第 1 章 : 健康照護者 運動傷害防護員 (AT)

1. 第1章:健康照護者運動傷害防護員(AT)

2. Chapter 1: The Athletic Trainer as a Health Care Provider

3. Athletic trainers specialize in preventing, recognizing, managing and rehabilitating injuries (專門：預防、辨識、管理和復健傷害) Function as a member of a health care team which also incorporates and involves a number of medical specialties (運作：以健康照護團隊模式含醫事人員） Provide a critical link between the medical community and physically active individuals （提供：社區醫療與個人運動間連結）

4. Historical Perspective • Early History • Evidence suggests that coaches, physicians & therapists existed in Greek and Roman civilizations（希臘和羅馬） • Assisted athletes in reaching top performance • Athletic trainers came into existence in the late 19th century in intercollegiate & interscholastic sports（大學間和校際間） • Early treatments involved rubs, counter-irritants, home remedies and poultices • （摩擦、對抗刺激劑、家庭偏方、糊藥）

5. Evolution of Contemporary Athletic Trainer（當代AT的發展） Traditional setting of practice included colleges and secondary schools（9-12年級） Dealing exclusively（獨有）with an athletic population Today certified athletic trainers (ATC) work in a variety of settings and with a variety of patient populations Professional sports, hospitals, clinics, industrial settings, the military, equipment sales, physician extenders（內科醫師的延伸）

6. Rapid evolution of the profession following WW I • Athletic trainers became specialists in preventing and managing injuries • Dr. S.E. Bilik wrote, The Trainer’s Bible (1917) • The Cramer brothers developed a line of liniments（塗藥） to treat ankle sprains (1920’s) and followed the publication The First Aider (1932) • In the 1930’s the NATA started to come into existence but then disappeared during WW II • In 1950 the NATA was reorganized and it has continued to flourish（繁榮）and expand（擴張）

7. With the evolution of the profession a number of milestones（里程碑）have been achieved Recognition of Acts as healthcare providers Increased diversity（多樣性）of practice settings Passage（管道）of practice acts Third party reimbursement（第三方賠償）for athletic trainers Constant revision （修正）and reform（重訂） of athletic training education

8. Changing Face of Athletic Training Profession • Role of the athletic trainer is more in line（在內部）, today, as a health care provider • 40% of athletic trainers are employed in clinics（診所）, hospitals（醫院）, industrial（工業的）and occupational （職業的）settings • Also involved in NASCAR, performing arts, military, NASA, medical equipment & sales, law enforcement, and the US government • Has resulted in changes in athletic training education

9. Athletic trainers do not just provide medical care to athletes or those just injured during physical activity • Becoming more aligned（對齊）as a clinical health care profession • Requires terminology（術語） changes • Patients and clients vs. athletes • Athletic clinic or facility vs. athletic training room • Athletic trainers – NOT TRAINERS!!

10. Sports Medicine and Athletic Training Broadfield （主要的範圍） of medical practices related to physical activity and sport（身體活動與運動） Involves a number of specialties involving active populations Typically classified（典型分類） as relating to performance enhancement （增進運動表現）or injury care and management（傷害照護與管理）

12. 運動醫學 Sports Medicine 促進運動表現傷害照護與管理 運動生理學　　　醫療實務操作 生物力學　　　　運動保健 運動力學　　　　運動治療 運動營養學　　　運動按摩治療 肌力訓練與調整　運動牙科 教練學　　　　　骨科醫學 個人適能訓練　　矯正與修補 　　　　　　　　運動整脊 　　　　　　　　運動腳病學　

13. Growth of Professional Sports Medicine Organizations International Federation of Sports Medicine (1928) American Academy of Family Physicians (1947) National Athletic Trainers Association (1950) American College of Sports Medicine (1954) American Orthopaedic Society for Sports Medicine (1972) （美國整形外科的運動醫協會） National Strength and Conditioning Association (1978) American Academy（學會） of Pediatrics（小兒科）, Sports Committee（委員會）(1979) Sports Physical Therapy Section of APTA (1981) NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (1985) National Academy of Sports Medicine (1987)

14. International Federation of Sports Medicine Federation （聯盟）Internationale de Medecine Sportive (FIMS) （國際運動醫學聯盟） Principal purpose to promote the study and development of sports medicine throughout the world Made up of national sports medicine associations of over 100 countries Organization includes many disciplines （章程）that are concerned with physically active individuals

15. American Academy of Family Physicians（美國家庭醫師學會） To promote and maintain high quality standards for family doctors who are providing continuing comprehensive（綜合的） health care to the public It is a medical association of more than 93,000 members Many team physicians（隊醫）are members of this organization

16. National Athletic Trainers’ Association（國家運動傷害防護員協會） To enhance the quality of health care for athletes and those engaged in physical activity, and to advance the profession of athletic training through education and research in the prevention, evaluation, management and rehabilitation of injuries The NATA now has 32,000 members

17. Figure 1-1

18. American College of Sports Medicine （美國運動醫學會） Patterned（仿）after FIMS (Umbrella Organization) Interested in the study of all aspects of sports Membership composed of medical doctors, doctors of philosophy, physical educators, athletic trainers, coaches, exercise physiologists, biomechanists, and others interested in sports （成員有：醫師、博士生、體育老師、運動傷害護員、教練、運動生理學家、生物力學家和其他對運動有興趣之人士） >20,000 members

19. American Orthopaedic Society for Sports Medicine（美國整形外科運動醫學協會） To encourage and support scientific research in orthopaedic sports medicine and to develop methods for safer, more productive and enjoyable fitness programs and sports participation Members receive specialized training in sports medicine, surgical procedures, injury prevention and rehabilitation 1,200 members are orthopaedic surgeons（整形外科醫師） and allied（結盟） health professionals

20. National Strength and Conditioning Association To facilitate （促進）a professional exchange of ideas in strength development as it relates to the improvement of athletic performance and fitness and to enhance, enlighten, and advance the field of strength and conditioning（肌肉適能和身體狀況調節） 30,000 strength and conditioning coaches（教練）, personal trainers（個人健身指導員）, exercise physiologists（運動生理學家）, athletic trainers（運動保健員）, researchers（研究者）, educators（教師）, sport coaches（運動教練）, physical therapists（物理治療師）, business owners（業者）, exercise instructors（運動講師） and fitness directors（體適能指導員） Accredited certification programs Certified Strength and Conditioning Specialist（專家）, (CSCS) NSCA Certified Personal Trainer (NSCA-CPT)

21. American Academy of Pediatrics, Sports Committee Dedicated to providing the general pediatrician and pediatric sub-specialist with an understanding of the basic principles of sports medicine and fitness and providing a forum（論壇） for the discussion of related issues To educate all physicians, especially pediatricians, about the special needs of children who participate in sports （目的在教育所有醫師，尤其是小兒科醫師。以增進對孩童在參與運動活動中的特殊需求的認識）

22. American Physical Therapy Association, Sports Physical Therapy Section To provide a forum to establish collegial relations between physical therapists, physical therapist assistants, and physical therapy students interested in sports physical therapy Promotes prevention, recognition, treatment and rehabilitation of injuries in an athletic and physically active population Provides educational opportunities through sponsorship of continuing education programs and publications

23. NCAA Committee on Competitive Safeguards and Medical Aspects of Sports Collects and develops（蒐集與發展）pertinent（相關） information regarding desirable training methods, prevention and treatment of sports injuries, and utilization（運用） of sound safety measures Disseminates（傳播） information and adopts（調整） recommended policies and guidelines designed to further the above objectives Supervises（監督）drug-education and drug-testing programs

24. National Academy of Sports Medicine Founded by physicians, physical therapists and fitness professionals Focuses on the development, refinement （細化，精緻）and implementation（履行） of educational programs for fitness, performance and sports medicine professionals Offer a variety of certifications (fitness and performance)

25. Other Health Related Organizations Various aspects of health related professions have also become involved Dentistry, podiatry, chiropractic medicine National, state and local organizations have also emerged Focus on athletic health and safety All bodies have worked towards the reduction of injury and illness in sport

26. Sports Medicine Journals A variety of publications exist, providing excellent resources to the sports medicine community Journal of Athletic Training（運動保健期刊） Journal of Sports Rehabilitation（運動復健期刊） International Journal of Sports Medicine（國際運動醫學期刊） Physician and Sports Medicine（內科與運動醫學） Clinics in Sports Medicine（臨床運動醫學） American Journal of Sports Medicine（美國運動醫學期刊） Sports Health（運動健康） Athletic Therapy & Training（運動治療與訓練） Training & Conditioning（訓練與調節） Athletic Training & Sports Health Care（運動保健與健康照護）

27. Employment Settings for the Athletic Trainer Employment opportunities are becoming increasingly diverse（不一樣） Dramatic transformation since 1950 Due largely to the efforts of the NATA Started out primarily in the collegiate setting, progressed to high schools and now 40% are found primarily in hospital and clinic settings（大學→高中→40%醫院和診所）

28. Settings include: Clinics and hospitals（診所與醫院） Physician extenders（ Industrial/Occupational settings（工廠） Corporate settings（公司企業） Colleges or Universities（大學） Secondary schools（中學） School districts（學校） Professional sports（專業運動項目） Amateur/Recreational/Youth sports（業餘/娛樂/青少年運動項目） Performing arts（表演藝術） Military & Law enforcement（軍/警務單位） Health & fitness clubs（健康管理中心＆體適能中心）

29. Treating Physically Active Populations運動的意涵 Consists of athletic, recreational or competitive activities（運動的、娛樂性、競爭性） Requires physical skills and utilizes （利用）strength, power, endurance, speed, flexibility, range of motion and agility（敏捷性） （要求運動技巧、運用肌耐力、爆發力、速度、柔軟度、關節活動度和敏捷性）

30. The Adolescent Athlete（青少年運動員） Focuses on organized competition（有組織的競爭） A number of sociological issues are involved（社會議題） How old or when should a child begin training? Skeletal maturity（骨骼成長）presents some challenges with respect to healthcare Physically（身）and emotional（心）adolescents can not be managed the same way as adults

31. The Aging Athlete（老人運動） Physiological and performance capability （能力）changes overtime（隨者時間，生理和運動能力會改變） Function will increase and decrease depending on point in lifecycle（生命週期） May be the result of both biological and sociological effects（生物和社會影響） High levels of physiological function can be maintained through an active lifestyle（動態生活） The impact on long-term health benefits have been documented（動態生活長期下來有助健康） Beginning an exercise program（運動計畫）

32. Exercise program should be gradual and progressive as long as no unusual signs or symptoms develop（分級和漸進式進行） Individuals over age 40 should have a physical and exercise testing before engaging in an exercise program（超過40歲者，運動前要先做運動評估）

33. Occupational Athlete　職業運動員 • Occupational, industrial or worker “athlete” are involved in strenuous, demanding or repetitive physical activity • May result in accidents（意外）and injury（傷害） • Involves • Instruction on ergonomic（人體力學） techniques to avoid injury associated with physical demand of job responsibilities • Intervention when injuries arise • Correcting mechanics（矯正機械）, faulty postures,（錯誤姿勢） strength deficits（肌力不夠）, lack of flexibility（柔軟度差） • Injury prevention is still critical（傷害預防是關鍵）

34. Roles & Responsibilities of the Athletic TrainerAT的角色和責任 Charged with injury prevention and health care provision（準備）for an injured patient Often requires a cadre of sports medicine professionals（要求對動醫學的專業） Athletic trainer deals with the patient and injury from its inception （起初）until the athlete returns to full competition （從起初受傷，照顧到恢復能在運動競技場比賽)

35. Roles and Responsibilities: Board of Certification Domains認證的領域 Injury/illness prevention & wellness protection 傷害預防與保健 Clinical evaluation and diagnosis 臨床評估與診斷 Immediate & emergency care急救 Treatment & rehabilitation 治療與復健 Organizational and professional health and well-being全人健康組織與專業

36. Prevention(預防) • Ensure safe environment(環境安全) • Conduct pre-participation physicals(引導) • Develop training and conditioning programs (訓練計畫設計) • Select and fit protective equipment properly (護具) • Explaining important diet and lifestyle choices(營養與規律生活) • Ensure appropriate medication use while discouraging substance abuse(避免藥物濫用)

37. Clinical Evaluation & Diagnosis (臨床評估與診斷) • Recognize nature and extent of injury(辨識) • Involves both on and off-field evaluation skills and techniques(評估技巧與技術) • Understand pathology of injuries and illnesses(病理學) • Referring to medical care(轉介醫療照護) • Referring to supportive services(轉介支持) • Immediate & Emergency Care(急救) • Administration of appropriate first aid and emergency medical care (CPR, AED) • Activation of emergency action plans (EAP)

