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Oldham JR, Meehan WP, Howell DR. Impaired eye tracking is associated with symptom severity but not dynamic postural control in adolescents following concussion. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:138-144. [PMID: 33130092 PMCID: PMC7987563 DOI: 10.1016/j.jshs.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The purpose of the study was to (1) examine the relationship between self-reported symptoms and concussion-related eye tracking impairments, and (2) compare gait performance between (a) adolescents with a concussion who have normal eye tracking, (b) adolescents with a concussion who have abnormal eye tracking, and (c) healthy controls. METHODS A total of 30 concussed participants (age: 14.4 ± 2.2 years, mean ± SD, 50% female) and 30 controls (age: 14.2 ± 2.2 years, 47% female) completed eye tracking and gait assessments. The BOX score is a metric of pupillary disconjugacy, with scores <10 classified as normal and ≥10 abnormal. Symptoms were collected using the Post-Concussion Symptom Scale (PCSS), and gait speed was measured with triaxial inertial measurement units. We conducted a linear regression to examine the relationship between PCSS and BOX scores and a two-way mixed effects analysis of variance to examine the effect of group (abnormal BOX, normal BOX, and healthy control) on single- and dual-task gait speed. RESULTS There was a significant association between total PCSS score and BOX score in the concussion group (β = 0.16, p = 0.004, 95% confidence interval (95%CI): 0.06‒0.27), but not in the control group (β = 0.21, p = 0.08, 95%CI: -0.03 to 0.45). There were no significant associations between PCSS symptom profiles and BOX scores in the concussion or control groups. There were also no significant differences in single-task (Abnormal: 1.00 ± 0.14 m/s; Normal: 1.11 ± 0.21 m/s; Healthy: 1.14 ± 0.18 m/s; p = 0.08) or dual-task (Abnormal: 0.77 ± 0.15 m/s; Normal: 0.84 ± 0.21 m/s; Healthy: 0.90 ± 0.18 m/s; p = 0.16) gait speed. CONCLUSION The concussed group with impaired eye tracking reported higher total symptom severity, as well as worse symptom severity across the 5 PCSS symptom domain profiles. However, eye tracking deficits did not appear to be driven by any particular symptom domain. While not statistically significant, the slower gait speeds in those with abnormal BOX scores may still be clinically relevant since gait-related impairments may persist beyond clinical recovery.
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Armento A, VanBaak K, Seehusen CN, Sweeney EA, Wilson JC, Howell DR. Presence and Perceptions of Menstrual Dysfunction and Associated Quality of Life Measures Among High School Female Athletes. J Athl Train 2021; 56:1094-1099. [PMID: 33626156 DOI: 10.4085/624-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Adolescent female athletes are at risk for menstrual dysfunction in the setting of exercise and low energy availability. Education regarding menstrual dysfunction and its associated consequences is important to promote athlete well-being. OBJECTIVES The primary aim was to determine the prevalence and characteristics of female athletes who believe that losing their period is a normal response to high training demands. The secondary aim was to explore the relationship between menstrual dysfunction and patient-reported quality of life measures. DESIGN Cross-sectional study. SETTING Pre-participation evaluations for a local high school district. PARTICIPANTS Female athletes,13-18 years old. INDEPENDENT VARIABLES Presence of menstrual dysfunction, and response (yes/no) to the question, "Do you think it is normal to lose your period during high levels of athletic training?" MAIN OUTCOME MEASURES Health history, family affluence, and patient-reported quality of life measures. RESULTS Forty four percent (n=40) of 90 adolescent athletes answered that losing their period was a normal response to a high level of training, and this group had lower BMI, were less likely to report being worried about current weight, and had a higher family affluence level than those who answered losing their period was not a normal response to training. The overall prevalence of menstrual dysfunction was 28%. After adjusting for age and BMI, menstrual dysfunction was significantly associated with higher levels of anxiety, fatigue, and pain interference. CONCLUSION Nearly half of our sample of adolescent female athletes perceive losing their period as a normal response to high training demands. Females with menstrual dysfunction reported higher levels of anxiety, fatigue, and pain interference than those without. Understanding adolescent perceptions of menstrual dysfunction and the characteristics of those with menstrual dysfunction can guide future educational interventions aimed at athletes at risk for the female athlete triad.
