Technology allows amputees to reach athletic potential


The Invictus Games finished up recently in Orlando, Fla. The participants in this multi-sport event were all wounded military personnel. Along with the Paralympics, these events are a tribute to the human spirit and specifically the drive to compete.

Among the athletes facing the greatest challenges are those who have suffered amputations. Battlefield injuries may be the result of explosive devices. Although the torso can be adequately protected, the limbs and the brain are vulnerable to injury. There also have been more amputations as a result of earthquakes and other natural disasters.

Although the most obvious debility is the biomechanical disadvantage of losing an extremity, there are serious potential complications.

After amputation, adequate healing of the remaining stump can be a challenge. The general health of the patient is crucial to healing. Patients with complicating conditions, including diabetes and vascular disease, are more likely to require a longer recuperation for adequate healing.

Another challenge is phantom pain. The nervous system is a network of peripheral nerves that communicate by sending signals to the brain where those signals are recognized and a pattern of limb movement is initiated.

When that network is disrupted after an amputation, the pattern remains in place, creating the often painful phenomenon of a phantom limb.

Research principally conducted by the military has led to the development of modern prostheses consisting of a complex system of hydraulic joints. “New prosthetic limbs are realizing the promise of full functional restoration for patients everywhere,” reports retired United States Army Colonel, Dr. Geoffrey Ling, who is now a professor of neurology at the Uniformed Services University of the Health Sciences in Maryland.

The tragedy of war has prompted technological breakthroughs that allow athletes who have suffered amputations to continue to reach their athletic potential.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Wearable technology for the elite athlete


Wearable technology has already made its way into almost everyone’s life to some degree. Interestingly, Major League Baseball (MLB) has now allowed the use of these technologies to track players’ performance. Using the data provided by these new devices has a lot of implications. 

Smartphones can now track how far and how quickly a person can walk. The Fitbit, Apple Watch, Fuelband and other devices can collect and analyze more data about the wearer’s physiology and sleep habits.

In the case of competitive sports, wearable technology can give an athlete a big advantage in regard to training habits and injury prevention.

Two devices approved by MLB for use during games this season look at different activities. One device is a sleeve that measures stress on elbows. This is specifically designed to collect data that will hopefully decrease the number of Tommy John surgeries that seems to be growing rapidly. The information can help create better coaching techniques and improved arm mechanics at all levels of play.

The other piece of approved wearable technology is a bioharness that monitors heart rate and breathing patterns in real time. These basic physiologic measures can help athletes gain necessary feedback to reach peak performance in stressful conditions.

One area of interest is the field of hydration and electrolyte balance. Specifically, the ability to monitor these parameters and avoid sudden death has become a goal of many scientists.

“The wearable technology industry related to the assessment of hydration status, sweat composition and body temperature has exploded in the past few years,” reports Dr. Douglas Casa, Professor of Kinesiology and CEO of the Korey Stringer Institute at UConn. “As of now we still do not have a valid wearable sensor that can reveal real-time hydration status or provide an accurate estimate of core body temperature. I predict this will change within the next 5 years and will be of great value to the equipment-laden soldier, laborer or athlete who could benefit from this information while training, competing, or working.”

Although many athletes are concerned with the privacy of physiologic data, their concern may be offset by the lifesaving ability this technology can provide.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu 

Athletes, especially women, can fall prey to eating disorders

Eating disorders have become a serious health concern. Athletes are no exception and in fact may be particularly vulnerable to one of these conditions. 

Anorexia nervosa, bulimia nervosa and binge-eating disorder are the most commonly recognized disturbances of eating and weight regulation. The finding that anorexia is associated with the highest mortality rate of any psychiatric disorder emphasizes the seriousness of these disorders.

Young women who participate in gymnastics, cheer and running events are particularly vulnerable. It has been reported that between 15 percent and 62 percent of female college athletes have disordered eating. This wide variation is indicative of how little is known about the prevalence of these conditions.

Another area of confusion is whether an eating disorder developes as a result of participation in a particular sport or if a person with an eating disorder choses a sport that will allow for this behavior. 

