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Huang Q, Mao X, Shi J, Pan J, Li A. Enhanced Cognitive Inhibition in Table Tennis Athletes: Insights from Color-Word and Spatial Stroop Tasks. Brain Sci 2024; 14:443. [PMID: 38790422 PMCID: PMC11117886 DOI: 10.3390/brainsci14050443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
The ability to inhibit conflicting information is pivotal in the dynamic and high-speed context of fast-ball sports. However, the behavioral and electrophysiological characteristics underlying the cognitive inhibition processes associated with table tennis expertise remain unexplored. This study aims to bridge these research gaps by utilizing the color-word Stroop task and the spatial Stroop task alongside event-related potential (ERP) measurements to investigate domain-general and domain-specific cognitive inhibition among table tennis athletes. The study involved a total of 40 participants, including 20 table tennis athletes (11 males and 9 females; mean age 20.75 years) and 20 nonathletes (9 males and 11 females; mean age 19.80 years). The group differences in the Stroop effect on behavioral outcomes and ERP amplitudes were compared within each task, respectively. In the color-word Stroop tasks, athletes exhibited smaller incongruent-related negative potential amplitudes (Ninc; 300-400 ms; p = 0.036) and a diminished Stroop effect on late sustained potential amplitudes (LSP; 500-650 ms; p = 0.028) than nonathletes, although no significant differences were observed in behavioral outcomes (p > 0.05). Conversely, in the spatial Stroop tasks, athletes not only responded more swiftly but also exhibited reduced Stroop effects on both LSP amplitudes (350-500 ms; p = 0.004) and reaction times (p = 0.002) relative to nonathletes. These findings suggest that table tennis athletes excel in cognitive inhibition in the context of both domain-general and domain-specific tasks, particularly exhibiting enhanced performance in tasks that are closely aligned with the demands of their sport. Our results support the neural efficiency hypothesis and improve our understanding of the interactions between cognitive functions and table tennis expertise.
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Affiliation(s)
- Qin Huang
- School of Psychology, Shanghai University of Sport, Shanghai 200438, China; (Q.H.); (X.M.); (J.S.); (J.P.)
- Center for Exercise and Brain Science, Shanghai University of Sport, Shanghai 200438, China
| | - Xuechen Mao
- School of Psychology, Shanghai University of Sport, Shanghai 200438, China; (Q.H.); (X.M.); (J.S.); (J.P.)
- Center for Exercise and Brain Science, Shanghai University of Sport, Shanghai 200438, China
| | - Jilong Shi
- School of Psychology, Shanghai University of Sport, Shanghai 200438, China; (Q.H.); (X.M.); (J.S.); (J.P.)
- Center for Exercise and Brain Science, Shanghai University of Sport, Shanghai 200438, China
| | - Jun Pan
- School of Psychology, Shanghai University of Sport, Shanghai 200438, China; (Q.H.); (X.M.); (J.S.); (J.P.)
- Center for Exercise and Brain Science, Shanghai University of Sport, Shanghai 200438, China
| | - Anmin Li
- School of Psychology, Shanghai University of Sport, Shanghai 200438, China; (Q.H.); (X.M.); (J.S.); (J.P.)
- Center for Exercise and Brain Science, Shanghai University of Sport, Shanghai 200438, China
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Imanaka K, Sugi T, Nakamoto H. Relationships between the magnitude of representational momentum and the spatial and temporal anticipatory judgments of opponent's kicks in taekwondo. Front Psychol 2023; 14:1193116. [PMID: 37809301 PMCID: PMC10551154 DOI: 10.3389/fpsyg.2023.1193116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
For successful actions in a fast, dynamic environment such as sports, a quick successful anticipation of a forthcoming environmental state is essential. However, the perceptual mechanisms involved in successful anticipation are not fully understood. This study examined the relationships between the magnitude of representational momentum (RM) as a forward displacement of the memory representation of the final position of a moving object (which implies that observers perceptually "see" a near future forthcoming dynamic environmental state) and the temporal and spatial anticipatory judgments of the opponent's high or middle kicks in taekwondo. Twenty-seven participants (university taekwondo club members and non-members) observed video clips of taekwondo kicks that vanished at one of 10 frame positions prior to the kick impact and performed three tasks consecutively: anticipatory coincidence timing (CT) with the arrival of kick impact, judgment of the kick type (high and middle kicks) by forced choice, and judgment of the vanishing frame position (measuring RM). Our results showed significant group effects for the number of correct kick-type judgments and the judgment threshold for kick-type choice (kick-typeJT), which was estimated in terms of individual psychometric function curves. A significant correlation was found between the magnitude of RM (estimated at kick-typeJT) and kick-typeJT, but not between the CT errors (estimated at kick-typeJT) and kick-typeJT. This indicates that the magnitude of RM may play an influential role in quick kick-type judgments, but not in coincidence timing while observing an opponent's kick motion. These findings suggest that subjective anticipatory perception or judgment of the future spatial state is vital to anticipatory actions under severe time constraints.