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Lempke LB, Howell DR, Eckner JT, Lynall RC. Examination of Reaction Time Deficits Following Concussion: A Systematic Review and Meta-analysis. Sports Med 2021; 50:1341-1359. [PMID: 32162242 DOI: 10.1007/s40279-020-01281-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reaction time (RT) deficits are reported following concussion, but it is unknown when these deficits normalize to pre-injury status. It is also unclear how factors such as RT measurement technique and participant characteristics influence post-concussion RT. OBJECTIVE The purpose of this systematic review and meta-analysis was to (1) characterize acute post-concussion (0-3 days) RT impairments, (2) examine RT recovery over time, and (3) explore moderating factors related to acute RT impairment following concussion. METHODS Database searches (PubMed, CINAHL, EBSCOhost) were conducted according to PRISMA guidelines for articles published in English from January 2002 to March 2019. Studies compared baseline-to-post-injury RT within individuals (within-subject) and/or RT in concussed individuals to non-concussed controls (between-subject). Sixty studies met inclusion criteria, reporting on a total of 9688 participants with 214 discrete RT effects (Hedges' d; between-subject: N = 29, k = 129; within-subject: N = 42, k = 85). Of the 214 effects, 93 occurred in the acute (0-3 days) post-injury timeframe (k = 47 between-subject). Numerous demographic [sex, age, concussion history, population type (athlete, military, and general population), athlete level (high school, college), and sport], and method-based (RT test and measure type, computerized neurocognitive testing platform, concussion definition, and time post-injury) moderators were examined for mean effect influence. Mixed-effects multi-level modeling with restricted-maximum-likelihood estimation was used to account for nested effects and high heterogeneity for the pooled effect size (D+). RESULTS Significant medium-magnitude RT deficits were observed acutely for between- (D+ = - 0.7279, 95% CI - 0.9919, - 0.4639, I2 = 88.66, p < 0.0001) and within-subject (D+ = - 0.7472, 95% CI - 0.9089, - 0.5855, I2 = 89.21, p < 0.0001) effect models. RT deficits were present at the sub-acute and intermediate-term timeframes for between-subject effects (sub-acute: D+ = - 0.5655, 95% CI - 0.6958, - 0.4352, p < 0.0001; intermediate-term: D+ = - 0.3219, 95% CI - 0.5988, - 0.0450, p = 0.0245). No significant RT mean effect was observed for the between-subject model at the long-term timeframe, indicating RT recovery among concussed participants relative to controls (D+ = 0.3505, 95% CI - 0.4787, 1.1797, p = 0.3639). Sex was a significant moderator for between-subject effects, with every 1% male sample size increase demonstrating - 0.0171 (95% CI - 0.0312, - 0.0029, p = 0.0193) larger RT deficits. Within-subject effect models resulted in RT measure type (simple: [D+ = - 0.9826] vs. mixed: [D+ = - 0.6557], p = 0.0438) and computerized neurocognitive testing platforms (ANAM: [D+ = - 0.3735] vs. HeadMinder CRI: [D+ = - 1.4799] vs. ImPACT: [D+ = - 0.6749], p = 0.0004) having significantly different RT-deficit magnitudes. No other moderators produced significantly different RT-deficit magnitudes (between-subject: [p ≥ 0.0763], within-subject: [p ≥ 0.1723]). CONCLUSIONS Robust RT deficits were observed acutely following concussion. Minimal magnitude differences were noted when comparing between- and within-subject effects, suggesting that pre-injury baselines may not add clinical value in determining post-injury RT impairment. RT deficits persisted up till the intermediate-term (21-59 days post-injury) timeframe and indicate lingering deficits exist. Mean effect size differences were observed between RT measure types and computerized neurocognitive testing platforms; however, all categories displayed negative effects consistent with impaired RT following concussion. Clinical interpretation suggests that measuring RT post-concussion is more important than considering the RT method employed so long as reliable and valid tools are used. PROSPERO Registration #CRD42019119323.
