alternating
between Summer and Winter Games, these are
flagship events for the Special Olympics Movement.
Featuring more than a week of grueling yet inspiring
international competition among thousands of
athletes, the World Games are viewed by millions
across six continents and more than a half-million
spectators including world leaders, celebrities and
dignitaries.
The “Spread the Word to End the Word®” Campaign is a
grassroots effort to get people around the world, including the
entertainment industry, to stop using the “R-word” (“retard” and
comparable words in different cultures). The campaign targets
students through school
events and social networking, inviting them to sign an online
pledge and spread the word on their campuses. To date, nearly
250,000 people have taken the online pledge while millions around
the world have signed petitions, displayed banners and taken
oaths to stop hurtful
language and banish prejudices.
To educate, motivate, and activate all youth to be agents of
change, schools in more than 75 countries around the world use
the Special Olympics Get Into It® curriculum. Get Into It is a K-12
service-learning curriculum designed to promote acceptance
and understanding of people’s differences, motivating them to
become advocates for and together with all people. Get Into It
has been translated into 23 languages and has reached more
than 4.5 million students in general education classrooms. The
full curriculum, as well as a variety of interactive web-based
components are available for free online.
Unified Sports® places individuals with
intellectual disabilities (athletes) and
individuals without intellectual disabilities
(partners) side-by-side on competitive sports
teams. As the fastest growing sports initiative
within Special Olympics, Unified Sports has
been shown to raise the self-esteem of all
participating athletes—with and without
intellectual disabilities.
Athlete Leadership Programs train Special
Olympics athletes to hold meaningful roles as
public speakers, board members, sport officials,
coaches, photographers and more. By
participating in the Special Olympics Movement
as leaders, not just recipients of services,
athletes help shape the public’s perceptions
about what they can do and gain skills that help
them excel off the playing field.
Special Olympics Mission
To provide year-round sports training and athletic competition in a variety of
Olympic-type sports for children and adults with intellectual disabilities (ID),
giving them continuing opportunities to develop physical fitness,
demonstrate courage, experience joy and participate in a sharing of gifts, skills
and friendship with their families, other Special Olympics athletes and the
community.
From the Backyard in 1962…
Camp Shriver: Shriver family lawn and home, 1962
To the first Games in 1968…
And to the Games of Today…
4.0 million athletes
200,000 unified partners
260,000 coaches
50,000 competitions
68% are ages 8 to 21
Public’s Knowledge of ID
 Worldwide, the public perceives individuals with ID
as moderately to severely impaired.
 More than 60% believe they are not capable of independent
living skills.
 In reality, the majority (85%+) have mild impairments and
are capable of significant independence.
Public’s Support for Inclusion
 Worldwide, the public believes that people with ID
should live at home and work in segregated settings.
 55% believe they should live at home.
 48% believe they should work in segregated workplaces.
 Worldwide, the public believes that children with ID
should learn in separate schools.
 Over 60% in all countries support this belief.
Access to Health Care
 General public
 Believes people with ID receive better health care than the
general population.
Healthcare for People with IDD
60%
50%
40%
Better
30%
Same
Worse
20%
10%
0%
Healthcare Quality
Access to Health Care
 General public
 Believes people with ID receive better health care than the
general population.
 Training of Health Care Professionals
 52% of medical school deans, 53% of dental school deans,
56% of students and 32% of medical residency program
directors responded that graduates were “not competent” in
treating people with ID.
Life Expectancy Increase
90
80
+30%
70
60
50
+200%
40
30
20
Gen. Pop.
10
0
1930s
PWID
2010s
Sensory
Impairment
Genetic
Acquired
Neurodevelopmental
Disorder
Neuromotor
Cerebrogenic
Conditions
Seizure
Disorder
Abnormal
Behavior
Syndrome
Specific
Somatic
Conditions
Cephalic
Cardio
Pulmonary
Genito
Urinary
Musclo
Skeletal
Endocrine Metabolic
Secondary Health Consequences
Secondary Health Consequences
Intellectual
Disability
People with Intellectual Disability
Motor impairment
Seizure disorders
Vision impairment
Hearing impairment
Behavioral disorders
20-30%
15-30%
up to 25%
up to 32%
15-35%
Secondary Health Consequences
Rampant dental decay secondary to the
patient’s inability to perform self-care
Fragile X
Syndrome
Fetal
Stroke
Down
Syndrome
Neurodevelopmental
Disorder
Autism
ID
Cerebral
Palsy
Healthy Athletes
Healthy Athletes
Healthy Athletes
Healthy Athletes
 636 screenings
 56 countries
 149,460 athletes:







Dentistry– 31, 386
Optometry– 29,892
Physical Therapy – 23,914
Health Promotion – 20,924
Audiology– 16,441
Podiatry– 14,946
Medical Exams – 11,957
Opening Eyes
 Provides visual screenings
 Provides sunglasses to athletes
 Provides corrective eyewear
 5.2% Never had an eye exam (US)
 23.5% world wide
 14.6% Eye Disease (US)
 15.8% world wide
 32.7% Need new glasses (US)
 28.2% world wide
Healthy Hearing
 Provides hearing screenings
 Provides hearing aids to athletes
 41.8% Blocked Ear Canal (US)
 38.6% world wide
 29.1% Failed pure tone testing (US)
 26.8% world wide
 3.5% Need hearing aids (US and worldwide)
FUN Fitness
 A Fitness Screening
 Flexibility, strength, balance, and aerobic condition
 42.3% needed improvement in balance (US)
 29.3% world wide
 59%% needed improvement in flexibility (US)
 33% needed improvement in strength (US)
 49% world wide
 66% Exercising more than 3 days per week (US)
 38% world wide
Health Promotion
• Provide and reinforce healthy lifestyle
information to athletes and families
• Establish best ways to shape lifestyle choices;
promote health literacy of persons with ID
• Provide both games-based and community
based opportunities for Health Promotion
• 24% Low bone density (US)
• 20% world wide
• 75% Obese and overweight (US)
• 33% world wide
• 5.3% Use Tobacco (US)
• 31% world wide
Fit Feet
• Provides screenings of the feet and ankles
• Assesses the correctness of footwear
• Provides community referral as needed
• 51% of females and 59% of males are
wearing the wrong size shoes!!
• 25% had ingrown toenails
• 11% had athlete’s foot
Special Smiles
 Provides dental screenings
 Provides mouth guards for athletes in contact
or high-risk sports
 12% in active dental pain (US)
 14% world wide
 24% had untreated dental decay (US)
 37% world wide
 47% had gingival signs (US and world wide)
 9.4% Needed urgent dental treatment (US)
 14.2% world wide
Decay
Abscess
MedFest
• Provides a free sports physical and other health
screenings to any potential Special Olympics athlete
• Provides referrals to community health providers
• 25% are taking medications which can negatively
impact the athletic experience
• 22% had at least one previously undiagnosed
medical condition
Medication Risks
 Major Health Risk Categories
 Long QT Syndrome (cardiac arrhythmia)
 Weight Gain
 Osteoporosis (low bone density)
 Constipation
 Sun Sensitivity
 Reflux
 Carries (dental cavities)
 Dehydration
Generic and Trade Name Medication Watch List
Abilify
Accuretic
Accutane
Acetazolamide
AcipHex
Acitretin
Acyclovir
Adalat
Adrenalin
Advil
Agenerase
Agrylin
Alavert
Albuterol
Aldactazide
Aldactone
Aldoclor
Aldomet
Aldoril
Aleve
Alferon
Alfuzosin
Alginic acid
Allegra
Altace
ALternaGEL
Aluminium products
Amantadine
Amaryl
Amiloride
Aminolevulinic Acid
Amiodarone
Amitriptyline
Amlodipine
Amphojel
Amprenavir
Anafranil
Anagrelide
Anaprox
Anaspas
Ancobon
Ansaid
