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Halmai B, Holsgrove TP, Vine SJ, Harris DJ, Williams GKR. The after-effects of occupational whole-body vibration on human cognitive, visual, and motor function: A systematic review. APPLIED ERGONOMICS 2024; 118:104264. [PMID: 38565009 DOI: 10.1016/j.apergo.2024.104264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 03/03/2024] [Indexed: 04/04/2024]
Abstract
Whole-body vibration (WBV) is prevalent in labour-related activities and can have adverse effects on the health and performance of the individuals exposed. However, evidence regarding the extent to which human functionality is affected following occupational WBV exposure has not been collated. The current systematic review sought to synthesize existing literature and assess the strength and direction of evidence regarding the acute after-effects of occupational WBV exposure on cognition, visual function, postural stability, and motor control. We conducted a comprehensive search of AMED, CINAHL, MEDLINE, PubMED, Psychology and Behavioural Sciences Collection, SPORTDiscus, APA PsychInfo, Cochrane Library, EMBASE, HMIC, Global Health, ProQuest Central, Scopus, Web of Science, and the US National Technical Information Service on April 26, 2023. Studies that quantified vibration exposure and measured acute changes in cognition, visual function, postural stability, and motor control from baseline to post-vibration were considered without date restriction. Out of the 2663 studies identified, 32 were eligible for inclusion. Based on the Risk of Bias in Non-Randomized Studies of Exposure (ROBINS-E) tool, the studies demonstrated low (66%), moderate (25%) and high risk of bias (9%). The findings indicate that after exposure to WBV, postural stability either deteriorates or remains unchanged. Inconsistent effects of WBV on cognition were reported, while visual function and motor control showed no pronounced changes following WBV. This might be attributed to assessment limitations such as learning effects in neuropsychological and motor tasks, and non-functional measures of vision employed. There was a lack of consistency in the characterization of vibration exposure and the assessment of associated effects on functional performance. Current evidence is therefore insufficient to provide definitive guidance for updating occupational health and safety regulations regarding WBV. However, this review highlights the potential for WBV to jeopardize post-exposure human performance and, consequently, safety. The completion of the review was supported by a UKRI EPSRC training grant. The review has been registered on PROSPERO (ref CRD42023391075).
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Affiliation(s)
- Barbara Halmai
- University of Exeter, Public Health and Sport Sciences, St Luke's Campus, Exeter, EX1 2LU, UK.
| | | | - Samuel J Vine
- University of Exeter, Public Health and Sport Sciences, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - David J Harris
- University of Exeter, Public Health and Sport Sciences, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Genevieve K R Williams
- University of Exeter, Public Health and Sport Sciences, St Luke's Campus, Exeter, EX1 2LU, UK.
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2
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Panzera JC, Podolak OE, Master CL. Contemporary diagnosis and management of mild TBI (concussions): What you need to know. J Trauma Acute Care Surg 2024; 96:865-869. [PMID: 38696496 DOI: 10.1097/ta.0000000000004297] [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: 05/04/2024]
Abstract
ABSTRACT Concussion is a common injury in children and adolescents and is a form of mild traumatic brain injury that surgeons will see in their acute care practice. With a rapidly changing evidence base for diagnosis and management, we will focus on the importance of timely identification and diagnosis, as well as the early initiation of active management of pediatric concussion immediately after injury through recovery. This approach involves the application of targeted therapies for specific deficits identified after concussion, addressing the individual pattern of symptoms experienced by patients following concussion. We will review what is known about the underlying pathophysiology that drives the clinical manifestations of concussion, the targeted clinical assessments that can both aid in the diagnosis of concussion, as well as drive the active rehabilitation of deficits seen after concussion. The standardized approach to the return to activities will also be described, including return to learning and sports.
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Affiliation(s)
- Joseph C Panzera
- From the Sports Medicine and Performance Center, (J.C.P.); Center for Injury Research and Prevention (O.E.P.); and Sports Medicine and Performance Center, Center for Injury Research and Prevention (C.L.M.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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3
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Mitchell KM, Dalton KN, Cinelli ME. A treadmill running research protocol to assess dynamic visual acuity and balance for athletes with and without recent concussion history. BMC Sports Sci Med Rehabil 2024; 16:112. [PMID: 38760838 PMCID: PMC11101338 DOI: 10.1186/s13102-024-00900-x] [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: 02/20/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024]
Abstract
Athletes interpret dynamic visual scenes quickly and accurately during physical exertion. It is important to understand how increased exertion may impact vision and cognition following sport-related concussion (SRC).Purpose To examine the effect of a treadmill running research protocol on the assessment of dynamic visual acuity (DVA) and balance for athletes with and without recent history of SRC.Methods Varsity athletes following recent SRC (CONC=12) were compared to athletes without SRC (ATHLETE=19). The DVA task presented a Tumbling 'E' target in four possible orientations during random walk (RW) or horizontal (H) motion at a speed of 30°/s. Participants performed DVA trials standing on a force plate (1000Hz) at four time points: 1) pre-exercise (PRE-EX), 2) immediately (POST1), 3) 10-minutes (POST10), and 4) 20-minutes post- exercise (POST20). Performance was calculated as a change in DVA score from PRE-EX and median response time (RT, ms). Balance control was analyzed using the root mean square of centre of pressure displacement (dCOP).Results Both groups maintained DVA scores for both motion types and exhibited immediate exercise-induced benefits on RT. Both groups had similar change in balance control strategy following treadmill exercise.Conclusion Both groups elicited similar exercise-induced benefits on DVA following exercise. A repeated measures assessment following vigorous exercise may provide meaningful insights about visual and neurocognitive functions for athletes returning to sport following concussion.