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Büttner F, Howell DR, Iverson GL, Doherty C, Blake C, Ryan J, Delahunt E. Participation in pre-injury level sport one-year following sport-related concussion: A prospective, matched cohort study. J Sci Med Sport 2021; 24:561-566. [PMID: 33495041 DOI: 10.1016/j.jsams.2020.12.014] [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: 05/27/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To estimate the times taken to receive clearance to return to sporting activity and to return to pre-injury level of sport competition following sport-related concussion, and to estimate the proportion of athletes who were participating at their pre-injury level of sport competition six months and one-year following sport-related concussion. DESIGN Prospective cohort study. METHODS Amateur, adult athletes (16-38 years old) were diagnosed with sport-related concussion at a university-affiliated hospital emergency department. Participants were assessed within one-week, upon medical clearance to return to sporting activity, two weeks following return to sporting activity, six months, and 12 months following sport-related concussion. We assessed sex-, age-, and activity-matched non-injured, control participants at matched time-points. Participants were asked during each study assessment whether they were participating in any sport, in a different sport than before their sport-related concussion, in the same sport but at a lower level of competition than before their sport-related concussion, or in the same sport at the same level of competition than before their sport-related concussion. RESULTS Fifty concussed participants and 50 non-injured, control participants completed the study. The median times taken to receive clearance to return to sporting activity and to return to pre-injury level of sport competition following sport-related concussion were 13 days (95%CI=12,16) and 31 days (95%CI=28,32), respectively. One-year following sport-related concussion, 52% of participants reported that they were no longer participating in the same sport and at the same level of competition as they were before their sport-related concussion, compared with only 24% of participants in the non-injured, control group (p=0.003). CONCLUSIONS A greater percentage of athletes in the concussion group were not participating at their perceived pre-injury level of sport competition one-year following sport-related concussion compared with a non-injured control group. Factors that explain the lower proportion of amateur athletes participating at their pre-injury level of sport competition one-year after sport-related concussion are likely multifaceted and should be considered in future investigations.
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Walker GA, Seehusen CN, Armento A, Provance AJ, Wilson JC, Howell DR. Family Affluence Relationship to Sports Specialization in Youth Athletes. Clin Pediatr (Phila) 2021; 60:50-55. [PMID: 32781852 DOI: 10.1177/0009922820949699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our objective was to examine the association between participant-reported family affluence and sport specialization level. We conducted a cross-sectional investigation of adolescent athletes. Specifically, participants completed a level of sport specialization (low/moderate/high) questionnaire and the Family Affluence Scale. The majority (52%) of the 195 youth athlete participants reported low, 33% reported moderate, and 15% reported high sport specialization. Sport specialization groups were similar in age (mean = 15.3 ± 1.6 years), proportion of females (49%), and time spent training (mean = 11.9 ± 5.0 hours per week). The high sport specialization group reported significantly greater family affluence than the low sport specialization group (Family Affluence Scale = 10.4 ± 1.7 vs 9.2 ± 1.9; P = .005). After covariate adjustment, higher levels of sport specialization remained significantly associated with greater family affluence (β = 0.48, 95% confidence interval = 0.11-0.86). Understanding the relationship between family affluence and sports specialization affords an opportunity to better identify and monitor populations likely to specialize in a single sport during high school.
