ATR 5700 Exam 1

athletic identity

the degree to which a person identifies the self as anathlete

hardiness

stable personality trait composed of three components:perceived control over the situation, view of the situation as a challenge as opposed to a threat, and commitment to changing the situation

stress is what and what does it do to the mind and body

- psychosomatic which means there are physical and psychological components

- disrupt equilibrium which decreases attentional focus, excessive tissue tension, hinder skill/motor coordination

manage stress

focus on practice at practice, good sleep and nutrition

high anxiety and stress increases the likelihood of what

injury

personal factors of psychosocial

- Injury history

- Coping skills, psychological

- Injury severity and type skills

- Injury cause

- Mood states

- Recovery status

- Gender, age, ethnicity

- Personality

- Prior sports experiences

- Self-motivation, self-esteem

- Socioeconomic status

- Motivational orientation

- Physical and nutritional

- Athletic identity health

- Pain tolerance

environmental factors of psychosocial

- Sport type

- Sport ethics

- Level of competition

- Rehabilitation environment

- Time in season

- Accessibility of services

- Scholarship status

- Playing status

- Coach and teammate influences

- Family dynamics

- Athletic trainer influences

- Social support networks

how to decrease risk of injury

educate coaches and staff about stress-injury relationship; monitor stress lvl; help ath cope, social support

explain U shape for injury and stress

high stress immediately after injury and before RTP

health coping

practicing relaxation, practicing behavior modification, utilizing social support networks, journaling, exercising, deep breathing,meditating, listening to music, eating right, laughing, sleeping

unhealthy coping

using alcohol, binge drinking, using marijuana, binge eating/purging, consuming too much caffeine, smoking, compulsive spending, isolation, violent behavior, denial, disassociation, overtraining

psychosocial strategies for AT

discuss and education injured ath; facilitate coping behaviors and positive response to injury and rehab; practical experience dealt w dysfunctional behavior related to rehab; apply psychosocial intervention during rehab; recognize professional limits; know when to refer and to whom

athlete expectation of HCP

- Types of psychosocial strategies athletic trainers should use◦ Evidence-based practice

- What athletes expect from athletic trainers◦ Differences in gender (male towards female AT, female towards AT)◦ Differences based on prior experience with athletic trainers◦ Differences based on injury history (e.g., first-time injured)

- Atmosphere and social support◦ Gender differences in social support following injury◦ Gender-based needs following injury

- ALL individuals want education and open communication

how to have a successful recovery

AT physically present; provide personal attention; provide ath w feedback; elicit feedback from ath

psychosocial strategies

- Goal setting

- Self-talk

- Relaxation

- Nonpharmacological pain management

- Motivation

- Patient education

- keep ath involved w team

- short term goals and possible self imagery

- variety in rehab

- edu and open comm

overconformer

Athlete who unconditionally accepts the norms of the sport ethic and follows them without reservation

underconformer

Athlete who rejects or dismisses the norms of the sport ethic

secondary gain

favorable consequences, such as increased attention from significant others and escape from stressful situations, or medication use,that occur in conjunction with the generally undesirable injury

sociocultural RF: physcial

out of shape/lack strength and flexibility (increase risk of injury); age and skeletal maturity; prior injury; training patterns

sociocultural RF: environmental

location of field, padding, equipmentl weather/surfaces

sociocultural RF: psychological

moode, unprepared, tiredness, stress level, coping resources

sociocultural RF

Coaches; Nature of sport; Officials; Presence of medical personnel at events; Sport norms

sport ethic

- make sacrifices for "the game" (sport = top priority)

- accept no obstacles in pursuit of success (go for dreams no matter the cost)

- strive for distinction (be the best, get top honors)

- accept risks and play through pain (stay composed)

why ath play through pain

- Love of the game

- Sense of time urgency

- Pressure from others

- Fears◦ Losing position or playing time◦ Being labeled "weak"

- Sense of fraternity with teammates

- Isolated from input outside of sport

gender differences in pain and injury

- Males are concerned with threat to masculinity if they don't play throughpain.

- Females are concerned with inconsistencies of being "athletic" and being a woman.