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Affiliation(s)
| | | | - Michael E Cinelli
- Wilfrid Laurier University, 75 University Ave. W., Waterloo, ON, N2L 3C5, Canada.
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Gardner CH, Kotlier JL, Fathi A, Castonguay J, Thompson AA, Bolia IK, Petrigliano FA, Liu JN, Weber AE, Gamradt SC. NCAA football players are at higher risk of upper extremity injury after first-time concussion. PHYSICIAN SPORTSMED 2024:1-5. [PMID: 38454779 DOI: 10.1080/00913847.2024.2327275] [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] [Received: 12/02/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Previous research has demonstrated that concussions increase the risk of subsequent lower extremity musculoskeletal injury in athletes. However, the risk of upper extremity injury in athletes' post-concussion is poorly understood. METHODS All concussed football players within a National Collegiate Athletic Association (NCAA) Division I conference athletic database were identified between 2017 and 2021. After exclusions, each athlete experiencing their first concussion was then retrospectively reviewed for upper extremity injuries in the year prior to their concussion and in the year beginning at 90 days after their concussion. All upper extremity injuries were identified and the odds ratio, 95% confidence interval, and statistical significance between groups were calculated in Microsoft Excel. RESULTS 160 de-identified football players from a single conference who were first diagnosed with concussions in the seasons from 2017 through 2021 met inclusion criteria. In these athletes the odds of upper extremity injury in year following first diagnosed concussion were 2.36 times higher than in the year prior (95% CI 1.13-4.95, p = 0.02). Shoulder was the most common site of injury with 57.7% of injuries compared to 19.2% in the hand, 15.4% in the elbow, 7.7% in the forearm, and 0% in the wrist. CONCLUSION This study demonstrates that collegiate football players are at a 2.36 times greater risk of upper extremity injury in the year following their first diagnosed concussion compared to the year preceding it. The most common site of upper extremity injury after concussion was the shoulder. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Carson H Gardner
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jacob L Kotlier
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Amir Fathi
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Justin Castonguay
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Ashley A Thompson
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Seth C Gamradt
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
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5
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Zhang Y, Caccese JB, Kiourti A. Wearable Loop Sensor for Bilateral Knee Flexion Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:1549. [PMID: 38475086 DOI: 10.3390/s24051549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
We have previously reported wearable loop sensors that can accurately monitor knee flexion with unique merits over the state of the art. However, validation to date has been limited to single-leg configurations, discrete flexion angles, and in vitro (phantom-based) experiments. In this work, we take a major step forward to explore the bilateral monitoring of knee flexion angles, in a continuous manner, in vivo. The manuscript provides the theoretical framework of bilateral sensor operation and reports a detailed error analysis that has not been previously reported for wearable loop sensors. This includes the flatness of calibration curves that limits resolution at small angles (such as during walking) as well as the presence of motional electromotive force (EMF) noise at high angular velocities (such as during running). A novel fabrication method for flexible and mechanically robust loops is also introduced. Electromagnetic simulations and phantom-based experimental studies optimize the setup and evaluate feasibility. Proof-of-concept in vivo validation is then conducted for a human subject performing three activities (walking, brisk walking, and running), each lasting 30 s and repeated three times. The results demonstrate a promising root mean square error (RMSE) of less than 3° in most cases.