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Walker GA, Wilson JC, Potter MN, Provance AJ, Kirkwood M, Howell DR. Age is associated with postural control performance following youth concussion. J Pediatr Rehabil Med 2021; 14:443-450. [PMID: 34219677 DOI: 10.3233/prm-190665] [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: 11/15/2022] Open
Abstract
PURPOSE To examine the effect of age on postural control outcomes among patients being seen during their initial post-concussion clinical visit. METHODS Youth patients were seen≤14 days post-concussion, and completed a series of postural control evaluations: tandem gait, Romberg, and Balance Error Scoring System (BESS) tests. RESULTS We included 109 children 8-12 years of age (24% female, evaluated median = 7 [interquartile range = 4-10] days post-injury) and 353 adolescents aged 13-18 years (36% female, evaluated median = 7 [4-10] days post-injury). There was a higher proportion of children who demonstrated abnormal tandem gait relative to adolescents (26% vs. 11%; p < 0.001). They also made more BESS errors in single (median = 5 [2-10] vs. 4 [2-6] errors) and tandem (median = 3 [1-6] vs. 2 [0-4]) firm stances. After covariate adjustment, children demonstrated worse tandem gait (adjusted odds ratio = 3.05, 95% CI = 1.68-5.53) and more firm surface BESS errors (double stance β=0.51, 95% CI = 0.22-0.80; single stance β= 1.18, 95% CI = 0.42-1.95; tandem stance β= 0.98, 95% CI = 0.28-1.68) than adolescents. CONCLUSIONS Tandem gait and BESS performance following concussion differ in children compared to adolescents who present within 2 weeks of injury. Clinicians assessing and managing concussion should recognize age differences in postural control performance when assessing those with concussion.
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Howell DR, Oldham J, Lanois C, Koerte I, Lin AP, Berkstresser B, Wang F, Meehan WP. Dual-Task Gait Recovery after Concussion among Female and Male Collegiate Athletes. Med Sci Sports Exerc 2020; 52:1015-1021. [PMID: 31985574 DOI: 10.1249/mss.0000000000002225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Few studies have investigated recovery between sexes using objective outcome measures. Our purpose was to examine the independent association between biological sex and recovery of postconcussion gait among collegiate athletes. METHODS We evaluated participants with a diagnosed concussion <7 d postinjury, and approximately 1.5 months and 3.5 months postinjury. Participants completed a single/dual-task gait evaluation and symptom inventory. During dual-task trials, they completed a mental task (backward subtraction, spelling, or month recitation). The primary outcome measure was height-adjusted gait velocity recovery, defined as achieving normal gait velocity using established values: >0.56 and >0.50 gait velocity (m·s)/height (m) under single and dual-task conditions, respectively. We used a multivariable Cox proportional hazard model to identify associations between sex and dual-task recovery, controlling for age, concussion history, symptom severity, and loss of consciousness at the time of injury. RESULTS Ninety-four individuals participated in the study: 47 (50%) were female athletes (mean age = 20.1, SD = 1.3 yr) and 47 (50%) were male athletes (mean age = 20.3, SD = 1.3 yr). Sex was not independently associated with height-adjusted single-task gait velocity recovery after controlling for potential confounders (hazard ratio = 1.62, 95% confidence interval = 0.87-3.01). However, male sex was independently associated with longer dual-task gait recovery time after controlling for potential confounders (hazard ratio = 2.43, 95% confidence interval = 1.11-5.35). CONCLUSION Male athletes required a longer duration of time after concussion to achieve dual-task gait recovery than female athletes. Thus, functional dual-task abilities after concussion may be affected differentially by sex and should be accounted for within individualized concussion management strategies.
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Abstract
After a concussion, a series of complex, overlapping, and disruptive events occur within the brain, leading to symptoms and behavioral dysfunction. These events include ionic shifts, damaged neuronal architecture, higher concentrations of inflammatory chemicals, increased excitatory neurotransmitter release, and cerebral blood flow disruptions, leading to a neuronal crisis. This review summarizes the translational aspects of the pathophysiologic cascade of postconcussion events, focusing on the role of excitatory neurotransmitters and ionic fluxes, and their role in neuronal disruption. We review the relationship between physiologic disruption and behavioral alterations, and proposed treatments aimed to restore the balance of disrupted processes.