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Affiliation(s)
- Kuniyasu Imanaka
- Department of Health Promotion Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Takahiro Sugi
- Graduate School of Humanities [Psychology], Tokyo Metropolitan University, Tokyo, Japan
| | - Hiroki Nakamoto
- Faculty of Physical Education, National Institute of Fitness and Sports in Kanoya, Kagoshima, Japan
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Topical Review: Perceptual-cognitive Skills, Methods, and Skill-based Comparisons in Interceptive Sports. Optom Vis Sci 2021; 98:681-695. [PMID: 34328450 DOI: 10.1097/opx.0000000000001727] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE We give a comprehensive picture of perceptual-cognitive (PC) skills that could contribute to performance in interceptive sports. Both visual skills that are low level and unlikely influenced by experience and higher-level cognitive-attentional skills are considered, informing practitioners for identification and training and alerting researchers to gaps in the literature.Perceptual-cognitive skills and abilities are keys to success in interceptive sports. The interest in identifying which skills and abilities underpin success and hence should be selected and developed is likely going to grow as technologies for skill testing and training continue to advance. Many different methods and measures have been applied to the study of PC skills in the research laboratory and in the field, and research findings across studies have often been inconsistent. In this article, we provide definitional clarity regarding whether a skill is primarily visual attentional (ranging from fundamental/low-level skills to high-level skills) or cognitive. We review those skills that have been studied using sport-specific stimuli or tests, such as postural cue anticipation in baseball, as well as those that are mostly devoid of sport context, considered general skills, such as dynamic visual acuity. In addition to detailing the PC skills and associated methods, we provide an accompanying table of published research since 1995, highlighting studies (for various skills and sports) that have and have not differentiated across skill groups.
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Online Movement Correction in Response to the Unexpectedly Perturbed Initial or Final Action Goals: An ERP and sLORETA Study. Brain Sci 2021; 11:brainsci11050641. [PMID: 34063437 PMCID: PMC8156469 DOI: 10.3390/brainsci11050641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/27/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
In this experiment, we explored how unexpected perturbations in the initial (grip posture) and the final action goals (target position) influence movement execution and the neural mechanisms underlying the movement corrections. Participants were instructed to grasp a handle and rotate it to a target position according to a given visual cue. After participants started their movements, a secondary cue was triggered, which indicated whether the initial or final goals had changed (or not) while the electroencephalogram (EEG) was recorded. The results showed that the perturbed initial goals significantly slowed down the reaching action, compared to the perturbed final goals. In the event-related potentials (ERPs), a larger anterior P3 and a larger central-distributed late positivity (600–700 ms) time-locked to the perturbations were found for the initial than for the final goal perturbations. Source analyses found stronger left middle frontal gyrus (MFG) activations for the perturbed initial goals than for the perturbed final goals in the P3 time window. These findings suggest that perturbations in the initial goals have stronger interferences with the execution of grasp-to-rotate movements than perturbations in the final goals. The interferences seem to be derived from both inappropriate action inhibitions and new action implementations during the movement correction.