The classic triad of low energy levels, delayed or absent menstrual periods and osteoporosis is a hallmark of these conditions. Considering 90 percent of bone development in women occurs before the age of 19, lifelong vulnerability to bone fractures are a consequence.

“Eating disorders are common in adolescent athletes training at a high-level. Some may go down a dangerous path trying to attain a supposed 'ideal' body type to enhance performance,” states Dr. Kathryn Ackerman, an endocrinologist specializing in conditions affecting female athletes. “While initial improvements in performance are often seen, these are unfortunately followed by more injuries, poorer recovery, more illnesses, and a decline in performance. Often the athlete struggles mentally and physically and the eating disorder that has developed gets overlooked.”

Denial on the part of athletes can play a big role in delaying diagnosis. Coaches and parents must be aware of early signs of an eating disorder and intervene immediately.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Allergic rhinitis can impede spring sports performance


Most competitive and participatory sports get underway in the spring. Many of these outdoor activities are played around a variety of grasses and trees that can trigger an allergic condition and interfere with athletic performance. 

The most common condition is allergic rhinitis or hay fever. Symptoms include sneezing, runny nose, coughing, postnasal drip, sore throat, eye irritation and a feeling of generalized fatigue. It is no surprise that these symptoms can be an obstacle to athletic success.

The allergic response is based on a series of events that are triggered by exposure to an allergen. In the case of allergic rhinitis the allergen is typically pollen, ragweed or a mold. After exposure, a cascade of actions follows. This cascade consists of a cellular response that includes inflammatory cells. 

Similar to other forms of inflammation, swelling of tissues and pressure-like pain are common. Treatment is directed toward desensitizing the body against reactions to a particular allergen or interrupting the inflammatory response at several levels.

Antihistamines are the most commonly used medications to reduce irritation of the eyes and nasal membranes. Often these are combined with a decongestant that may be sedating and should be avoided by athletes. Nasal and oral steroids can reduce the overall response to allergens but may be among banned substances for competitive athletes and would require a therapeutic exemption.

Newer drugs originally designed to treat asthma, like Singulaire, block inflammatory chemicals and are a very effective treatment for allergic rhinitis in athletes.

“Untreated allergies can lead to worsening of nasal congestion and reactive airway disease or asthma which can impair breathing and oxygen absorption,” reports Dr. Gregory Lesnik, a Norwich ear, nose and throat specialist. “Additionally, untreated allergies can result in an overall decline in energy levels causing suboptimal athletic performance.”

Effective treatment of seasonal allergic rhinitis can provide a needed boost toward achieving athletic goals before taking the field.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Exercise may help with Parkinson’s symptoms


Parkinson’s Disease is among the most common movement disorders. It affects approximately 10 million people worldwide. Although there are many new pharmacologic therapies available, it appears that regular exercise may be among the most effective.

Movement disorders are a general category of illnesses that consist of involuntary movements that range from a mild tremor to violent spasms.

Parkinson’s disease is a constellation of symptoms and physical findings. The hallmark on examination is a combination of a tremor at rest, slowed movements, rigidity and postural instability.

The pathology is based on decreased production of dopamine, a neurochemical produced in the brain that regulates movement.

Patients will often present with complaints of falling and noticeable changes in handwriting. Sudden falls often lead to broken bones and lengthy hospitalizations.

Medical treatment has been available for approximately 50 years in the form of medication that can increase the declining levels of dopamine. There are now medications that can slow the metabolism of dopamine that has been produced.

“Regular physical activity has been associated with neuroprotection and has shown to improve gait and balance in Parkinson's disease,” reports Dr. Bernardo Rodrigues, a neurologist specializing in movement disorders at the University of Connecticut.

Programs that promote active motion such as “Big and Loud” physical therapy and aerobic exercise for 30 minutes three or more days per week are the key to the effectiveness of the neuroprotective factors produced in the brain.

Recent research has shown that patients with Parkinson’s disease who participate in Latin dancing programs have better outcomes regarding mobility when compared to those who did not participate. This may be related to the physical as well as mental demands of this activity.