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Wingerson MJ, Seehusen CN, Walker G, Wilson JC, Howell DR. Clinical feasibility and utility of a dual-task tandem gait protocol for pediatric concussion management. J Athl Train 2020; 58:446986. [PMID: 33150416 PMCID: PMC10072090 DOI: 10.4085/323-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of post-injury motor performance, has demonstrated clinical utility, but is limited by time availability and test uniformity. OBJECTIVE To assess intrasession reliability between tandem gait test trials and determine the number trials necessary for optimal utility and feasibility in clinical decision-making following concussion. DESIGN Cross-Sectional Study Setting: Pediatric Sport Medicine Clinic Participants: Adolescent athletes who recently sustained a concussion (n=44; age=15.4±1.8 years; 39% female) and were seen for care within 14 days (7.3±3.2 days) of their injury, as well as uninjured control participants (n=73; age=15.8±1.3 years; 41% female). All participants completed three single-task and three dual-task tandem gait trials. OUTCOME MEASURES We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and Intraclass Correlation Coefficients to determine intrasession reliability. We also compared performance between groups, and calculated area under the curve (AUC) values to identify the ability of each trial to distinguish between groups. RESULTS Both the concussion and control group demonstrated high intrasession reliability between tandem gait trials under single (R ≥ 0.82; ICC≥ 0.93) and dual-task conditions (R ≥ 0.79; ICC≥ 0.92). The greatest group classification values were obtained from the second single-task trial (AUC = 0.89) and first dual-task trial (AUC = 0.83). Test completion time provided excellent between-group discrimination in single-task and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC ≤ 0.67). CONCLUSION Tandem gait assessments may only require two trials under single-task and one trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (time requirement) of the test, while maintaining excellent discriminatory ability.
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Provance AJ, Brewer MK, Seehusen CN, Younger BT, Howell DR. Athletic trainer employment, physician access and care delivery in secondary schools. PHYSICIAN SPORTSMED 2020; 48:407-411. [PMID: 31961763 DOI: 10.1080/00913847.2020.1719444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Objective: To evaluate the source of employment of athletic trainers (ATs), access to team physicians, and usage of up-to-date (implementation of the most current international sports medicine societies' position statements and evidence-based literature policy and procedure manuals in secondary schools. Methods: We conducted a cross-sectional study among National Athletic Trainers' Association (NATA) members. NATA 'Research Survey Request' was contacted to obtain 1,000 e-mail addresses of ATs who actively worked in the secondary school setting. We evaluated AT employment, access to team physicians, and usage of up-to-date policy and procedure manuals within different residential areas (urban, suburban, and rural) and school distinctions (public vs. private). Results: Two-hundred ninety-six responses were received (30% response rate). The majority (72%) of ATs reported having an assigned team physician for their school. Approximately one-third (36%) of ATs reported being employed by a hospital, clinic, or outreach facility. Fifty-one percent of ATs reported having a policy and procedure manual that was developed and reviewed with their team physician. There was a significantly greater amount of suburban ATs who reported having an up-to-date policy and procedure manual (urban 45% vs. suburban 60% vs. rural 39%; p = 0.007). Significantly more ATs who were employed in a public school setting reported conducting annual policy and procedure manual reviews than those employed in private school settings (public 63% vs. private 49%; p = 0.045). Conclusions: The majority of ATs have assigned team physicians and a third is employed by a medical group. A high number of ATs reported not having a policy and procedure manual that was developed and reviewed with their team physician. Sports medicine teams within secondary schools, particularly in private schools, should strive to develop and maintain an up-to-date policy and procedure manual that is frequently reviewed with their team physician.
