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Schmitz B, Smulligan KL, Wingerson MJ, Walker GA, Wilson JC, Howell DR. Double Vision and Light Sensitivity Symptoms are Associated With Return-to-School Timing After Pediatric Concussion. Clin J Sport Med 2023; 33:264-269. [PMID: 36395518 DOI: 10.1097/jsm.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the association between academic time loss postconcussion and vision symptoms/impairments among pediatric patients. DESIGN Cross-sectional. SETTING Sports medicine clinic. PATIENTS Pediatric patients seen for care in a sports medicine clinic between the ages 6 and 18 years (n = 212; mean age = 14.3, SD = 2.4 years; 48% female) were evaluated within 21 days of concussion (mean = 9.8, SD = 5.7 days). INDEPENDENT VARIABLE Patients were grouped based on academic time loss (missed >5 days vs ≤5 days of school) at their initial postconcussion evaluation. OUTCOME MEASURES Patients rated concussion symptoms using the Health and Behavior Inventory (HBI) and underwent near point of convergence (NPC) testing. We compared groups on specific HBI symptom ratings of dizziness, blurry vision, seeing double, and light sensitivity, as well as NPC break and recovery point distances. RESULTS Two hundred twelve patients were included; n = 36 (17%) who reported missing >5 days of school. After adjusting for time since injury, parental education level, mechanism of injury, and preinjury anxiety, patients who reported missing >5 days of school had higher ratings of double vision (β = 0.27; 95% confidence interval [CI], 0.01-0.53; P = 0.04) and light sensitivity (β = 0.506; 95% CI, 0.061-0.951; P = 0.02), but not dizziness (β = 0.390; 95% CI, -0.047 to 0.827; P = 0.08) or blurry vision (β = 0.026; 95% CI, -0.352 to 0.404; P = 0.89). CONCLUSION Missing >5 days of school was associated with worse double vision and light sensitivity symptoms. Given the importance of vision in learning, assessing postconcussion vision symptoms may facilitate a successful return to school. Clinicians should assess a wide spectrum of vision-specific symptoms to ensure appropriate support during the return-to-school process.
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Sweeney EA, Little CC, Wilson JC, Potter MN, Seehusen CN, Howell DR. Comparison of Braces for Treatment of Sever's Disease (Calcaneal Apophysitis) in Barefoot Athletes: A Randomized Clinical Trial. J Athl Train 2023; 58:437-444. [PMID: 36094612 DOI: 10.4085/1062-6050-0266.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sever's disease (calcaneal apophysitis) is a common condition in youth athletes, including those who participate in barefoot sports. Health care professionals often recommend that young athletes with Sever's disease wear heel cups in their shoes while active, but barefoot athletes are unable to use heel cups. OBJECTIVE To compare the efficacy of 2 braces used by barefoot athletes with Sever's disease. DESIGN Randomized controlled clinical trial. SETTING Pediatric sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS A total of 43 barefoot athletes aged 7 to 14 years were enrolled, and 32 completed the study (age = 10.3 ± 1.6 years; 29 girls, 3 boys). INTERVENTION(S) Participants were randomized to the Tuli's Cheetah heel cup (n = 16) or Tuli's The X Brace (n = 16) group for use during barefoot sports over the 3-month study period. MAIN OUTCOME MEASURE(S) Participants completed self-reported assessments after diagnosis (baseline) and 1, 2, and 3 months later. The primary outcome was the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical score (3 months postenrollment). The secondary outcomes were OxAFQ-C school or play and emotional scores and the visual analog scale pain score. RESULTS The percentage of time wearing the brace during barefoot sports was not different between the Cheetah heel cup and The X Brace groups (82% versus 64% of the time in sports; P = .08). At 3 months, we observed no differences for the OxAFQ-C physical (0.79 versus 0.71; P = .80; Hedges g = 0.06), school or play (0.94 versus 1.00; P = .58; Hedges g = 0.26), or emotional (1.00 versus 1.00; P = .85; Hedges g = 0.21) score. Visual analog scale pain scores during activities of daily living and sports were lower (better) at the 2- and 3-month time points than at baseline (P < .001). CONCLUSIONS Both groups demonstrated improvements in ankle and foot function across time, but no between-groups differences were seen at 3 months. Given these results, barefoot athletes with Sever's disease may consider using either brace with barefoot activity to help improve pain and functional status.
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Fryar C, Howell DR, Seehusen CN, Tilley D, Casey E, Sweeney EA. Link Between the Female Athlete Triad and Gymnastics-Related Injury in Retired Collegiate Gymnasts. Clin J Sport Med 2023:00042752-990000000-00117. [PMID: 37185819 DOI: 10.1097/jsm.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 03/02/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To compare gymnastics-related injuries between former collegiate gymnasts who did and did not report components of the female athlete triad (Triad) during college, including disordered eating or menstrual irregularity. We hypothesized that athletes reporting these 2 triad symptoms would have higher rates of time loss injury and injuries requiring surgery. DESIGN Retrospective case-control. SETTING Online survey. PATIENTS Four hundred seventy former collegiate gymnasts. INTERVENTIONS Athletes completed online survey distributed through social media. MAIN OUTCOME MEASURES Participants were grouped based on self-reported menstrual irregularity and disordered eating during college. We compared time loss injuries, injuries resulting in surgery, and injury locations between the groups using χ2 analyses. RESULTS Seventy percent (n = 328) of participants in this study reported a time loss college injury without surgery, and 42% (n = 199) reported an injury during college that required surgical treatment. A significantly greater proportion of gymnasts with only disordered eating reported a time loss gymnastics injury (without surgery) compared with those who reported only menstrual irregularity during college (79% vs 64%; P =0 .03). A significantly greater proportion of the disordered eating-only group reported a spine injury compared with the menstrual irregularity-only group (P = 0.007) and the group who reported neither menstrual irregularity nor disordered eating (P = 0.006). CONCLUSIONS College gymnasts who experienced disordered eating were more likely to experience a nonsurgical time loss injury while in college, as well as spine injury compared with those with menstrual irregularity. Sports medicine providers should be aware of the association between injuries and individual components of Triad in gymnasts beyond bone stress injuries.
