MedFest Manual for Clinical Directors - Special Olympics

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two of the above negative outcomes. Often athletes with one of the listed conditions
will receive partial clearance for participation. That is, clearance to participation in
some sports, but not in others. In these cases, it is important for the clinician to know
in which sports the athlete plans to participate. The clinician may then provide specific
clearance for those sports, if the athlete is not at an increased risk for negative outcomes.
The second part of Section 2 (TR) asks about specific neurological signs which may
indicate significant risk associated with trauma to the spinal column. Athletes with any
of these symptoms, especially if the symptoms are new or of a progressive nature, should
be denied clearance for any sport in which traumatic impact is a possibility. Additionally,
these athletes should be referred for immediate medical follow-up.
Section 3 (Endurance Risk)
Section 3 (ER) presents a list of conditions which may predispose the athlete to
an increased risk of negative outcomes associated with endurance sports, such as
dehydration, electrolyte abnormalities, heat stroke, heat exhaustion or complications
related to these issues. In many cases, these athletes can be fully cleared for athletic
activity, especially in sports which do not require significant activity for prolonged
periods of time. Other athletes, however, may only receive partial clearance or clearance
contingent upon discussion with Special Olympics staff and coaches regarding endurance
risk prevention and proper hydration techniques.
Section 4 (Psychiatric Risk)
Psychiatric disorders are often associated with intellectual disabilities. Athletes with
self-injurious or aggressive behavior are of most concern when considering the health
and safety of Special Olympics athletes. As with seizures, a 12-month period of control
over self-injurious behavior or aggressive behavior may be indicative of a higher level of
athlete safety in the future. While most psychiatric conditions are not a contraindication
to sports participation, a significant recent history of self-injurious or aggressive behavior
may be cause for partial clearance or denial pending further medical evaluation. In
making this determination, a clinician should consider the severity of the incidents, the
circumstances involved and the sports in which the athlete will be participating. As an
example, an athlete with mildly aggressive behavior participating in an individual sport
may not pose much risk to the health and safety of other athletes and therefore could be
cleared for participation. However, a strongly aggressive person with a frequent history of
biting, scratching and gouging who wants to play a team sport may need to demonstrate
significant improvement in behavior before being cleared for participation.
Athletes with Down Syndrome Only
Currently, all athletes with Down syndrome must be screened, by x-ray, for atlantoaxial
instability (AAI). If they have AAI, they must sign a waiver to participate in certain
sports. Because symptomatic AAI appears to be correlated with spinal cord injury, a
physical exam of athletes who are positive for AAI is extremely important. Athletes
exhibiting physical signs and symptoms of AAI should not be cleared for any sports
participation until a parent or guardian has discussed these findings with a primary care
physician or a neurologist.