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Parikh HB, Gagliardi AG, Howell DR, Albright JC, Mandler TN. Femoral nerve catheters and limb strength asymmetry at 6 months after primary anterior cruciate ligament reconstruction in pediatric patients. Paediatr Anaesth 2020; 30:1109-1115. [PMID: 32735731 DOI: 10.1111/pan.13983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The postoperative implications of single-injection femoral nerve blockade and femoral nerve catheter placement for anterior cruciate ligament reconstruction are not well defined among pediatric patients. Femoral nerve blockade may be associated with deficits in quadriceps symmetry at 6 months postoperative. AIMS We compared outcomes after primary anterior cruciate ligament reconstruction surgery in pediatric patients who received either a single-injection femoral nerve block or femoral nerve catheter and a single-injection popliteal nerve block. METHODS We conducted a retrospective chart review of patients 10-19 years of age who underwent anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft by a single orthopedic surgeon at two of our locations. Of 88 patients analyzed, 31 received single-injection femoral nerve blockade (52% female, mean age = 15.6 ± 1.8 years) and 57 received femoral nerve catheter (53% female, mean age = 15.6 ± 1.7 years). Time from surgery to return-to-sport clearance and movement symmetry were compared between groups at approximately 6 months postoperatively. RESULTS The single-injection femoral nerve blockade group exhibited significantly greater single-leg squat symmetry than did the femoral nerve catheter group (95.5 ± 6.7% vs 88.3 ± 9.3%; P = 0.02; mean difference = 7.2%, 95% CI = -1.1, 13.3) 6 months postoperatively. There was no difference in time from surgery to return-to-sport clearance between groups (median = 247 [interquartile range = 218-295] days vs 268 [241-331] days; P = 0.22; mean difference = 40 days; 95% CI = -23, 102). CONCLUSION Though time to return to sport did not differ, patients in the femoral nerve catheter group exhibited greater single-leg squat asymmetry than did those in the femoral nerve blockade group approximately 6 months postoperatively. Persistent functional deficits may be important to consider when treating pediatric patients undergoing anterior cruciate ligament reconstruction.
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Mannix R, Levy R, Zemek R, Yeates KO, Arbogast K, Meehan WP, Leddy J, Master C, Mayer AR, Howell DR, Meier TB. Fluid Biomarkers of Pediatric Mild Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2020; 37:2029-2044. [DOI: 10.1089/neu.2019.6956] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Meyers RN, Howell DR, Provance AJ. The Association of Finger Growth Plate Injury History and Speed Climbing in Youth Competition Climbers. Wilderness Environ Med 2020; 31:394-399. [PMID: 32981830 DOI: 10.1016/j.wem.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Finger growth plate injuries are the most common injury among youth climbers, and the association between these injuries and speed climbing, a mandatory discipline in the 2021 Olympics, has not been examined previously. Our primary purpose was to examine the demographic and training characteristics of adolescent competition climbers who reported a history of a finger growth plate injury compared to those who did not report a history of a finger growth plate injury. Our secondary purpose was to determine whether training characteristics differed between adolescent competition climbers who did and did not report speed climbing. METHODS Our study was a cross-sectional study design. We surveyed adolescent climbers who competed in the 2017 USA Climbing Sport and Speed Youth National Championships. Questions assessed climbing injury history and current rock-climbing training characteristics. RESULTS Two-hundred sixty-seven adolescent competition climbers, 14±3 (9-18) y of age (mean±SD with range), completed the survey. Those with a history of a finger growth plate injury reported greater approximate time spent speed climbing throughout the year (β=1.28, 95% CI 0.11-2.46, P=0.032) and training regularly on the International Federation of Sport Climbing speed wall (adjusted odds ratio=3.95, 95% CI 1.14-13.7, P=0.031). CONCLUSIONS Training regularly at practices on the speed wall was associated with a self-reported history of finger growth plate injuries among elite youth competition climbers. Speed climbing should be limited, especially during periods of rapid growth.
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Hänninen T, Parkkari J, Howell DR, Palola V, Seppänen A, Tuominen M, Iverson GL, Luoto TM. Reliability of the Sport Concussion Assessment Tool 5 baseline testing: A 2-week test-retest study. J Sci Med Sport 2020; 24:129-134. [PMID: 32868203 DOI: 10.1016/j.jsams.2020.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/17/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine short-term test-retest reliability of the Sport Concussion Assessment Tool 5 (SCAT5). DESIGN Longitudinal study. METHODS Sixty-two professional male ice hockey players (mean age=22.5, SD=3.2) completed a preseason baseline test twice over a two-week interval. Half of the players were tested by the same assessor on both testing sessions. Spearman's correlations (rs) were used to determine linear agreements, and Wilcoxon signed rank tests (sig r) were used to determine mean differences, between testing sessions. RESULTS Symptoms had high test-retest reliability (Score: rs=0.85, p<0.001, sig r p<0.001; Severity: rs=0.84, p<0.001, sig r p<0.001). The reliability coefficients for the SAC (rs=0.58, p<0.001, sig r: p=0.412), and mBESS (rs=0.40, p=0.001, sig r: p=0.607) were considerably lower than symptoms. More than half (52%) of the athletes reported at least one baseline symptom (Md=1, M=2.2, SD=3.3). The most commonly reported symptoms were fatigue or low energy and neck pain. The broad ranges of SAC total scores (range=28-45, Md=35, M=35.4, SD=4.2) and SAC test-retest change scores (range -7 to +11) were mostly due to variability on the memory performance, tested using 10-item word lists. The number of mBESS single leg stance errors (Md=1, Md 3.2, SD=4.0) was greater than Tandem stance errors (Md=0, Md=2.0, SD=3.6). CONCLUSIONS The two-week test-retest reliability of the SCAT5 baseline scores varied from moderate to high. However, there was considerable individual variability on the SAC and mBESS scores and most players have notable short-term fluctuation on performance even if uninjured. Recommendations for interpreting change on the SCAT5 are provided.
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Gagliardi AG, Walker GA, Dahab KS, Seehusen CN, Provance AJ, Albright JC, Howell DR. Sports participation volume and psychosocial outcomes among healthy high school athletes. J Clin Transl Res 2020; 6:54-60. [PMID: 33263090 PMCID: PMC7700768] [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: 06/01/2020] [Revised: 06/25/2020] [Accepted: 07/09/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We assessed the association between hours/week of sports participation and psychosocial outcomes among high school athletes. We hypothesized that more hours of participation would be associated with the lower levels of anxiety and depressive symptoms. METHODS Participants completed the Patient-reported Outcomes Measurement Information System (PROMIS) Pediatric Profile 25 quality of life and other questionnaires to assess sports participation, socioeconomic status, and health history. We evaluated the multivariable relationship between hours/week in sport and PROMIS scores while adjusting for the independent effect of age and varsity team status. RESULTS A total of 230 high school athletes participated in this study (mean=15.4±1.2 years of age). More hours/week playing sports were significantly associated with the lower levels of depressive symptoms (coefficient=-0.073, 95% CI=-0.137, -0.010; P=0.02). Sports participation was not significantly associated with any other psychosocial domain scores on the PROMIS questionnaire. CONCLUSION More hours of sports participation were significantly associated with the lower depressive symptoms, but no other psychosocial domain. While our findings are cross-sectional, sport participation may play a role in attenuating symptoms of depression in high school athletes. RELEVANCE FOR PATIENTS Sports participation may play a beneficial role in lessening depressive symptoms among healthy high school students.