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Magliato SN, Wingerson MJ, Seehusen CN, Smulligan KL, Simon SL, Wilson JC, Howell DR. Sleep Problems After Concussion Are Associated With Poor Balance and Persistent Postconcussion Symptoms. J Child Neurol 2023; 38:198-205. [PMID: 37122172 DOI: 10.1177/08830738231170721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We examined the association of self-reported sleep problems with clinical measures of postural stability, memory performance, symptom burden, and symptom duration following youth concussion. Patients 6-18 years of age presenting ≤21 days postconcussion underwent a clinical evaluation including modified Balance Error Scoring System, single- and dual-task tandem gait, immediate and delayed recall, and symptom severity. We calculated time from injury until symptom resolution and determined the proportion of patients who developed persistent postconcussion symptoms, defined as a symptom duration >28 days postconcussion. We grouped patients based on whether they reported sleep problems at their postconcussion clinical evaluation and compared symptom-based and functional outcomes between groups. Of the 207 patients included, n = 97 (14.3 ± 2.9 years; 49% female; initial visit 10.2 ± 5.8 days postconcussion) reported sleep problems postconcussion and n = 110 (14.3 ± 2.4 years; 46% female; initial visit 9.3 ± 5.4 days postinjury) did not. Those reporting sleep problems postconcussion had significantly more modified Balance Error Scoring System errors than those without (8.4 ± 5.5 vs 6.7 ± 4.7; P = .01), but similar tandem gait and memory performance. A significantly greater proportion of those who reported sleep problems postconcussion experienced persistent postconcussion symptoms than those who did not (53% vs 31%; P = .004). After adjusting for time from concussion to clinical visit and preconcussion sleep problems, postconcussion sleep problems were associated with a 2 times greater odds of developing persistent postconcussion symptoms (adjusted odds ratio = 2.02, 95% CI = 1.01, 4.06; P = .049). Identifying sleep problems early following concussion may allow clinicians to implement targeted treatment recommendations to improve sleep and provide an optimal recovery environment.
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Chesler KC, Howell DR, Khodaee M, Pierpoint LA, Comstock RD, Provance AJ. Are Different Aged Youth Skiers and Snowboarders Experiencing Different Injury Characteristics? Wilderness Environ Med 2023; 34:45-54. [PMID: 36610917 DOI: 10.1016/j.wem.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/15/2022] [Accepted: 10/14/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Skiing and snowboarding are popular winter sports with significant youth participation and inherent potential for injury. We investigated the relationship between age and injury characteristics exhibited by youth skiers and snowboarders. METHODS In this cross-sectional study, we investigated injury characteristics among youth skiers and snowboarders at a ski resort, examining the association between age and injury type. We compared injury characteristics among young children (aged 3-6 y), school-aged children (aged 7-14 y), and older adolescents (aged 15-17 y) using χ2, and examined predictive variables for injuries at different anatomical locations using logistic regression. RESULTS Compared with snowboarding, skiing was associated with greater odds of lower extremity (adjusted odds ratio [aOR]=6.8, 95% confidence interval [CI]: 4.89, 9.47, P<0.001) and head/face/neck (aOR=1.63, 95% CI: 1.20, 2.21, P=0.002) injuries. Compared with skiing, snowboarding was associated with greater odds of upper extremity injury (aOR=5.9, 95% CI: 4.6, 7.6, P<0.001). Age group significantly affected injury mechanism (χ2 [df=12, n=1129]=42.882, P<0.0001) and diagnosis (χ2 [df=12, n=1129]=43.093, P<0.0001). Young child skiers had the highest proportion of injuries to the head/neck/face and lower extremities and a significantly higher proportion of collision injuries and fractures than older skiers. Young child skiers most frequently injured the lower leg/ankle, while older skiers most frequently injured the knee. CONCLUSIONS Youth skiers exhibited predominately lower extremity injuries, while snowboarders exhibited predominately upper extremity injuries. Age significantly affected injury mechanism and injury diagnosis in youth skiers. Specifically, younger skiers tended to suffer more fractures and collision injuries than older youth skiers.
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Gagliardi AG, Walker G, Dahab K, Pearce S, Howell DR, Albright JC. High healing rate of stable femoral condyle osteochondritis dissecans in young patients placed in a hinged knee brace locked in extension: a retrospective study. J Pediatr Orthop B 2023; 32:170-177. [PMID: 36700964 DOI: 10.1097/bpb.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report the rate of stable femoral condyle osteochondritis dissecans (OCD) lesion healing in adolescents using a locked hinged knee brace for a minimum of 6 weeks or until pain free, followed by physical therapy. Patients aged 5-18 at the time of a primary diagnosis of femoral condyle OCD were reviewed. Patients who presented with an unstable lesion necessitating surgery, lacked follow-up >6 months after diagnosis or before symptoms resolution, or were noncompliant were excluded. We assessed progression to surgery, association between surgery and lesion size, lesion grade, symptoms, laterality, and patient factors. Lesion width and depth and condyle size were measured on X-ray and MRI, and the scaled size of the lesion relative to the condyle was calculated. Sixty-four patients were included: 12.5% (n = 8; 50% female; mean age = 12.5 ± 1.0 years) progressed to surgery and 87.5% (n = 56; 20% female; mean age=11.5 ± 1.9 years) healed. No significant effects were identified between groups. The surgical group compared to the non-surgical group was braced for a similar amount of time (72.6 ± 51.4 vs. 54.9 ± 23.2 days; P = 0.09), presented initially with a similar lesion size (322.5 ± 298.7 vs. 211.2 ± 178.4 mm2; P = 0.14), and had a similar proportion of Grade 1 lesions (63% vs. 85%; P = 0.11). Female sex (P = 0.04) and longer time in the brace (P = 0.04) were associated with progression to surgery.