Exercise can be a crucial element of a rehabilitation program for Parkinson’s disease.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Safety of artificial turf needs further study


The feel and smell of natural turf has been a big part of the pleasure derived from outdoor sports. Increasingly over the past 50 years, that aspect of sports participation has been replaced with various artificial materials. Today, the safety of those materials has come into question.

The original Astroturf field consisted of nylon strands woven into a carpet and was designed for an indoor stadium like the Houston Astrodome. A subsequent version was made up of a tighter weave and more compact surface. These forms resulted in injuries from impact with a firm surface and friction burns.

This led to the current generation of artificial turf fields consisting of longer, softer synthetic strands filled with granulated recycled rubber. These fields now provide a softer surface with improved traction for cleated footwear.

Despite these innovations, an increase in the frequency of lower extremity injuries can be related to the change from natural to artificial surface. Among these injuries are turf toe, a painful condition that results from injury to the ligaments supporting the great toe. An increase in anterior cruciate ligament knee injuries is also believed to be related to the change in playing surface.

“The evidence suggests that synthetic turf increases the chance for injury, and at best the more natural the surface the less increase in injury — especially for the football player,” reports Dr. Stephanie Mazerolle, Assistant Professor of Kinesiology at the University of Connecticut. “I think when considering playing surface, natural surfaces (i.e. grass) may offer a more favorable environment when it comes to the safety of the student-athlete.”

More recently, ESPN’s “Outside the Lines” and others have called for further investigation into anecdotal reports of increased cases of cancer in athletes who have high exposure to the so-called “crumb rubber” fields. Soccer goalies are particularly vulnerable given their exposure to the rubber particles especially when playing indoors. The principal forms of reported cancers are blood related such as leukemia and lymphoma.

Despite the economic advantages of artificial turf, more investigation regarding safety must be carried out.  

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Education is key to preventing concussions

Eleven high school students died in 2015 while playing football. Seven of those players lost their lives to brain injuries. The question now facing parents, physicians, athletes and coaches is whether more can be done to avoid severe brain injuries. Potential solutions may be centered on education, legislation and rule changes.

In 2009, the state of Washington approved the Lystedt Law. It is named for Zachery Lystedt, a 13-year-old junior high school football player who suffered permanent brain damage after being allowed to return to a game shortly after a concussion. Since then, all 50 states have passed some variation of this law requiring that a player suspected of having suffered a concussion must be removed from a contest and not allowed to return until cleared in writing from a medical professional.

These laws typically require all scholastic coaches to complete an education program that addresses the signs of concussion. Unfortunately, these laws only address coaches at the high school or higher level.

Ironically, despite best efforts at education, the most vulnerable brains are at the youth level where there are approximately 3 million football players, 3 million soccer players and another 500,000 hockey players. This also is the level where there are the least experienced coaches and often no athletic trainers.

Rule changes at every level have been met with resistance from traditionalists. Interestingly, many professional coaches and former players believe that contact is not necessary to teach the necessary skills to advance in these sports.

Recent studies looking at the effectiveness of these laws have demonstrated increased reporting of concussions but no firm direct correlation with the educational efforts associated with them.

“As a pediatric neurologist, I am acutely aware of the importance of physical activity and sports for the developing brain and body,” said Dr. Meeryo Choe, a pediatric sports neurologist and assistant professor at UCLA Mattel Children’s Hospital. “Playing a team sport can teach children about teamwork, responsibility and sportsmanship. As children progress through years of participation, they may also learn leadership skills in a unique way. Participation in sports should always begin with education on not only the rules of the game, but how to play the game safely, no matter the sport.”

The remedy for any public health problem is education and concussion is no exception.  

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu.

Popularity of combat workouts skyrocketing

Combat sports have provided a major entertainment diversion throughout history. Today, boxing and martial arts have become popular participation sports for many who are on the road to fitness.

Records dating back to 4000 B.C. recount “pankration,” a predecessor to what we now know as mixed martial arts (MMA). Historically, this sport developed in parallel to boxing. Participants were typically slaves or criminals who fought for their freedom.