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Nasu D, Yamaguchi M, Kobayashi A, Saijo N, Kashino M, Kimura T. Behavioral Measures in a Cognitive-Motor Batting Task Explain Real Game Performance of Top Athletes. Front Sports Act Living 2020; 2:55. [PMID: 33345046 PMCID: PMC7739838 DOI: 10.3389/fspor.2020.00055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
Excellent athletic performance in baseball and softball batting is achieved through the momentary cognitive-motor processes. However, in previous studies, cognitive and motor processes are investigated separately. In this study, we focused on the difference in the time of swing onset (a delta onset) during a batting task where 17 elite female softball batters hit balls randomly thrown at two different speeds by pitchers. The delta onset included both cognitive and motor processes because the batters needed to anticipate the ball speed and discriminate their swing motion according to the time-to-contact. Then, we investigated the relationship between the delta onset and the batting outcomes of the batting task, and the relationship between the experimental outcomes and actual batting performance (batting average) over a season. We used path analysis to clarify the structure of the cognitive-motor processes and consequent performance. We found that the batters who had a larger delta onset attained superior batting outcomes (i.e., higher exit velocity and lower miss ratio) in the batting task, and these experimental outcomes explained 67% of the batting average in real games. On the other hand, the cognitive scores (judgement accuracy and rapidity) obtained from a button pressing task, where batters responded to a ball by pressing a button instead of actually swinging, explained only 34% of the batting average. Therefore, our model quantitatively describes the key cognitive-motor structure for athletes and can partially predict a batter's performance in real games. These findings suggest that it is important to employ both cognitive and motor processes in performing tasks, such as this batting task, to properly evaluate a batter's actual ability.
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Affiliation(s)
- Daiki Nasu
- NTT Communication Science Laboratories, Nippon Telegraph and Telephone Corporation, Kanagawa, Japan
| | - Masumi Yamaguchi
- NTT Communication Science Laboratories, Nippon Telegraph and Telephone Corporation, Kanagawa, Japan
| | - Akemi Kobayashi
- NTT Communication Science Laboratories, Nippon Telegraph and Telephone Corporation, Kanagawa, Japan
| | - Naoki Saijo
- NTT Communication Science Laboratories, Nippon Telegraph and Telephone Corporation, Kanagawa, Japan
| | - Makio Kashino
- NTT Communication Science Laboratories, Nippon Telegraph and Telephone Corporation, Kanagawa, Japan
| | - Toshitaka Kimura
- NTT Communication Science Laboratories, Nippon Telegraph and Telephone Corporation, Kanagawa, Japan
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Sato D, Yamazaki Y, Yamashiro K, Onishi H, Baba Y, Ikarashi K, Maruyama A. Elite competitive swimmers exhibit higher motor cortical inhibition and superior sensorimotor skills in a water environment. Behav Brain Res 2020; 395:112835. [PMID: 32750463 DOI: 10.1016/j.bbr.2020.112835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/11/2020] [Accepted: 07/23/2020] [Indexed: 01/24/2023]
Abstract
Motor skill learning leads to task-related contextual behavioral changes that are underpinned by neuroplastic cortical reorganization. Short-term training induces environment-related contextual behavioral changes and neuroplastic changes in the primary motor cortex (M1). However, it is unclear whether environment-related contextual behavioral changes persist after long-term training and how cortical plastic changes are involved in behavior. To address these issues, we examined 14 elite competitive swimmers and 14 novices. We hypothesized that the sensorimotor skills of swimmers would be higher in a water environment than those of novices, and the recruitment of corticospinal and intracortical projections would be different between swimmers and novices. We assessed joint angle modulation performance as a behavioral measure and motor cortical excitation and inhibition using transcranial magnetic stimulation (TMS) at rest and during the tasks that were performed before, during, and after water immersion (WI). Motor cortical inhibition was measured with short-interval intracortical inhibition and long-interval intracortical inhibition by a paired-pulse TMS paradigm. We found that 1) the sensorimotor skills of swimmers who underwent long-term training in a water environment were superior and robustly unchanged compared with those of novices with respect to baseline on land, during WI, on land post-WI and 2) intracortical inhibition in water environments was increased in swimmers but was decreased in non-swimmers at rest compared to that on land; however, the latter alterations in intracortical inhibition in water environment were insufficient to account for the superior sensorimotor skills of swimmers. In conclusion, we demonstrate that environment-related contextual behavioral and neural changes occur even with long-term training experience.
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Affiliation(s)
- Daisuke Sato
- Department of Health and Sports, Niigata University of Health and Welfare, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Japan.
| | - Yudai Yamazaki
- Research Fellow of Japan Society for the Promotion of Science, Japan; Laboratory of Exercise Biochemistry and Neuroendocrinology, Faculty of Health and Sport Sciences, University of Tsukuba, Japan; Sports Neuroscience Division, Advanced Research Initiative for Human High Performance (ARIHHP), Faculty of Health and Sport Sciences, University of Tsukuba, Japan
| | - Koya Yamashiro
- Department of Health and Sports, Niigata University of Health and Welfare, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Japan
| | - Yasuhiro Baba
- Department of Health and Sports, Niigata University of Health and Welfare, Japan
| | - Koyuki Ikarashi
- Field of Health and Sports, Graduate School of Niigata University of Health and Welfare, Japan
| | - Atsuo Maruyama
- Department of Rehabilitation Medicine, Kagoshima University, Japan
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Yu M, Liu Y. Differences in executive function of the attention network between athletes from interceptive and strategic sports. J Mot Behav 2020; 53:419-430. [PMID: 32654658 DOI: 10.1080/00222895.2020.1790486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The differences in the executive attention network and the related blood oxygen characteristics of the right frontal-parietal network brain area between athletes from interceptive and strategic sport were investigated. Strategic athletes had higher accuracy and longer reaction time (RT) compared with interceptive sports athletes, lower flanker conflict effects on accuracy compared to the other two group. It was accompanied by significant activation of the rdLPFC and the rIFG. Strategic athletes had higher flanker conflict effects on RT compared with interception athletes under the invalid cue condition, which was accompanied by significant activation of the right IFG. The strategic athletes complete the task under the condition of invalid clues indicating top-down control, and which is closely related to the activation of the right frontal-parietal network.
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Affiliation(s)
- Miao Yu
- Jilin Sport University, Changchun, China
| | - Yibing Liu
- Jilin Sport University, Changchun, China
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Tochikura I, Sato D, Imoto D, Nuruki A, Yamashiro K, Funada R, Maruyama A. Baseball Players' Eye Movements and Higher Coincident-Timing Task Performance. Percept Mot Skills 2020; 127:571-586. [PMID: 32075492 DOI: 10.1177/0031512520905435] [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: 11/17/2022]
Abstract
Previous studies have reported that baseball players have higher than average visual information processing abilities and outstanding motor control. The speed and position of the baseball and the batter are constantly changing, leading skilled players to acquire highly accurate visual information processing and decision-making. This study sought to clarify how movement of the eyes is associated with baseball players’ higher coincident-timing task performance. We recruited 15 right-handed baseball players and 15 age-matched track and field athletes. On a computer-based coincident-timing task, we instructed participants to stop a computer image of a moving target by pressing a button at a designated point. We presented bidirectional moving targets with various velocities, presented in a random order. The targets’ moving angular velocity varied between 100, 83, 71, 63, 56, 50, and 46 deg/s. We conducted 168 repetitions (42 reps × 4 sets) of this coincident-timing task and measured participants’ eye movements during the task using Pupil Centre Corneal Reflection. Mixed-design analysis of variance results revealed participant group effects in favor of baseball players for timing absolute error and low absolute error, as predicted from prior visual processing and decision-making research with baseball players. However, in contrast to prior research, we found significantly shorter smooth-pursuit onset latency in elite baseball players, and there were no significant group differences for saccade onset and offset latencies. This may be explained by the difference in our research paradigm with mobile targets randomly presented at various velocities from the left and right. Our data showed baseball players’ higher than normal simultaneous timing execution for making decisions and movements based on visual information, even under laboratory conditions with randomly moving mobile targets.