- Females are more likely to openly discuss their injuries

underconformity behavior

intolerant/unable to ID "normal" pain, over report injuries, fake injury to avoid strenuous workout, depend on AT, malingering

normal behavior

"gamers", understand good v bad pain, tolerate some discomfort, report pain and injuries appropriately and in timely manner, adhere to rehab protocol, understand need rest to heal, consider long term consequences when making short term participation decision

overconformity behavior

"gamers gone wild", no concern for long term health consequence, hide/not report injuries, disregard/ignore medical advice to rest, over adhere to rehab protocol, misuse/abuse pain med to play through pain

challenges of privacy of pt

- Strong emotional ties to athletes and team

- Outside pressures

- Understaffed to provide coverage to all

- Desire to please coaches

- Concerns over job security

- Concerns over personal reputation

factors that influence reasonable risk

sport played, body part injured, dev lvl of ath, time in season

assess conformity behaviors

ROAQ, risk behavior conformity in sport injury, self assessment of sport ethic conformity

intervention overconformity

- Education◦ Assess pain on pain continuum◦ Discuss long-term consequences of playing through pain and injury◦ Peer modeling◦ Risk assessment grid◦ Include athlete's support network

- Communication◦ Clarify participation limits with coaches and athlete◦ Explain rationale for restrictions

- Goal setting with appreciation for time urgency◦ Safe benchmarks for returning to play◦ "Bulls-eye" approach to rehabilitation◦ Negotiate surgical schedules

- Decrease media glorification of playing through injury

intervention underconformity

- Education◦ "Good" versus "bad" pain

- Identify possible sources of secondary gain

- Assure athlete's motives for participation are intrinsic

therapeutic presence

- Ethical values and personal traits, part of profession and caregiver role

- Effective clinician shows compassion, valuing of others, scientific problem-solving approaches, acceptance of others' individuality, and carefulness of speaking

- Things that go against the professional role would be: prejudice, indifference, perfectionism,rigidity, depersonalization, patronizing, selfishness, and insecurity

unable to cont having a therapeutic presence factors

burnout and lack of reflection

prospective or forward reasoning

directed by the initial data and intended to find the goal

deductive or backward reasoning

is governed by goal instead of the data and aims to discover the basic data and facts

concept mapping

Visual representations of information (charts, graphic organizers, tables,flowcharts, timelines)

evidence appraisal

taking the acquired information and critiquing it by systematically reviewing its relevance, validity and its application to your specific clinical question

interactive collaboration

allows all to work together in the resolution of a problem

burnout

psychological syndrome that includes emotional exhaustion,depersonalization of patients, and decreased perception of personal accomplishment

characteristics of burnout

decreased work quality (suggests decreased pt care), increased substance abuse, and more reporting of depressive symptoms

causes of burnout in AT

work-family conflict, role strain, challenges w professional socialization

causes of work family conflict

Number of hours worked, Travel requirements, Staffing patterns, Lack of work flexibility, Rescheduled or delayed practices or games

role ambiguity

lack of specificity in a job description

role conflict

no ambiguity, but multiple roles were unharmonious with each other

role overload

a situation where job requirements exceeded the time and energy availability ofthe individual

role incongruity

occurred with job expectations were not compatible with the employee's ownvalues and beliefs

role incompetence

when an individual was not prepared for the role in terms of knowledge or skills

professional socialization phases

- Envisioning the role

- Formal preparation

- Organizational entry

- Role revolution

- Gaining stability

effects of burnout

- Headaches

- High blood pressure

- Weight concerns

- Indigestion

- Fatigue

- Sleeplessness

- Inability to fight off simple infections

- Experience emotional problems such as irritability and depression

- Attrition of ATs (salary, hours worked, and overall lack of job satisfaction, nature of work life balance and role strain)

- Substance abuse (increased alcohol use)

alleviate burnout

- Identify factors and modify them

- Establishing boundaries

- Determining priorities

- Learning to say "no"

- Developing a social support system (friends, family coworkers, and others)

- Strong coworker support system

- Role of the Head ATs in promoting appropriate work-life balance for their assistants -head ATs need to model work-life balance, promote appropriate disengagement from one's role, encourage cooperation among staff members, and provide administrative support

- Adequate staffing patterns and formalized work schedules

prevent loss of therapeutic presence

- Stress management

- Mitigation of burnout factors

- Professional development plan

- Reflection exercises

- Manageable daily schedule

- Mentors

- Goal setting

- Personality types, challenging patients

- Risks for stress and burnout

cognitive appraisal

interpretation of a situation

cognitive relaxation

a relaxation method that includes verbal and visual cues, which lead individuals to a relaxing time and place

primary appraisal

initial assessment of a situation to evaluate it as a threat or challenge

secondary appraisal

secondary assessment of a situation,including assessment of available coping resources

somatic relaxation

a relaxation method that leads the participant to a relaxed state through focus on the breath and breathing patterns

physiological effect of stress

Increased heart rate, Increased respiration, Increased blood pressure, Decreased healing, Impaired sleep

how does a gender have stress expression

female: emotional

male: aggressive

cognitive effect of stress

increased worries, Intrusive thoughts, Attention and focus difficulties

emotional effects of stress

frustration, depression, anxiety

behavioral effects of stress

poor choices, sleeping difficulties, rehab nonadherence

stress --> adrenocorticotropic hormone --> _____ --> _____

cortisol leads to chronic stress, depression, suppressed immune system

decreased cortisol does what

increase positive mood, decrease perceived stress and anxiety lvls; lower pain lvl and reinjury anxiety increases healing

stress-injury model

- Psychosocial antecedents influence how an individual interprets stress.