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Wilson JC, Seehusen C, Coonan D, Cuddeback T, Walker G, Howell DR. The Relationship Of Subjective And Objective Sleep Measures In Pediatric Concussion. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000683820.89407.0a] [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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92
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Sweeney EA, Potter MN, Pimental RE, Carollo JJ, Howell DR. Spinal Range Of Motion And Back Pain In Female Artistic Adolescent Gymnasts. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675600.09866.2e] [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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93
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Daley M, Oldham J, Lanois C, Howell DR, Mannix R, Sartanowicz D, Meehan WP. Psychotropic Medication Use And Concussion History Among Adolescent Athletes. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000681352.36944.1a] [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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Reinking SE, Wilson JC, Walker GC, Seehusen C, Howell DR. Fear Of Re-injury Correlates With Concussion Symptoms And Reaction Time Among Adolescents With Concussion. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000685924.81808.d6] [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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Howell DR, Hunt D, Aaron SE, Taylor JA, Meehan WP, Tan CO. Symptom And Physiological Response To Exercise Following Concussion. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675284.01951.be] [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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96
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Aaron SE, Howell DR, Ozturk ED, Daniels R, Hunt D, Hamner JW, Taylor JA, Meehan WP, Tan CO. Acute Adolescent Concussion: Cerebrovascular Reactivity, Symptom Burden, And Exercise Response. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000670096.16706.f8] [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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97
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Seehusen CN, Wilson JC, Walker GA, Reinking SE, Howell DR. Quantifying Physical Activity After Concussion: The Relationship Between Sleep Quality, Symptoms, And Steps. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678784.72051.30] [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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98
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Van Deventer KA, Seehusen CN, Walker GA, Wilson JC, Howell DR. The Diagnostic And Prognostic Utility Of Dual-task Tandem Gait For Pediatric Concussion. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000683792.65038.bb] [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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99
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Koerte IK, Schultz V, Sydnor VJ, Howell DR, Guenette JP, Dennis E, Kochsiek J, Kaufmann D, Sollmann N, Mondello S, Shenton ME, Lin AP. Sex-Related Differences in the Effects of Sports-Related Concussion: A Review. J Neuroimaging 2020; 30:387-409. [PMID: 32533752 PMCID: PMC8221087 DOI: 10.1111/jon.12726] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/30/2020] [Indexed: 01/11/2023] Open
Abstract
Sports-related concussion is a serious health challenge, and females are at higher risk of sustaining a sports-related concussion compared to males. Although there are many studies that investigate outcomes following concussion, females remain an understudied population, despite representing a large proportion of the organized sports community. In this review, we provide a summary of studies that investigate sex-related differences in outcome following sports-related concussion. Moreover, we provide an introduction to the methods used to study sex-related differences after sports-related concussion, including common clinical and cognitive measures, neuroimaging techniques, as well as biomarkers. A literature search inclusive of articles published to March 2020 was performed using PubMed. The studies were reviewed and discussed with regard to the methods used. Findings from these studies remain mixed with regard to the effect of sex on clinical symptoms, concussion-related alterations in brain structure and function, and recovery trajectories. Nonetheless, there is initial evidence to suggest that sex-related differences following concussion are important to consider in efforts to develop objective biomarkers for the diagnosis and prognosis of concussion. Additional studies on this topic are, however, clearly needed to improve our understanding of sex-related differences following concussion, as well as to understand their neurobiological underpinnings. Such studies will help pave the way toward more personalized clinical management and treatment of sports-related concussion.
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Pimentel R, Potter MN, Carollo JJ, Howell DR, Sweeney EA. Peak sagittal plane spine kinematics in female gymnasts with and without a history of low back pain. Clin Biomech (Bristol, Avon) 2020; 76:105019. [PMID: 32402899 DOI: 10.1016/j.clinbiomech.2020.105019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/16/2020] [Accepted: 04/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Female gymnasts have a greater prevalence of back pain compared to other female athletes. There is little evidence that female artistic gymnasts with and without back pain demonstrate different movement patterns during gymnastics skills. The purpose of this study was to determine if there were differences in back movements during back walkovers and back handsprings among female artistic gymnasts. METHODS Female artistic gymnasts (8-18 years old) with and without back pain wore inertial sensors on their torso, arms, and legs while performing back walkovers (N = 14) and back handsprings (N = 15) on the floor and balance beam at their training gymnastics facilities. FINDINGS Gymnasts with back pain had similar spine peak extension, peak flexion, and range of motion during back walkovers and back handsprings compared to gymnasts without back pain. Additionally, no differences in sagittal plane spine kinematics were found between the groups at any specific time point during either the back walkover or back handspring skills. However, a large portion of the data collected was excluded during quality assurance, thus our final sample sizes are small. INTERPRETATION These findings suggest that gymnasts with back pain have similar sagittal plane movements to those without back pain. The relationship between back pain and gymnastics training load/intensity is currently unclear. We suggest future studies to investigate common artistic gymnastics skills and back pain prevalence with more participants, full-body motion analysis with kinetic measurement capabilities, and longitudinally for those demonstrating back pain.
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