Anusol
Anzemet
Apokyn
Apomorphine
Arelan
Aripiprazole
Armour Thyroid
Arsenic trioxide
Artane
Astelin
Atacand
Atarax
Atazanavir
Atenolol
Atiq System
Atorvastatin
Atripla
Atrovent
Avalide
Avelox
Aventyl
Avonex
Azelastine
Azilect
Azithromycin
Azmacort
Baclofen
Bactrim
Beclomethazone
Benadryl
Benazepril
Bentyl
Benztropine
Bepridil
Betamethazone
Betapace
Bextra
Biaxin
Bisacodyl
Bismuth subsalicylate
Bromocriptine
Budesonide
Bumetanide
Bumex
Buprenex
Buprenorphine
Butorphanol
Caffeine
Calan
Calcium
Calcium polycarbophil
Caltrate
Capecitabine
Capoten
Captopril
Carafate
Carbamazepine
Carbatrol
Carbidopa
Cardene
Cardioquin
Cardizem
Carvedilol
Castor oil
Cataflam
Catapres
Celebrex
Celecoxib
Celontin
Cerebyx
Cetirizine
Cevimeline
Chibroxin
Chloral hydrate
Chloropropamide
Chloroquine
Chlorothiazide
Chlorpheniramine
Chlorpromazine
Chlorthalidone
Chlor-Trimeton
Cidofovir
Ciprofloxacine
Cisapride
Citracal
Clarinex
Clarithromycin
Claritin
Clemastine fumarate
Clidinium
Clindagel
Clindamycin
Clinoril
Clomipramine
Clonidine
Clorpres
Clozapine
Clozaril
Codeine
Cogentin
Colace
Combipres
Combivent
Compazine
Comtan
Cordarone
Coreg
Cortisone
Corvert
Cozaar
Crixivan
Cyclophosphamide
Cyproheptadine
Cytomel
Cytoxan
Dalgan
Dantrium
Dantrolene
Darvocet
Darvon
Daypro
Declomycin
Deflazacort
Demadex
Demeclocycline
Demerol
Depacon
Depakene
Depakote
Depo-Provera
Desipramine
Desloratadine
Dexamethazone
Dextrothyroxine
Dezocine
DiaBeta
Diabinese
Diamox
Diclofenac
Dicyclomine
Diflunisal
Dilantin
Dilaudid
Diltiazem
Diovan
Diphenhydramine
Diphenoxylate/atropine
Disopyramide
Ditropan XL
Diucardin
Diuril
Divalproex
Dobutamine
Dobutrex
Docusate
Dofetilide
Dolasetron
Dolobid
High Risk for Long QT
Possible Risk for Long QT
Risk for Obesity
Dolophine
Domperidone
Dopamine
Doryx
Doxepin
Doxycycline
Droperidol
Dulcolax
Duragesic
Duramorph
Dyazide
Dynacirc
Dyrenium
E.E.S.
EC-Naprosyn
Efavirenz
Effexor
Efudex
Elavil
Eldepryl
Eligard
Elmiron
Emtricitabine
Enalapril
Entacapone
Entocort EC
Epinephrine
Epipen
Ergamisol
Erythrocin
Erythromycin
Esidrix
Eskalith
Estrogen
Etodolac
Etrafon
Eulexin
Evoxac
Factive
Felbamate
Felbatrol
Feldene
Felopdipine
Femiron Daily
Fenofibrate
Fenoprofen
Fentanyl
Feosol
Fergon
Fer-In-Sol
`
Risk for Constipation
Risk for Sun Sensitivity
Risk for Osteoporosis
Fexofenadine
Filgrastim
Flecainide
Floxin
Flucytosine
Flunisolide
Fluorouracil
Fluphenazine
Flurbiprofen
Flutamide
Fortovase
Foscarnet
Foscavir
Fosinopril
Fosphenytoin
Furosemide
Gabapentin
Gatifloxacin
Gaviscon
Gemfibrozil
Gemifloxacin
Geodon
Glimepiride
Glipizide
Glucotrol
Glyburide
Glycerin
Goserelin
Granisetron
Grifulvin V
Griseofulvin
Guanfacine
Haldol
Halfan
Halofantrine
Haloperidol
HCTZ
Heparin
Hydrochlorothiazide
Hydrocodone
Hydrocortisone
HydroDIURIL
Hydroflumethiazide
Hydromorphone
Hydroxychloroquine
Hydroxyzine
Hygroton
Hyoscyamine
Hyzaar
Ibuprofen
Ibutilide
Ifex
Ifosfamide
Imipramine
Imitrex
Imodium
Inadapamide
Inapsine
Indapamide
Inderide
Indinavir
Indocin
Indomethacin
Insulin
Interferon Alpha-2b
Interferon Alpha-n3
Interferon beta-1a
Intron A
Intropin
Invirase
Ipratropium bromide
Iron
Isoproterenol
Isoptin
Isotretinoin
Isradipine
Isuprel
Janimine
Kaletra
Kaodene
Kaolin-Pectin
Kapectolin
Kerastick
Ketek
Ketoprofen
Ketorolac
Kytril
Lactinex granules
Lactobacillus
Lasix
Leuprolide
Levamisole
Levaquin
Levitra
Levodopa
Levo-Dromoran
Levofloxacin
Levomethadyl
Levophed
Levorphanol
Generic and Trade Name Medication Watch List
Levothyroxine
Levoxyl
Levulan
Lexxel
Librax
Limbitrol
Liorersal
Liothyronine
Lipitor
Lisinopril
Lithium
Lithobid
Lodine
Lomotil
Loperamide
Lopid
Lopinavir
Loratadine
Lorcet
Lortab
Losartan
Lotensin
Lozol
Ludiomil
Lupron
Maalox
Magaldrate
Mannitol
Maprotiline
Maxzide
Mebaral
Mecamylamine
Medrol
Medroxyprogesterone
Mellaril
Meloxicam
Meperidine
Mephenytoin
Mephobarbital
Meridia
Mesalamine
Mesoridazine
Methadose (Methadone)
Methazolamide
Methotrexate
Methsuximide
Methyldopa
Methylprednisolone
Metolazone
Micardis
Microzide
Midamor
Mineral oil
Minizide
Mirapex
Mirtazapine
Moban
Mobic
Moduretic
Moexpril
Molindone
Monodox
Monopril
Morphine
Motilium
Motrin
Moxifloxacin
MS Contin
Mykrox
Mylanta
Mylicon
Nabumetone
Nafarelin
Nalbuphine
Nalfon
Naloxone
Naprelan
Naprosyn
Naproxen
Narcan
Nardil
Navane
NebuPent
Nelfinavir
Neptazane
Neupogen
Neurontin
Nicardipine
Nifedipine
Nimodipine
Nimotop
Nipent
Nisoldipine
Noctec
Nolvadex
Norco
Norepinephrine
Norfloxacin
Norpace
Norpramin
Nortriptyline
Norvasc
Norvir
Nubain
Numorphan
Octreotide
Ofloxacin
Olanzapine
Ondansetron
Orap
Orlaam
Ormazine
Orudis
Oruvail
Oxaprozin
Oxcarbazepine
Oxybutynin
Oxycontin (Oxycodone)
Oxymorphone
Pacerone
Pamelor
Paramethasone
Parenteral
Parlodel
Pediazole
Penostatin
Pentam
Pentamidine
Pentasa
Pentazocine
Pentosan
Pepto-Bismal
Percocet
Percodan
Pergolide
Periactin
Permax
Permitil
Perphenazine
Pertofrane
Phenelzine
Phenobarbital
Phenylephrine
Phenytek
Phenytoin
Photofrin
Pilocarpine
Pimozide
Piroxicam
Plaquenil
Plendil
Polythiazide
Polytrim
Porfimer Sodium
Posture
Pramipexole
Prednisolone
Prednisone
Preventil
Prinivil
Prinzide
Pro-Banthine
Procainamide
Procan
Procardia
Prochlorperazine
Progesterone
Prograf
Prolixin
Proloid
Pronestyl
Propanthelene
Propoxyphene
Propulsid
Protopic
Protriptyline
Provera
Pulmicort
Pulmicort
Quetiapine
Quinaglute
Quinidine
Rabeprazole
Ramipril
Ranexa
Ranolazine
Rapamune
Rasagiline mesylate
Rebetron
Relafen
Remeron
Renese
Requip
Reyataz
Rheumatrex
Rhinocort
Ribavirin
Riopan
Risperdal
Risperidone
High Risk for Long QT
Possible Risk for Long QT
Risk for Obesity
Ritonavir
Ropinirole
Roxicodone
Roxithromycin
Rulide
Salagen
Sandostatin
Saquinavir
Scopolamine
Selegiline
Septra
Sequels
Serentil
Seroquel
Serostim
Sibutramine
Sildenafil
Simethicone
Sinamet
Sinequan
Sirolimus
Slow Fe
Solu-Medrol
Somatropin
Sonata
Sorbitol
Soriatane
Sotalol
Sparfloxacin
Spiriva
Spironolactone
Stadol
Stelazine
Sucralfate
Sudafed
Sular
Sulfa-Trimethoprim
Sulfisoxazole
Sulindac
Sumatriptan
Surmontil
Symmetrel
Synarel
Synthroid
Tacrolimus
Talwin
Tambocor
Tamoxifen
Tasmar
Tavist
Risk for Constipation
Risk for Sun Sensitivity
Risk for Osteoporosis
Tazarotene
Tazorac
Tegretol
Telithromycin
Tenex
Tenofovir
Tenoretic
Tequin
Testosterone
Tetracycline
Thimethaphan
Thioridazine
Thiothixene
Thorazine
Thorazine
Thyroglobulin
Thyroid
Tiamate
Tiazac
Tikosyn
Timolide
Tiotropium bromide
Tizanidine
Tofranil
Tolcapone
Tolectin
Tolmetrin
Topamax
Topiramate
Toradol
Toresemide
Tramadol
Transderm
Trelstar
Trexall
Triamcinolone
Triamterene
TriCor
Trifluoperazine
Trihexyphenidyl
Trilafon
Trileptal
Trimethoprim-Polymyxin
Trimipramine
Triostat
Triptorelin
Trisenox
Trovafloxacin
Trovan
Truvada
Tums
Tylenol No. 3 or No. 4
Tylox
Ultram
Uniretic
Univasc
Uroxatral
Valacyclovir
Valdecoxib
Valproate
Valproic acid
Valsartan
Valtrex
Vardenafil
Vascor
Vaseretic
Vasotec
Venlafaxine
Verapamil
Versamine
Verteporfin
Vfend
Viagra
Vibramycin
Vibra-Tabs
Vicodin
Vicoprofen
Viracept
Vistaril
Vistide
Visudyne
Vitamin A
Vivactil
Voltaren
Voltaren
Voriconazole
Xeloda
Zagam
Zaleplon
Zanaflex
Zaroxolyn
Zestoretic
Zestril
Ziac
Ziprasidone
Zithromax
Zoladex
Zovirax
Zyprexa
Zyrtec
Medication Risk
 Long QT Syndrome (cardiac arrhythmia)



Rule of 5%
 5% of SO athletes take an at risk medication
 5% of those athletes will have long QT syndrome
 5% of athletes with long QT will have a cardiac event
Detection - medication screening tool and EKG
Prevention – switch medications, do not engage in sports that
elevate the pulse (e.g. bocce or bowling), know where the
nearest AED is, in case of cardiac event.