- Cognitive appraisal influences stress response.

- Stress response influences injury risk

worry --> rumination --> ____ --> ____

increase in negative self talk which leads to negative mood state

psychosocial antecedents to stressors

- Personality (hardiness, optimism, pessimism)

- History of stressors (Life stress, Daily hassles, Previous injuries)

- Coping resources

AT intervene to reduce injury risk

monitor ath stress, assess coping, psychosocial strat

stress management tool kit

- Stress symptom checklist (increases awareness about levels and sources of stress)

- Relaxation podcasts (with and without visual cues)

- Positive self-talk podcast to identify stressors and negative self-talk

- Simple breathing exercises podcast

- Sleep-induction podcasts

Interdisciplinary team interprofessional team (IDT/IPT)

healthcare to individual, family, community by @ least 2 HCP work collab w pt and caregivers to accomplish shared goals w/in and across settings for coordinated and high quality care

IDT/IPT readmission stats

20% reduction w/in 30 days readmission

PT not involved then 4x higher readmission

counseling in IDT/IPT

have positive behavior, negative behavior discouragement, alleviate caregiver burden, CBT, remotivation

AIDES

Acknowledge and affirm person you are meeting

I introduce self

D define duration of session

E explain flow of and expectation for the session

S set tone w stated intention to collab

barriers to health promotion

lack of time, lack interest/awareness, inadequate knowledge, lack resources (insurance reimbursement)

models to follow for IDT/IPT

floater team, long term care, assisted living, technology

principles of IDT/IPT

- personnel: leadership skill mix, individual characteristics

- resource: personal rewards, training and development, physical setting, clear vision

- communication: strategy and structure, supportive climate, respect and understand roles, quality focus

rules of engagement of IDT/IPT

aware own involvement, weighted of feedback, preplanning, emotional neutrality

effective leader components

regulate emotion, reference to customer service, right things the right way, transparency, constructive feedback

cognitive restructuring

a cognitive behavioral strategy used to identify and replace irrational or maladaptive thoughts that often occur in anxiety-provoking situations

countering

a technique used to challenge the veracity of irrational and/or maladaptive thoughts by using logical counter statements

dissociative imagery

a relaxation strategy to distract the athlete from focusing on injury-related pain

emotion focused coping

strategies aimed at reducing the negative emotional response associated with stress; may be the only realistic option when the source of stress is outside of the person's control

healing imagery

focusing attention on a target visual stimulus to produce a specific physiological change that can promote healing

instrumental coping

tsrategies that target the causes of stress in practical ways that address the stress-producing problem or situation,consequently directly reducing the stress; examples include finding out about the injury, attempting to alleviate sources of stress and discomfort, and listening to the advice of health professionals

post traumatic growth

a positive psychological change experienced as a result of highly challenging life events and circumstances

kubler ross

denial, anger, bargaining, depression, acceptance

(bargaining and depression have little evidence of being seen in the ath)

Brown and Stoudemire

shock (immediate), intense preoccupation, accept (reorganization)

Hardy and Crace

denial anger sadness acceptance reorganization

heil

- distress (disruptive of injury and emotional imbalance)

- denial (lack acceptance of severity and rehab)

- determined coping (accept severity and prognosis and proactive incorporate coping)

*cyclical process

Brewer

injury, appraisal, emotional response, behavioral response

Udry, Gould, Bridges and Beck

- injury relevant processing: pain and extent

emotional upheaval and reactive behavior: agitated, emo depleted, isolated, disconnected, shock, disbelief, denial, self pity

- positive outlook: accept injury and deal with consequences

integrated model of response to sport injury

emphasize preinjury and post injury factor influence reaction

Brewer anderson van roalte

injury, bio, psych, social correlations -> injury characteristics, sociodemographic variable, bio variable, psych variable, sociala fn contextual variable, intermediate biopsychological response, rehab outcomes

Hedspeth and Greck

-

factors that influence injury rxn

- Personality attributes and characteristic, Sport context, Injury history, Injury context, Other pressures

negative factors of rehab adherence

injured athlete pessimism◦ Unrealistic expectations regarding the effort required during rehab◦ Fear of reinjury and pain experienced during rehabilitation

red flag with hgh athletic identity

increased risk for negative mood disturbance and depression after injury

red flag with concussive athlete

increase suicide risk

Athletic ID after injury how to help

rehab = athletic performance, maintain connection w sport