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Smulligan KL, Wingerson MJ, Little CC, Wilson JC, Howell DR. Early physical activity after concussion is associated with sleep quality but not dizziness among adolescent athletes. J Sci Med Sport 2023; 26:183-188. [PMID: 36804710 PMCID: PMC10106390 DOI: 10.1016/j.jsams.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To assess the association between early physical activity and post-concussion sleep quality, dizziness, and postural stability among adolescents with concussion compared to uninjured controls. DESIGN Cross-sectional. METHODS Adolescents ages 13-18 years assessed within 14 days post-concussion and uninjured controls. Those with concussion reported if they participated in physical activity between the concussion and assessment. Participants completed the Dizziness Handicap Inventory, Pittsburgh Sleep Quality Index, and single/dual-task tandem gait. RESULTS We enrolled 34 participants with concussion (early physical activity: n = 10, age = 15.8 ± 1.6 years, 70% female; no physical activity: n = 24, age = 16.0 ± 1.3 years, 50% female) and 21 uninjured controls (age = 16.0 ± 1.8 years, 48% female). Compared to controls, the no physical activity group reported worse sleep quality (Pittsburgh Sleep Quality Index: 3.8 ± 2.7 vs 8.0 ± 4.9 points, p = 0.002) and single-task tandem gait time (13.7 ± 3.4 vs 21.2 ± 8.1 s, p = 0.0006), while the early physical activity group did not (Pittsburgh Sleep Quality Index: 3.8 ± 2.7 vs 5.8 ± 3.2 points, p = 0.38; single-task tandem gait: 13.7 ± 3.4 vs 19.0 ± 5.7 s, p = 0.08). Compared to controls, early/no physical activity groups reported worse dizziness (Dizziness Handicap Inventory: 2.0 ± 3.4 vs 22.9 ± 23.8 vs 27.4 ± 19.2 points, p < 0.0001). There were no significant between-group differences for dual-task tandem gait (24.1 ± 8.0 vs 24.8 ± 6.2 vs 26.6 ± 7.3 s, p = 0.57). CONCLUSIONS The no physical activity group reported worse sleep quality and slower single-task tandem gait than controls, while both groups reported similar sleep quality and tandem gait. Early physical activity may promote sleep quality and postural stability, or early physical activity may be a function of improved sleep and postural stability after concussion.
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Lempke LB, Oldham JR, Passalugo S, Willwerth SB, Berkstresser B, Wang F, Howell DR, Meehan WP. Influential Factors and Preliminary Reference Data for a Clinically Feasible, Functional Reaction Time Assessment: The Standardized Assessment of Reaction Time. J Athl Train 2023; 58:112-119. [PMID: 35476022 PMCID: PMC10072093 DOI: 10.4085/1062-6050-0073.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Clinical reaction-time (RT) measures are frequently used when examining patients with concussion but do not correlate with functional movement RT. We developed the Standardized Assessment of RT (StART) to emulate the rapid cognitive demands and whole-body movement needed in sport. OBJECTIVE To assess StART differences across 6 cognitive-motor combinations, examine potential demographic and health history confounders, and provide preliminary reference data for healthy collegiate student-athletes. DESIGN Prospective, cross-sectional study. SETTING Clinical medicine facilities. PATIENTS OR OTHER PARTICIPANTS A total of 89 student-athletes (56 [62.9%] men, 33 [37.1%] women; age = 19.5 ± 0.9 years, height = 178.2 ± 21.7 cm, mass = 80.4 ± 24 kg; no concussion history = 64 [71.9%]). MAIN OUTCOME MEASURE(S) Student-athletes completed health history questionnaires and StART during preseason testing. The StART consisted of 3 movements (standing, single-legged balance, and cutting) under 2 cognitive states (single task and dual task [subtracting by 6's or 7's]) for 3 trials under each condition. The StART trials were calculated as milliseconds between penlight illumination and initial movement. We used a 3 × 2 repeated-measures analysis of variance with post hoc t tests and 95% CIs to assess StART cognitive and movement differences, conducted univariable linear regressions to examine StART performance associations, and reported StART performance as percentiles. RESULTS All StART conditions differed (P ≤ .03), except single-task standing versus single-task single-legged balance (P = .36). Every 1-year age increase was associated with an 18-millisecond (95% CI = 8, 27 milliseconds) slower single-task cutting RT (P < .001). Female athletes had slower single-task (15 milliseconds; 95% CI = 2, 28 milliseconds; P = .02) and dual-task (28 milliseconds; 95% CI = 2, 55 milliseconds; P = .03) standing RT than male athletes. No other demographic or health history factors were associated with any StART condition (P ≥ .056). CONCLUSIONS The StART outcomes were unique across each cognitive-motor combination, suggesting minimal subtest redundancy. Only age and sex were associated with select outcomes. The StART composite scores may minimize confounding factors, but future researchers should consider age and sex when providing normative data.
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Wingerson MJ, Wilson JC, Seehusen CN, Walker GA, Howell DR. Patient Characteristics Predictive of Immediate and Delayed Word Recall Performance Following Adolescent Concussion. Int J Sports Med 2023; 44:72-77. [PMID: 36096148 DOI: 10.1055/a-1941-5673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Clinicians rely on objective concussion assessments that may be influenced by patient characteristics, creating difficulties in isolating the effect of concussion on patient function. The purpose of our study was to identify characteristics associated with performance on the Sport Concussion Assessment Tool 5th edition (SCAT5) 10-word recall test following adolescent concussion. We evaluated patients seen for care within 14 days of concussion (n=125; 15.2±1.6 years of age, range=11-18 years; 46% female; 6.9±3.4 days post-concussion). Patient demographic (age, sex, medical and concussion history, etc.), injury (timing of presentation, symptom severity, sport-type, etc.), and clinical test (Modified Balance Error Scoring System [mBESS], tandem gait) characteristics were assessed, in addition to SCAT5 immediate and delayed memory testing using the 10-word recall list. Immediate and delayed recall performance was significantly associated with concussion symptom burden and cognitive accuracy during tandem gait, although effect sizes were notably small. Specific variables such as age, sex, diagnosis of ADD/ADHD, and performance on other clinical assessments were not significantly associated with recall performance after controlling for covariates. Further, the 10-word recall list demonstrates specific advantages over previously used 5-word lists by way of decreased ceiling effects and reduced interference of inherent patient characteristics.