Both sports were eventually banned by the Emperor Theodisius when he felt that they provided too much diversion. The earliest recorded boxing match was in 1681 when the Duke of Abermarle waged a match between his butcher and butler.

Modern era combat athletes are among the best-trained in the world. Fighting demands stamina, strength and agility. Those who are successful have mastered those skills and possess the ability to concentrate and plan strategy under severe conditions.

Combat athletes’ work outs consist of intense roadwork to build cardiovascular endurance. A normal average resting heart rate is between 60 and 100 beats-per-minute. The resting heart rates of combat athletes are often in the 40 beats-per-minute range. This is reflective of superior cardiac efficiency.

Strength is improved by resistive exercise with weight training and repetitively hitting a heavy bag. Superior coordination is attained by drills that require timing such as jumping rope and hitting a speed bag.

“Boxing provides a great workout due to the variability of the fitness skills,” reports Jody Sheely, boxing trainer at Strike Force gym in Norwich and former boxer.

 Interestingly, many of the activities utilized for combat sports training do not require striking or choking an opponent and may be an essential part of a new fitness regimen for many who will never get in a ring or cage.  

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu.

Don't neglect working out your brain along with your other muscles

Athletes spend many hours honing skills in their particular sports while building strength and stamina. More recently, they are devoting time toward establishing more efficient thought processes and better performance.

The human brain is made up of nerve cells that are organized in networks that interact to perform specific functions. These specialized networks influence all activities.

The simplest action is a reflex. A reflex consists of movement that doesn’t require any thought. The neurons necessary communicate directly through the spinal cord without any cognitive input.

One goal of training is to eliminate as many variables as possible while performing the specific task. This type of mental training can take several forms and coaches are now employing a variety of professionals to work with their teams.

Visualization is probably the best-known technique. Visualization involves repeatedly anticipating an outcome or situation before it occurs. Kickers see the ball going through the uprights, golfers visualize a perfect shot and football defenders see themselves making a crucial tackle.

Mindfulness is a technique used to relax the mind. It is essentially a skill used to eliminate all interfering thoughts and allowing concentration only on the task at hand.

Like most athletic skills, these techniques become most effective when they are practiced. Repeatedly applying visualization and mindfulness with a discipline such as yoga can dramatically improve performance.

“Yoga and mindfulness are a powerful combination of physical, mental and spiritual skill work that compliments and enhances sport-specific conditioning,” states Carol Pandiscia, a yoga and mindfulness instructor who works with high-level athletes.

Although these skills have been frequently applied in sports, they are effective instruments for success in any profession.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Airbag technology makes downhill skiiers safer

Downhill ski racers practice their craft by gliding down the side of a mountain at speeds in excess of 80 miles per hour. The slightest mistake at those speeds can end in tragedy. New technological innovations may avoid life-threatening injuries.

On Dec. 19, Olympic champion, Mathias Mayer, was the beneficiary of a technological breakthrough that has gradually become more accepted in the sport of ski racing. A protective vest that inflates in a similar way to an automobile airbag can now provide necessary protection in a potential crash.

The airbag system is one of two that are currently approved for competitive use. The protective vest will inflate when the struggling athlete reaches an angle and vector that can only result in a fall. These calculations are based on data input from the vest and appropriate algorithms.

The inflated vest softens the impact to the chest and supports the neck. Approximately 40 people die from ski and snowboard-related accidents each year. Many of these are brain injuries.

Helmet technology has evolved to the current level where a helmet is lightweight while providing maximum protection. Typically, these injuries occur at high velocity and involve skull fracture and hemorrhage within the brain.

Neck injuries that result from sudden extension of the cervical spine similar to whiplash in a high-speed automobile accident can cause fracture of the cervical spine and potential paralysis.

Another less common neck injury is the result of tearing of the vertebral arteries leading to the brain and causing a massive stroke. This is believed to be the injury that may have caused the death of freestyle skier Sarah Burke.

More common injuries to the lower extremities have been diminished thanks to improved ski boot design and quick release bindings.

As winter sports become more extreme, protective equipment design must also improve.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu