PowerPoint Presentation

Journey to South Africa:

Do Pediatric Athletes Face the Same Challenges in Cape Town and Columbus?James P. MacDonald, MD, MPHDivision of Sports MedicineNationwide Childrens HospitalAmerican Medical Society for Sports MedicineBRING MY LASER POINTER to show things on slidesOct 8 to 22

Overall: incorporate my CME objectives but mostly focus on S Africa?invite J PalugaScan in old photos of Africame in Peace Corps

Not only my old photos, but photos from a brooks in google share drive

30 mins1AMSSMAmerican Medical Society for Sports MedicineFounded 19913000+ membersNon-operative, sports medicine M.D./D.O.

Travelling FellowshipDestinations2014 Australia2015 South Africa2016 ItalyStructure2 Jr Fellows, 1 Sr Fellow

Travelling fellowship modelled after AOSSM for many yearsAMSSM its in its infancy2SASMASouth African Sports Medicine AssociationBiennial congressesMulti-disciplinaryPhysiciansResearchersPhysiotherapistsBiokineticistsHostsCurrent PresidentJon PatriciosIncoming PresidentPhathokuhle ZondiFuture PresidentPierre Viviers

South African Sports Medicine AssociationGet info from Jon Pat, Phathokuhle3Its Personal(or) the view from Table Mountain19892015

Back to the futurethe photos of me, Swaziland, S. Africa back in the dayAbout 25 years agoLions Head4Apartheid

its personal continued showing white beaches/etc.Talk a little bit about modern S African politics5Swaziland

Its personal continued showing my Swaziland6RSA - The Country

Republic of South Africa 55 million peopleEthnic MixFirst Democratic Elections held in 1994Nelson Mandela 1st president elected by allANC still in powerPopular sportsRugby Union (Springboks!)CricketAthleticsSoccerAthleticsSize of two texas

Rugby World Cup was taking place80.2%Black8.8%Coloured8.4%White2.5%Asian

Sports Rugby World Cup taking place7Athletics

Oscar PistoriusCastor Semanya8

ItineraryUniv. of StellenboschCape TownUniv. of PretoriaPilanesberg Game ReserveJohannesburg/SowetoSandton Convention Centre & SASMA conferenceFlight NYC to Joburg then to Cape TownAbout 14 hours NYC to Joburg but only 7 hrs difference10New friends..

Junior Fellow

Alison Brooks Univ of Wisconsin12Senior Fellow

Old Friends

Jon patricios Speaking at ACSMWith him at end of SASMA14The food!

A little bit of learning

Transitionwere supposed to do some CME in this talkHave a picture of me lecturingor maybe my slide from one of the talks16Talks Given

PCL Injuriesnon-operative managementThe Pediatric Exercise PrescriptionThe trouble with kids: whats different about pediatric concussions?Concussions in the NFL: is a $45 billion industry 'state of the art'?Scientific papershow to get published?Prolonged rest vs. early PT in patients with active spondylolysisR Rodenberg chapter in UpToDateImpromptu how to get published and my own at uni

Discuss how this last talk was about data from NCH and is nowAn accepted manuscript in CJSM17RCT(N = 88, Age = 11 22)Strict rest 5 dUsual care No difference in neurocog or balance measuresIntervention group had more daily postconcussive symptoms & slower resolutionPro cohort(N = 335; Age = 8 23)Patient self-report of cognitive activityDivided into quartilesMean duration of symptoms 43dAssociated with slower recoveryInitial PCSS levelCognitive activity

How much cognitive rest?Brown et al. Pediatrics 2014Thomas et al. Pediatrics 2015Usual care: Because human data on postinjury exertion are limited, expert consensus recommends 24 48 hours of rest before beginning a stepwise return to activityIm a Co-I Ginger Yang at our CIRP more objectively measure cognitive activityBeen some back and forth in the recent medical literature http://www.momsteam.com/strict-rest-after-concussion-does-not-improve-recovery-new-study-findsBrown Pediatrics: http://pediatrics.aappublications.org/content/early/2014/01/01/peds.2013-2125.abstracthttp://pediatrics.aappublications.org/content/early/2014/01/01/peds.2013-2125.abstract

Thomas study Usual care 1 2 d rest followed by stepwise return to activityMost notable outcome not expected!

18Functional guidelines are currently recommendedThe steps in the graduated return to play are (24 - 48)No activity and rest until asymptomatic*Light aerobic exercise (e.g., walking)Sport-specific trainingNon-contact drillsFull-contact drillsGame play

Kids take longer to recoverOn average HS kids take twice as long as college students (10 14 d)Most studies find younger kids take even longerMay have residual important changes even once sx improved

Return to playTYPICALLY SPEND 24 - 48 AT EACH LEVEL** new AJSM study

The recoveryfrom concussion in children generally occurs over alonger time period than in adults. This is evident intime for symptom resolution,9 as well as neurocognitiverecovery.10 11 On an average, concussed highschool athletes take twice as long to recover(1014 days) than college and professional athletes(37 days),9 12 and preadolescent children may takeeven longer to recover. These effects may have significantimpact on the childs ability to return toschool because of the concussive neurocognitivedeficits such as slowed information processing,difficulty forming new memory and inability toconcentrate.19Exercise is Medicine

Translate the difficulty of putting this into practice20We say tomato, you say tomato

Biokineticist vs. Athletic TrainerPhysical Therapist vs. PhysiotherapistIf alison has a photo of the pub near the training room..Nitrous for reduction21SASMA 2015

Karim khan photohow to get published--impromptuSome other photos from AlisonInclude photo of biokientcist22Some Amazing Sport Facilities

Rugby is King

Presidents BoxSoccer is a gentlemans sport played by barbarians while Rugby is a barbarians sport played by gentlemen.

Talk about rugby wearing a coat and tiePhoto of andile and we all25Safari

Pilansberg26HistoryVoortrekker MonumentPretoriaMandela SquareJohannesburg

Mandela statueVoortrekker monument27Ive changed/Its changed

Mandela statue in the square and mandela on the currencyUnifying, revered figure

Former president AMSSM Jonathan DreznerApartheid museum stickers28Soweto

Add photo

You would not have been able to go to the famous township Add photo of baragwanath and add photo of street sign soweto29Thanks to sponsors

Thanks to the AMSSM and DJO Global underwriterThanks also to Division Chief T Pommering for releasing me for 2 weeks in middle of the busiest time of our year30Cheers

Add my iPad screen saver here31