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Lempke LB, Passalugo S, Baranker BT, Hunt D, Berkstresser B, Wang F, Meehan WP, Howell DR. Relationship and Latent Factors Between Clinical Concussion Assessments and the Functional Standardized Assessment of Reaction Time (StART). Clin J Sport Med 2022; 32:e591-e597. [PMID: 35878887 PMCID: PMC9633339 DOI: 10.1097/jsm.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the relationships and latent factors within the Standardized Assessment of Reaction Time (StART), and between StART and current clinical assessments. DESIGN Cross-sectional study. SETTING Clinical medicine facility. PARTICIPANTS Eighty-nine healthy collegiate student-athletes (63% male, age: 19.5 ± 0.9 years, 28% ≥1 concussion history). ASSESSMENT OF RISK FACTORS Student-athletes completed StART and clinical assessments during preinjury testing. MAIN OUTCOME MEASURES Standardized Assessment of Reaction Time consisted of 3 conditions (standing, single-leg balance, cutting) under 2 cognitive states (single task and dual task) for 3 trials each condition. Clinical assessments were the Sport Concussion Assessment Tool (SCAT) symptom checklist, Standardized Assessment of Concussion (SAC), tandem gait (single task and dual task), and Immediate PostConcussion Assessment and Cognitive Testing (ImPACT). We used Pearson- r correlation coefficients and exploratory factor analysis (EFA) to examine relationships and latent factors between StART and clinical assessments. RESULTS Null to moderate correlations presented among the StART outcomes (r range: 0.06-0.70), and null to small correlations between StART and clinical assessments (r range: -0.16 to 0.34). The three-factor EFA for solely StART explained 70.6% total variance: functional movement (cutting), static dual-task (standing and single-leg balance), and static single task (standing and single-leg balance). The five-factor EFA for StART and clinical assessments explained 65.8% total variance: gait (single-task and dual-task tandem gait), functional movement (StART single-task and dual-task cutting), static dual-task (StART standing, single-leg balance), neurocognitive (ImPACT verbal memory, visual memory, visual-motor speed), and static single task (StART standing, single-leg balance). No other outcomes met the factor loading threshold. CONCLUSIONS StART displayed 3 distinct categories and had minimal redundancy within its subtests. StART did not meaningfully correlate with clinical assessments, suggesting that StART provides unique information by examining more functional, reactive movement.
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Stockbower KA, Howell DR, Seehusen CN, Armento AM, Walker GA. Sport specialization, sleep, fatigue, and psychosocial ratings: do highly specialized athletes differ from their less specialized peers? PHYSICIAN SPORTSMED 2022; 50:400-405. [PMID: 34171984 DOI: 10.1080/00913847.2021.1947736] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine if sleep quality, fatigue, anxiety, depressive symptoms, or perceptions of sport participation differ between high-, moderate-, and low-specialized high school athletes with or without prior injuries. METHODS During pre-participation physical examinations (PPE), high school athletes completed questionnaires on sport specialization level, history of time-loss orthopedic injury, perceptions of sport participation, as well as sleep quality (Pittsburgh Sleep Quality Index (PSQI)), fatigue, anxiety, and depressive symptoms (Patient-Reported Outcomes Measurement Information System (PROMIS®)). Athletes were grouped according to sport specialization level and history of prior time-loss orthopedic injury. RESULTS A total of 186 athletes completed the study: 49% (n = 92; mean age = 15.3 ± 2.0 yrs; 50% female) were low specialized, 34% (n = 64; mean age = 15.3 ± 1.3 yrs; 47% female) were moderately specialized, and 16% (n = 30; mean age = 15.7 ± 1.1 yrs; 57% female) were highly specialized. Groups were similar for demographics, training volume, and injury history. Compared to the moderate-specialization group, highly specialized athletes reported higher levels of fatigue (3.1 ± 3.7 vs. 1.5 ± 2.2; p = 0.02), anxiety (3.6 ± 4.1 vs. 1.8 ± 2.6; p = 0.02), and depressive symptoms (2.4 ± 4.0 vs. 0.8 ± 2.0; p = 0.02). No differences in psychometric ratings, sleep quality, or perceptions of sport participation were observed between the low/moderate- or low/high-specialization groups. We did not observe any significant differences between groups who did and did not report a history of prior time-loss orthopedic injury. CONCLUSIONS Highly specialized high school athletes report higher levels of fatigue, more anxiety symptoms, and more depressive symptoms than their moderately specialized peers, despite no differences in training volume or injury history. Low specialized athletes did not differ from moderately specialized or highly specialized athletes in the aforementioned domains, and there were no differences in sleep quality across specialization groups. These findings add to the current body of literature on early sport specialization by illustrating the distinctive psychosocial implications of sport specialization and demonstrating the need for further prospective research.
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Wingerson MJ, Smulligan KL, Wilson JC, Walker G, Howell DR. Sociodemographic And Injury Characteristics Predictive Of Time To Presentation At A Specialty Clinic After Concussion. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000875828.44522.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jain D, Arbogast KB, McDonald CC, Podolak OE, Margulies SS, Metzger KB, Howell DR, Scheiman MM, Master CL. Eye Tracking Metrics Differences among Uninjured Adolescents and Those with Acute or Persistent Post-Concussion Symptoms. Optom Vis Sci 2022; 99:616-625. [PMID: 35848958 PMCID: PMC9361745 DOI: 10.1097/opx.0000000000001921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Eye tracking assessments that include pupil metrics can supplement current clinical assessments of vision and autonomic dysfunction in concussed adolescents. PURPOSE This study aimed to explore the utility of a 220-second eye tracking assessment in distinguishing eye position, saccadic movement, and pupillary dynamics among uninjured adolescents, those with acute post-concussion symptoms (≤28 days since concussion), or those with persistent post-concussion symptoms (>28 days since concussion). METHODS Two hundred fifty-six eye tracking metrics across a prospective observational cohort of 180 uninjured adolescents recruited from a private suburban high school and 224 concussed adolescents, with acute or persistent symptoms, recruited from a tertiary care subspecialty concussion care program, 13 to 17 years old, from August 2017 to June 2021 were compared. Kruskal-Wallis tests were used, and Bonferroni corrections were applied to account for multiple comparisons and constructed receiver operating characteristic curves. Principal components analysis and regression models were applied to determine whether eye tracking metrics can augment clinical and demographic information in differentiating uninjured controls from concussed adolescents. RESULTS Two metrics of eye position were worse in those with concussion than uninjured adolescents, and only one metric was significantly different between acute cases and persistent cases. Concussed adolescents had larger left and right mean, median, minimum, and maximum pupil size than uninjured controls. Concussed adolescents had greater differences in mean, median, and variance of left and right pupil size. Twelve metrics distinguished female concussed participants from uninjured; only four were associated with concussion status in males. A logistic regression model including clinical and demographics data and transformed eye tracking metrics performed better in predicting concussion status than clinical and demographics data alone. CONCLUSIONS Objective eye tracking technology is capable of quickly identifying vision and pupillary disturbances after concussion, augmenting traditional clinical concussion assessments. These metrics may add to existing clinical practice for monitoring recovery in a heterogeneous adolescent concussion population.
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Sidhar K, Baugh CM, Wilson JC, Spittler J, Walker GA, Armento AM, Howell DR. Socioeconomic status and injury history in adolescent athletes: Lower family affluence is associated with a history of concussion. J Clin Transl Res 2022; 8:292-298. [PMID: 35975186 PMCID: PMC9373721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 10/26/2022] Open
Abstract
Background While healthcare and health outcome disparities have been studied across a variety of different injuries, their relation to concussion incidence and management are relatively understudied. Aim The aim of this study was to evaluate the association between history of concussion or musculoskeletal injury, and family affluence and/or school-level measures of socioeconomic status. Methods We conducted a cross-sectional study of adolescent athletes in a local school district. Adolescent athletes (n = 192; mean age = 15.3, SD = 1.6 years; 49% female), who presented for a pre-participation physical evaluation reported concussion and injury history, and family affluence scale (FAS) scores. We also examined the percent of students on free/reduced lunch at each school compared to state averages. Independent variables, individual FAS score and school-based marker of socioeconomic status, were compared between those with and without a history of concussion and time-loss musculoskeletal injury. Results Of the participants, 40 (21%) reported a history of concussion. Athletes with a concussion history had significantly lower FAS scores than athletes without a history of concussion (mean difference = 0.7, 95%CI = 0.1, 1.4; P = 0.027). There was no significant difference in FAS scores between those with and without a history of time-loss musculoskeletal injury (mean difference = 0.0, 95% CI = -0.5, 0.5; P = 0.97). Athletes with a history of concussion had a higher proportion of a prior time-loss musculoskeletal injury (68% vs. 32%; P < 0.001). After adjusting for age, school free-reduced lunch rate, and history of musculoskeletal injury, a lower FAS score was associated with concussion history (adjusted odds ratio = 0.79; 95% CI = 0.64, 0.96; P = 0.019). Concussion and musculoskeletal injury were not associated with school-level markers of socioeconomic status. Conclusion Lower individual measures, but not school-level measures, of socioeconomic status were associated with a history of concussion in our sample of adolescent athletes. Relevance for Patients Enhance providers' understanding of how socioeconomic factors may impact concussion history and empower providers to adequately screen for and provide concussion education to mitigate disparities.
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Howell DR, Hunt DL, Oldham JR, Aaron SE, Meehan WP, Tan CO. Postconcussion Exercise Volume Associations With Depression, Anxiety, and Dizziness Symptoms, and Postural Stability: Preliminary Findings. J Head Trauma Rehabil 2022; 37:249-257. [PMID: 34320557 PMCID: PMC8789955 DOI: 10.1097/htr.0000000000000718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association between postconcussion exercise volume and changes in depression, anxiety, dizziness, and postural stability. DESIGN Secondary analysis of a single-site prospective clinical trial. SETTING Cerebrovascular research laboratory. PARTICIPANTS Participants completed questionnaires and underwent tests of gait and balance within 2 weeks of a concussion (mean = 11 ± 3 days postconcussion) and approximately 1 month later (mean = 41 ± 7 days postconcussion). Exercise volume was tracked by weekly exercise logs. INTERVENTIONS On the basis of a previous work classifying exercise volume following concussion, we grouped participants according to self-reported exercise volume between visits as high exercise volume (≥150 min/wk) or low exercise volume (<150 min/wk). MAIN OUTCOME MEASURES Participants completed assessments evaluating anxiety and depression (Hospital Anxiety and Depression Scale), dizziness (Dizziness Handicap Inventory), and postural stability (tandem gait and modified Balance Error Scoring System). RESULTS Thirty-eight participants completed the study, of which 22 were in the high exercise volume group (mean = 71 ± 40 min/wk; 16.8 ± 2.1 years; 59% female) and 16 were in the low exercise volume group (mean = 379 ± 187 min/wk; 17.5 ± 2.1 years; 31% female). Although depression symptoms were not significantly different initially (mean difference = 1.5; 95% CI, -0.68 to 3.68; P = .24), the high exercise volume group had significantly lower depression symptom scores at follow-up (mean difference = 3.0; 95% CI, 1.40 to 4.47; P < .001). Anxiety symptoms (mean difference = 2.8; 95% CI, 0.3 to 5.4; P = 0.03), dizziness symptoms (mean difference = 10.9; 95% CI, 0.2 to 21.5; P = .047), single-task tandem gait (mean difference = 3.1 seconds; 95% CI, 0.2 to 6.0; P = .04), and dual-task tandem gait (mean difference = 4.2 seconds; 95% CI, 0.2 to 8.2; P = .04) were significantly better among the high exercise volume group. CONCLUSION Greater exercise volumes were associated with lower depression, anxiety, and dizziness symptoms, and faster tandem gait performance. These preliminary findings suggest a potentially beneficial role for exercise within several different domains commonly affected by concussion.