38. Treatment and Rehabilitation • Design preventative training systems系統 • Rehabilitation program design復健 • Supervising rehabilitation programs督導 • Incorporation of therapeutic modalities治療方式 and exercise整合 • Offering psychosocial intervention社會心理 • Organizational & Professional Health and Well-being 有組織的&專業性的 • Record keeping 紀錄保持 • Ordering supplies and equipment 支援與器材 • Establishing policies and procedures制度與流程 • Supervising personnel 監督人員

39. Professional Responsibilities • Athletic trainer as educator 教師角色 • Athletic trainer and continuing education 持續進修 • Athletic trainers as counselor 諮商者角色 • Athletic trainers as researcher研究角色 • Incorporation of evidence based medicine 醫學 • Participating and acquiring evidence for 證據efficacious patient care

40. Importance of Engaging Evidence Based Practice • Evidence driving patient care • Failure to engage in evidenced based care could jeopardize patient care缺證據恐危急病患照顧 • EVB Steps • Develop clinical question • Search literature 研究 • Appraise evidence 估量 • Apply evidence 提供 • Assess outcomes 評估

41. Developing a clinical question • Utilizes the PICO format (Patient, Intervention, Comparison, Outcome) • Searching the literature • Using key words to assemble 招集 a comprehensive 廣泛的assessment of available literature • Evaluating the strength of the evidence • Type of study vs. quality of evidence • Must critically嚴格地 evaluate and rate估價 the evidence • Applying the evidence • Integrating evidence with patient needs and values • Bridging barriers between research evidence and clinical decisions to ensure optimal care

42. Assessing Treatment Outcomes • Determining effectiveness • Outcomes assessment measures • Condition-oriented evidence 以調整狀況為主的證據 • Patient-oriented evidence 以患者本身為主的證據 • Patient perceptions, experience, patient-centered goals • Disablement model 表示”無能”的方式 • Evaluates functional loss due to impairment and impact on quality of life 判斷功能喪失，是以損害患者生活品質為考量 • Comprehensive assessment 廣泛性評估 • Patient reported outcomes 患者報告結果 • Global ratings of change 總體的變化分級

43. Personal Qualities of the Athletic Trainer Stamina and the ability to adapt (精力和適應能力) Empathy(心情轉換) Sense of humor(幽默) Communication(溝通) Intellectual curiosity(理性的好奇心) Ethical practice(道德感) Professional memberships(專業)

44. Athletic Trainer and the Athlete Major concern on the part of the ATC should be the injured patient關心 All decisions impact the patient衝擊 The injured patient must always be informed(報告，告知) Be made aware of the how, when and why that dictates the course of injury rehabilitation支配

45. The patient must be educated about injury prevention and management (患者需被教育：有關傷害的預防和管理) Instructions should be provided regarding training and conditioning (教學:提供對訓練和調整情況的關心) Inform the patient to listen to his/her body in order to prevent injuries(傾聽身體訊號，預防運動傷害)

46. Athletic Trainer and Parents Athletic trainers must keep parents informed, particularly in the secondary school setting Injury management and prevention The parents decision regarding關心healthcare must be a primary consideration Insurance保險plans may dictate care Selection of physician(保險支配照護資源)

47. The athletic trainer, physician and coaches must be aware and inform parents of Health Insurance Portability and Accountability Act (HIPAA) 健康保險便携性與責任法案(HIPAA) Regulates dissemination宣傳 of health information Protects patient’s privacy and limits the people who could gain access進入的權利to medical records (保護和限制獲得病人的醫療紀錄)

48. The Athletic Trainer and the Team Physician 隊醫 Athletic trainer works under direct supervision of physician(AT是在隊醫的督導下工作) Physician assumes a number of roles Serves to advise and supervise ATC Physician and the athletic trainer must be able to work together Have similar philosophical 達觀的，理性的opinions regarding 關心injury management Helps to minimize discrepancies 不一致 and inconsistencies 不協調

49. The physician醫師 is responsible for compiling 編輯 medical histories and conducting 主導physical exams Pre-participation screening 運動前的評估 Diagnosing injury 診斷傷害 Deciding on disqualifications 取消資格 Decisions regarding athlete’s ability to participate based on medical knowledge and psychophysiologicaldemands of sport Attending practice and games出席練習或比賽 Commitment to sports and athlete 對運動本身與運動員有責任義務

50. Potentially serve as the academic program medical director(醫學學術指導) Coordinates and guides medical aspects of program(在醫學方面計畫的協調與指導) Provides input into educational content and provides programmatic instruction(提供教育內容與具綱領性的研究架構)