Medication Risk
 Weight Gain



Another rule of 5% - in SO athletes these medications appear
to cause, on average, a 5% increase in body mass compared to
athletes not taking these medications.
Detection – bathroom scale, BMI chart
Prevention – switch medications, encourage portion control
and better eating habits
Medication Risk
 Osteoporosis (low bone density)
 Another rule of 5% - about 5% of SO athletes have Osteoporosis
 About 15% of SO athletes have osteopenia
 The lower the bone density, the higher to bone fracture risk
 21% of SO athletes have broken a bone
 Athletes that take these medications have bone density scores that
are 0.6 less on average than other SO athletes.
 0.0 vs -0.6 (-1.0 = osteopenia)
 Detection – DEXA or peripheral bone scan (at HP venue)
 Prevention – switch medications, weight bearing exercise, more
sunlight, more vitamin D, more calcium. Avoid sports with trauma
potential if t-scores are lower than -2.5 (osteoporosis).
Medication Risk
 Constipation




Laxatives are one of the most common prescribed
medications to people with ID (up to 48%)
If bad enough, constipation can lead to impaction and
intestinal rupture
Detection – the first sign might be behavioral changes in the
athlete, decreased desire for sports. Just ask or get a history
from the family/caregivers.
Prevention – high fiber diet, laxatives, hydration
Medication Risk
 Sun Sensitivity



Around 20% of SO athletes take medications that can cause
sun sensitivity (easy burning, or rash associated with sun
exposure)
Detection – redness, rash, blistering or peeling of skin on sun
exposed areas
Prevention – medication review, sun screen, long sleeves, hat,
pants, sunglasses.
Medication Risk
 Reflux




Very common problem in patients with ID (up to 36%)
Causes “heartburn”, can lead to behavior problems, eating
problems, enamel erosion and tooth loss, esophageal cancer
Detection – May appear as behavioral problems, may be
detected by dentist at Special Smiles if they see “posterior
enamel erosion”, definitive testing comes from a GI specialist
Prevention – Medication review, anti-reflux medications
Contact
Thank You!
[email protected] – Global Medical Advisor
Special Olympics Special Smiles
World Games 2011
Steven P. Perlman D.D.S, M.Sc.D, D.H.L. (hon)
Senior Global Clinical Advisor and Founder Special Olympics Special Smiles
Professor of Pediatric Dentistry Boston University School of Dental Medicine
President American Academy of Developmental Medicine and Dentistry
Allen Wong, DDS, EdD, DABSCD
North America Clinical Advisor Special Olympics Special Smiles
Professor, Dental Practice- Director AEGD and Hospital Dentistry Program
Pacific Dugoni School of Dentistry
Special Smiles Program-outline
 History of the Beginnings of Special Smiles (Steve)
 Spread of SOSS
 Special Smiles and AGD
 Where we were and where we are going with Smiles
 CAMBRA and Special Olympics ( Allen)
 Raisin and Special Olympics
 Getting involved with Special Smiles
World Games 2011 Results
 To be updated
CAMBRA and Special Smiles
 Caries Management By Risk Assessment and “legal”
 Getting training
 Implementing facets of CAMBRA
Pictures
Raisin Project
 How it began?
 Results of initial pilot
 Results of Idaho World Games
Lessons learned ?
Questions
Steven P. Perlman D.D.S, M.Sc.D, D.H.L. (hon)
[email protected]
Allen Wong, DDS, EdD, DABSCD
[email protected]
Matthew Holder, MD, MBA
[email protected]