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Hunt DL, Oldham J, Aaron SE, Tan CO, Meehan WP, Howell DR. Dizziness, Psychosocial Function, and Postural Stability Following Sport-Related Concussion. Clin J Sport Med 2022; 32:361-367. [PMID: 34009789 PMCID: PMC8426409 DOI: 10.1097/jsm.0000000000000923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine if self-reported dizziness is associated with concussion symptoms, depression and/or anxiety symptoms, or gait performance within 2 weeks of postconcussion. DESIGN Cross-sectional study. SETTING Research laboratory. PARTICIPANTS Participants were diagnosed with a concussion within 14 days of initial testing (N = 40). Participants were divided into 2 groups based on their Dizziness Handicap Inventory (DHI) score: 36 to 100 = moderate/severe dizziness and 0 to 35 = mild/no dizziness. INTERVENTIONS Participants were tested on a single occasion and completed the DHI, hospital anxiety and depression scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and Post-Concussion Symptom Inventory (PCSI). Three different postural control tests were use: modified Balance Error Scoring System, single-/dual-task tandem gait, and a single-/dual-task instrumented steady-state gait analysis. MAIN OUTCOME MEASURES Comparison of patient-reported outcomes and postural control outcomes between moderate/severe (DHI ≥ 36) and mild/no (DHI < 36) dizziness groups. RESULTS Participants with moderate/severe dizziness (n = 19; age = 17.1 ± 2.4 years; 63% female) reported significantly higher symptom burden (PSCI: 43.0 ± 20.6 vs 22.8 ± 15.7; P = 0.001) and had higher median HADS anxiety (6 vs 2; P < 0.001) and depression (6 vs 1; P = 0.001) symptom severity than those with no/minimal dizziness (n = 21; age = 16.5 ± 1.9; 38% female). During steady-state gait, moderate/severe dizziness group walked with significantly slower single-task cadence (mean difference = 4.8 steps/minute; 95% confidence interval = 0.8, 8.8; P = 0.02) and dual-task cadence (mean difference = 7.4 steps/minute; 95% confidence interval = 0.7, 14.0; P = 0.04) than no/mild dizziness group. CONCLUSION Participants who reported moderate/severe dizziness reported higher concussion symptom burden, higher anxiety scores, and higher depression scores than those with no/mild dizziness. Cadence during gait was also associated with the level of dizziness reported.
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Oldham JR, Lanois CJ, Caccese JB, Crenshaw JR, Knight CA, Berkstresser B, Wang F, Howell DR, Meehan WP, Buckley TA. Association Between Collision Sport Career Duration and Gait Performance in Male Collegiate Student-Athletes. Am J Sports Med 2022; 50:2526-2533. [PMID: 35736366 DOI: 10.1177/03635465221104685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Investigations of estimated age of first exposure to repetitive head impacts from collision and contact sports have shown no associations with neurocognitive or neurobehavioral function at the collegiate level, but the effect of career duration may be a more comprehensive factor. Understanding whether longer career duration influences gait performance would provide insights into potential neurological impairment. PURPOSE To examine the relationship between career duration of collision sports and single/dual-task gait performance in collegiate student-athletes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS We recruited 168 male student-athletes from collision sports: football, lacrosse, ice hockey, and wrestling (mean ± SD age, 19.2 ± 1.3 years; height, 184.5 ± 7.2 cm; mass, 94.3 ± 15.9 kg; estimated age of first exposure, 8.6 ± 3.1 years; career duration, 10.6 ± 3.0 years). All participants completed a baseline single- and dual-task gait assessment before the start of their athletic season. Inertial measurement units were used to measure gait speed and stride length. During the dual task, participants were asked to perform working memory cognitive tasks while walking. The dependent variables were single/dual-task gait speed and stride length, cognitive accuracy, and dual-task cost. The relationship between career duration, analyzed as a continuous variable, and the dependent variables was analyzed using a linear regression. RESULTS There were no significant associations between career duration and single-task gait speed (1.16 ± 0.16 m/s; β = -0.004; P = .35; 95% CI = -0.012 to 0.004; η2 = 0.005) or dual-task gait speed (1.02 ± 0.17 m/s; β = -0.003; P = .57; 95% CI = -0.011 to 0.006; η2 = 0.002). There were also no significant associations between career duration and single/dual-task stride length, cognitive accuracy, or dual-task cost. CONCLUSION Career duration among collegiate collision sport athletes was not associated with single- or dual-task gait performance, suggesting that a greater exposure to repetitive head impacts is not detrimental to dynamic postural control at the college level. However, the effects of diminished gait performance over the lifetime remain to be elucidated.
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Smulligan KL, Wingerson MJ, Seehusen CN, Wilson JC, Howell DR. Postconcussion Dizziness Severity Predicts Daily Step Count during Recovery among Adolescent Athletes. Med Sci Sports Exerc 2022; 54:905-911. [PMID: 35081096 DOI: 10.1249/mss.0000000000002877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Physical activity (PA) after concussion is an important aspect of appropriate clinical management. However, symptoms or functional deficits may reduce patient propensity toward PA, thereby negatively affecting recovery. Our purpose was to examine whether postconcussion dizziness, total symptom severity, or postural stability predicts PA level in the 2 wk after initial evaluation. METHODS We evaluated adolescent athletes within 14 d of concussion on assessments of symptoms, dizziness, and postural stability. Athletes were provided an activity monitor to track PA for 2 wk after the evaluation. Our primary outcome was step count (mean steps per day). Potential predictor variables included sex, Post-Concussion Symptom Inventory (PCSI) total symptom severity, individual PCSI ratings of dizziness and balance impairment, and postural stability assessments (single- and dual-task tandem gait, modified Balance Error Scoring System). To examine predictors of PA, we calculated correlation coefficients between steps per day and each potential predictor and included significantly correlated variables in a multivariable regression model. RESULTS Participants were ages 12-18 yr (n = 35, 15.2 ± 1.7 yr, 49% female) and initially evaluated 7.3 ± 3.0 d after concussion. Upon univariable evaluation, PCSI dizziness rating (Pearson R = -0.49, P = 0.003) and sex (mean difference, 2449 steps per day; P = 0.05) were associated with steps per day. Within the multivariable regression analysis, PCSI dizziness rating (β = -1035; 95% confidence interval, -191 to -1880; P = 0.018), but not sex, predicted average steps per day in the 2 wk after initial evaluation. CONCLUSIONS Self-reported dizziness, but not overall symptom severity or postural stability, assessed within 14 d of concussion predicted daily step count in the subsequent 2 wk. Given the importance of PA for concussion recovery, treating acute postconcussion dizziness can potentially reduce a barrier to PA and improve recovery trajectories.