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Affiliation(s)
- Ikumi Tochikura
- Field of Health and Sports, Graduate School, Niigata University of Health and Welfare, Kita-Ku, Niigata, Japan
| | - Daisuke Sato
- Department of Health and Sports, Niigata University of Health and Welfare, Kita-Ku, Niigata, Japan.,Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Kita-Ku, Niigata, Japan
| | | | - Atsuo Nuruki
- Center for General Education, Institute for Comprehensive Education, Kagoshima University, Kourimoto, Japan
| | - Koya Yamashiro
- Department of Health and Sports, Niigata University of Health and Welfare, Kita-Ku, Niigata, Japan.,Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Kita-Ku, Niigata, Japan
| | - Ren Funada
- Department of Health and Sports, Niigata University of Health and Welfare, Kita-Ku, Niigata, Japan
| | - Atsuo Maruyama
- Rehabilitation and Physical Medicine, Kagoshima University, Sakuragaoka, Japan
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Meng FW, Yao ZF, Chang EC, Chen YL. Team sport expertise shows superior stimulus-driven visual attention and motor inhibition. PLoS One 2019; 14:e0217056. [PMID: 31091297 PMCID: PMC6519903 DOI: 10.1371/journal.pone.0217056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/03/2019] [Indexed: 01/09/2023] Open
Abstract
Previous studies on athletes' cognitive functions have reported superior performance on tasks measuring attention and sensorimotor abilities. However, how types of sports training shapes cognitive profile remains to be further explored. In this study, we recruited elite athletes specialized in badminton (N = 35, female = 12) and volleyball (N = 29, female = 13), as well as healthy adult controls (N = 27, female = 17) who had not receive any regular sports training. All participants completed cognitive assessments on spatial attention, sensory memory, cognitive flexibility, motor inhibition, and the attention networks. The results showed that athletes generally showed superior performance on selective cognitive domains compared to healthy controls. Specifically, compared to the healthy control, volleyball players showed superior on iconic memory, inhibitory control of action, and attentional alerting, whereas badminton players showed advantages on iconic memory and basic processing speed. Overall, volleyball players outperformed badminton players on those tasks require stimulus-driven visual attention and motor inhibition, likely due to different training modalities and characteristics of specialty that involves even more complex cognitive processes. To conclude, our findings suggest cognitive plasticity may drive by sports training in team/individual sports expertise, manifesting cognitive profile in sport expertise with distinct training modalities.
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Affiliation(s)
- Fan-Wu Meng
- Graduate Institute of Sports Training, University of Taipei, Taipei, Taiwan
- Office of Physical Education, Chung Yuan Christian University, Taoyuan City, Taiwan
| | - Zai-Fu Yao
- Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Chihhung Chang
- Institute of Cognitive Neuroscience, National Central University, Taoyuan City, Taiwan
| | - Yi-Liang Chen
- Graduate Institute of Sports Training, University of Taipei, Taipei, Taiwan
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Wasserman EB, Abar B, Shah MN, Wasserman D, Bazarian JJ. Concussions are associated with decreased batting performance among Major League Baseball players. Am J Sports Med 2015; 43:1127-33. [PMID: 25784627 DOI: 10.1177/0363546515576130] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concussions impair balance, visual acuity, and reaction time--all of which are required for high-level batting performance--but the effects of concussion on batting performance have not been reported. The authors examined this relationship between concussion and batting performance among Major League Baseball (MLB) players. HYPOTHESIS Batting performance among concussed MLB players will be worse upon return to play than batting performance among players missing time for noninjury reasons. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors identified MLB players who sustained a concussion between 2007 and 2013 through league disabled-list records and a Baseball Prospectus database. For a comparison group, they identified players who went on paternity or bereavement leave during the same period. Using repeated-measures generalized linear models, the authors compared 7 batting metrics between the 2 groups for the 2 weeks upon return, as well as 4 to 6 weeks after return, controlling for pre-leave batting metrics, number of days missed, and position. RESULTS The authors identified 66 concussions and 68 episodes of bereavement/paternity leave to include in the analysis. In the 2 weeks after return, batting average (.235 vs .266), on-base percentage (.294 vs .326), slugging percentage (.361 vs .423), and on-base plus slugging (.650 vs .749) were significantly lower among concussed players relative to the bereavement/paternity leave players (time×group interaction, P<.05). In weeks 4 to 6 after leave, these metrics were slightly lower in concussed players but not statistically significantly so. CONCLUSION Although concussed players may be asymptomatic upon return to play, the residual effects of concussion on the skills required for batting may still be present. Further work is needed to clarify the mechanism through which batting performance after concussion is adversely affected and to identify better measures to use for return-to-play decisions.
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Affiliation(s)
- Erin B Wasserman
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Beau Abar
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Manish N Shah
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Division of Geriatrics, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Daniel Wasserman
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Division of Geriatrics, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Physical Medicine & Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USAD.W. performed this work on his own time independent of any affiliation.Investigation performed at the University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jeffrey J Bazarian
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Physical Medicine & Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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