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Chen DL, Meyers RN, Provance AJ, Zynda AJ, Wagner KJ, Siegel SR, Howell DR, Miller SM. Early Sport Specialization and Past Injury in Competitive Youth Rock Climbers. Wilderness Environ Med 2022; 33:179-186. [PMID: 35484015 DOI: 10.1016/j.wem.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Sport specialization has been shown to have negative effects on athletes but has not been studied within rock climbing. This study seeks to evaluate the proportion and impact of specialization in pediatric climbers. METHODS Climbers (ages 8-18 y) were recruited from throughout the United States to complete a 1-time survey regarding climbing experience, training patterns, and injury history. The main outcome of proportion of climbers suffering an injury was assessed within the last 12 mo and within their entire climbing experience (defined as "lifetime" injury). Early specialization was defined as exclusive participation in climbing, with training for >8 mo‧y-1, prior to age 12 y (late specialization if after age 12 y). RESULTS Participants (n=111, 14±3 y [mean±SD], 69 females) were high-level climbers. Fifty-five percent of participants specialized in climbing, and 69% of those specialized early. Hand and ankle injuries occurred most commonly. Seventy-eight percent of late specialized climbers had a lifetime injury. Late specialized climbers were 1.6 times (95% CI: 1.1-2.3) more likely than early specialized climbers to have had a lifetime injury and 1.8 times (95% CI: 1.1-2.8) more likely to have had an injury in the last 12 mo. No difference in overuse injuries was found between specialization groups. CONCLUSIONS Early specialization is common among youth climbers but was not associated with an increase in injuries. Late specialization was associated with a higher likelihood of having had a climbing injury in the last 12 mo and during an entire climbing career.
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Neely L, Smulligan KL, Wingerson MJ, Seehusen C, Simon S, Wilson JC, Howell DR. Evaluating the Association of Sleep & Physical activity with Prolonged Concussion Symptoms. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Howell DR, Wingerson MJ, Kirkwood MW, Grubenhoff JA, Wilson JC. Early aerobic exercise among adolescents at moderate/high risk for persistent post-concussion symptoms: A pilot randomized clinical trial. Phys Ther Sport 2022; 55:196-204. [DOI: 10.1016/j.ptsp.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/22/2022]
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Gagliardi AG, Howell DR, Stein JM, Monson MA, Pearce SS, Albright JC. Prediction of quadriceps tendon-patellar bone autograft diameter in adolescents with 2-dimensional magnetic resonance imaging and anthropometric measures. Skeletal Radiol 2022; 51:619-623. [PMID: 34291324 DOI: 10.1007/s00256-021-03874-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study evaluates the correlation between the bone end and soft tissue end of the quadriceps tendon-patellar bone autograft (QPA) size and pre-operative MRI measurements of the quadriceps tendon along sections to be included in the graft harvest in adolescents. We also assessed association between graft diameter and anthropometric measures (height, weight, and BMI), age, and sex. METHODS Patients (10-18 years) who underwent QPA ACL reconstruction and had a pre-operative MRI were considered for inclusion. Age, height, and weight, tibial and femoral side graft diameter, and patellar bone block dimensions were collected. Using a pre-operative 2D sagittal plane MRI, we measured the quadriceps at 10-mm increments above the patella, up to 40 mm. We assessed correlation between the bone-end graft diameter and the AP measure at 10 mm above the patella, and correlation between the soft-tissue end graft diameter and the most proximal AP measure. RESULTS A total of 103 patients were included. A significant correlation between the soft-tissue side graft diameter and most proximal AP measurement was observed (rs = 0.51; p < 0.001). However, measurements significantly underestimated the soft-tissue end graft diameter (9.6 ± 0.8 vs. 7.4 ± 1.1; p < 0.001). There was no correlation between the bone-end graft diameter and AP measurement 10 mm above the patella. Anthropometric measures were not associated with graft size. Skeletal maturity was associated with smaller graft size (p = 0.08). CONCLUSION Soft-tissue end graft diameter is associated with the AP measure of the quadriceps at 20-40 mm above the superior pole of the patella.
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Howell DR, Seehusen CN, Carry PM, Walker GA, Reinking SE, Wilson JC. An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk: A Randomized Clinical Trial. Am J Sports Med 2022; 50:1120-1129. [PMID: 35060759 DOI: 10.1177/03635465211069372] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Existing data suggest that after concussion, athletes experience an increased risk of subsequent injury. Exploring methods that may reduce injury risk after successful postconcussion return to play may lead to new treatment approaches. PURPOSE To examine the efficacy of a neuromuscular training (NMT) intervention on acute sports-related time-loss injury over the subsequent year relative to standard of care. STUDY DESIGN Randomized clinical trial; Level of evidence, 1. METHODS A total of 27 youth athletes were assessed initially postconcussion (median, 7 days postconcussion; interquartile range [IQR], 5-10) and after return-to-play clearance (median, 40 days postconcussion; IQR, 15-52). After return-to-play clearance, they were randomly assigned to NMT intervention (n = 11; mean ± SD age, 14.7 ± 1.7 years; 36% female) or standard of care (n = 16; mean ± SD age, 15.3 ± 1.8 years; 44% female). The intervention (duration, 8 weeks; frequency, 2 times per week) included guided strength exercises with landing stabilization focus. Standard of care received no recommendations. For the subsequent year, athletes prospectively completed a monthly log of sports-related injuries and organized sports competitions. RESULTS During the first year after postconcussion return-to-play clearance, sports-related time-loss injuries were more common among standard of care relative to NMT intervention (75% [95% CI, 48%-93%] vs 36% [95% CI, 11%-69%]). After adjusting for age and sex, the hazard of subsequent injury in the standard-of-care group was 3.56 times (95% CI, 1.11-11.49; P = .0334) that of the NMT intervention group. Sports participation was similar between NMT intervention and standard of care during the year-long monitoring period (hours of organized sports per month; median, 12 [IQR, 2.6-32.1] vs 15.6 [IQR, 3.5-105.9]; P = .55). The age- and sex-adjusted incidence of injuries was 10.2 per 1000 competitive exposures (95% CI, 3.7-28.4) in the standard-of-care group as opposed to 3.4 per 1000 (95% CI, 0.9-13.4) in the NMT intervention group. After adjusting for age and sex, incidence of injuries was higher for standard of care vs NMT intervention (rate ratio, 2.96 [95% CI, 0.89-9.85]; P = .076). CONCLUSION Although preliminary, our findings suggest that an NMT intervention initiated after return-to-play clearance may significantly reduce sports-related time-loss injuries over the subsequent year. REGISTRATION NCT03917290 (ClinicalTrials.gov identifier).
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Daisy CC, Varinos S, Howell DR, Kaplan K, Mannix R, Meehan WP, Wang F, Berkstresser B, Lee RS, Froehlich JW, Zurakowski D, Moses MA. Proteomic Discovery of Noninvasive Biomarkers Associated With Sport-Related Concussions. Neurology 2022; 98:e186-e198. [PMID: 34675105 PMCID: PMC8762586 DOI: 10.1212/wnl.0000000000013001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/14/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sport-related concussions affect millions of individuals across the United States each year, and current techniques to diagnose and monitor them rely largely on subjective measures. Our goal was to discover and validate objective, quantifiable noninvasive biomarkers with the potential to be used in sport-related concussion diagnosis. METHODS Urine samples from a convenience series of healthy control collegiate athletes who had not sustained a concussion and athletes who sustained a concussion as diagnosed by a sports medicine physician within 7 days were collected prospectively and studied. Participants also completed an instrumented single-task gait analysis as a functional measure. Participants were recruited from a single collegiate athletic program and were ≥18 years of age and were excluded if they had a concomitant injury, active psychiatric conditions, or preexisting neurologic disorders. Using Tandem Mass Tags (TMT) mass spectroscopy and ELISA, we identified and validated urinary biomarkers of concussion. RESULTS Forty-eight control and 47 age- and sex-matched athletes with concussion were included in the study (51.6% female, 48.4% male, average age 19.6 years). Participants represented both contact and noncontact sports. All but 1 of the postconcussion participants reported experiencing symptoms at the time of data collection. Insulin-like growth factor 1 (IGF-1) and IGF binding protein 5 (IGFBP5) were downregulated in the urine of athletes with concussions compared to healthy controls. Multivariable risk algorithms developed to predict the probability of sport-related concussion showed that IGF-1 multiplexed with single-task gait velocity predicts concussion risk across a range of postinjury time points (area under the curve [AUC] 0.786, 95% confidence interval [CI] 0.690-0.884). When IGF-1 and IGFBP5 are multiplexed with single-task gait velocity, they accurately distinguish between healthy controls and individuals with concussion at acute time points (AUC 0.835, 95% CI 0.701-0.968, p < 0.001). DISCUSSION These noninvasive biomarkers, discovered in an objective and validated manner, may be useful in diagnosing and monitoring sport-related concussions in both acute phases of injury and several days after injury. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT02354469 (submitted February 2015, first patient enrolled August 2015). CLASSIFICATION OF EVIDENCE This study provides Class III evidence that urinary IGF-1 and IGFBP5 multiplexed with single-task gait velocity may be useful in diagnosing sport-related concussion.
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Jain D, Arbogast K, McDonald C, Podolak O, Margulies S, Metzger K, Howell DR, Scheiman M, Master C. Objective Eye Tracking Metrics of Vision and Autonomic Dysfunction Distinguish Adolescents With Acute Concussion and Those with Persistent Post-Concussion Symptoms from Uninjured Controls. Neurology 2022. [PMID: 34969887 DOI: 10.1212/01.wnl.0000801788.22299.a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the utility of an eye-tracking assessment in distinguishing binocular alignment, saccadic movement, and pupillary dynamics among uninjured adolescents, acute cases (= 28 days since concussion), and persistent cases (>28 days since concussion). BACKGROUND Visual and autonomic system disturbances are common sequelae of concussion. Quantification of visual and autonomic dysfunction via an eye tracking device could provide an objective method of acute diagnosis and subacute identification of ongoing injury. DESIGN/METHODS We compared 347 eye tracking metrics, derived from a 220 seconds eye-tracking assessment, among 132 uninjured adolescents (mean age: 15.3, 56.2% female), 110 acute cases (mean days since injury: 12.5, mean age: 15.4, 46.4% female), and 95 persistent cases (mean days since injury: 53.6, mean age: 15.4, 70.2% female) using Kruskal-Wallis tests with Bonferroni corrections to account for multiple comparisons. RESULTS Nine eye-tracking metrics were significantly associated with injury status. One measure of binocular alignment (acute v. control: p = 0.003, persistent v. control: p = 0.001) and one measure of saccadic movement (acute v. persistent: p = 0.03, acute v. control: p = 0.03, persistent v. control: p < 0.001) were worse in cases. Cases had larger left and right mean and median pupil size than uninjured adolescents (acute v. control, p < 0.001; persistent v. control, p < 0.001). Cases had greater differences in mean (acute v. control: p < 0.001, persistent v. control: p < 0.001), median (acute v. control, p < 0.001, persistent v. control, p = 0.003), and variance of (acute v. control: p < 0.001, persistent v. control: p < 0.001) left and right pupil size. Eight of these metrics distinguished female cases from uninjured adolescents, but similar differences were not observed in male participants. CONCLUSIONS Objective eye tracking technology can identify vision and pupillary disturbances after concussion. These metrics could be integrated into clinical practice to monitor recovery in a heterogeneous adolescent concussion population and may identify sex-specific differences in autonomic dysfunction.
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