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Affiliation(s)
- Yingzhe Zhang
- ElectroScience Laboratory, Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH 43212, USA
| | - Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Asimina Kiourti
- ElectroScience Laboratory, Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH 43212, USA
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Oldham JR, Bowman TG, Walton SR, Beidler E, Campbell TR, Smetana RM, Munce TA, Larson MJ, Cullum CM, Bushaw MA, Rosenblum DJ, Cifu DX, Resch JE. Sport Type and Risk of Subsequent Injury in Collegiate Athletes Following Concussion: a LIMBIC MATARS Consortium Investigation. Brain Inj 2024:1-9. [PMID: 38317302 DOI: 10.1080/02699052.2024.2310782] [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: 03/01/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To investigate the association between sport type (collision, contact, non-contact) and subsequent injury risk following concussion in collegiate athletes. MATERIALS AND METHODS This retrospective chart review of 248 collegiate athletes with diagnosed concussions (age: 20.0 ± 1.4 years; height: 179.6 ± 10.9 cm; mass: 79.0 ± 13.6 kg, 63% male) from NCAA athletic programs (n = 11) occurred between the 2015-2020 athletic seasons. Acute injuries that occurred within six months following concussion were evaluated. Subsequent injuries were grouped by lower extremity, upper extremity, trunk, or concussion. The independent variable was sport type: collision, contact, non-contact. A Cox proportional hazard model was used to assess the risk of subsequent injury between sport types. RESULTS Approximately 28% (70/248) of athletes sustained a subsequent acute injury within six months post-concussion. Collision sport athletes had a significantly higher risk of sustaining any injury (HR: 0.41, p < 0.001, 95% CI: 0.28, 0.62), lower extremity (HR: 0.55, p = 0.04, 95% CI: 0.32, 0.97), and upper extremity (HR: 0.41, p = 0.01, 95% CI: 0.20, 0.81) injuries following concussion. No differences between sport types were observed for other injuries. CONCLUSION Collision sport athletes had a higher rate of any subsequent injury, lower, and upper extremity injuries following concussion. Future research should focus on sport-specific secondary injury prevention efforts.
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Affiliation(s)
- Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas R Campbell
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Racheal M Smetana
- Neuropsychology Assessment Clinic, University of Virginia Health, Charlottesville, Virginia, USA
| | - Thayne A Munce
- Environmental Influences on Health & Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - Michael J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Daniel J Rosenblum
- United States Navy, Virginia Beach, Virginia, USA
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- United States Navy, Virginia Beach, Virginia, USA
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Chmielewski TL, Suzuki S, Dubose D, Herman DC, Clugston JR, Horodyski M. Mild Quadriceps and Hamstring Strength Deficits Do Not Persist After Sport-Related Concussion. Sports Health 2023; 15:512-518. [PMID: 36517989 PMCID: PMC10293567 DOI: 10.1177/19417381221136140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Risk for lower extremity musculoskeletal injury increases after sport-related concussion (SRC) and may result from unresolved motor control deficits. Muscle weakness is a deficit that could contribute to musculoskeletal injury risk. HYPOTHESIS Athletes with SRC will demonstrate quadriceps and hamstring muscle weakness at the time of return to sport and 30 days later compared with controls. STUDY DESIGN Prospective matched cohort. LEVEL OF EVIDENCE Level 3. METHODS A total of 31 athletes with SRC (CONCUSSION) were matched by sex, age, and activity level to controls (CONTROL). Testing was conducted at initial assessment and 30 days later; initial assessment in CONCUSSION occurred when cleared for return to play. Isokinetic testing assessed quadriceps and hamstring strength of the dominant and nondominant legs at 60 and 180 deg/s. Peak torque values were normalized to body mass (N-m/kg). Data were analyzed with repeated measures general linear models (group × time), and effect sizes were calculated. RESULTS Analysis at 60 deg/s included 26 matched pairs (15 male per group) and at 180 deg/s included 30 matched pairs (17 males per group). Time from concussion to initial assessment was 21.3 (7.8) mean (standard deviation) days. No significant interactions or main effects were detected (P > 0.05). Across muscle groups, legs, and testing speeds, effect sizes at initial assessment were small (d = 0.117 to 0.353), equating to a strength deficit in CONCUSSION of 0.04 to 0.18 N-m/kg, and effect sizes were further reduced at 30-day follow-up (d = -0.191 to 0.252). CONCLUSION In athletes with SRC, quadriceps and hamstring strength were decreased only minimally at return to play compared with controls and the difference lessened over 30 days. CLINICAL RELEVANCE Strength deficits may not be a major contributor to increased lower extremity musculoskeletal injury risk after SRC. Strength training could be implemented before return to play after SRC to mitigate any strength deficits.
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Affiliation(s)
- Terese L. Chmielewski
- TRIA Orthopedic Center, Bloomington, Minnesota
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota
| | - Shuhei Suzuki
- TRIA Orthopedic Center, Bloomington, Minnesota
- ATP Tour Inc, Ponte Vedra Beach, Florida
| | - Dominique Dubose
- Department of Rehabilitative Sciences, Bethune-Cookman University, Daytona Beach, Florida
| | - Daniel C. Herman
- Department of Physical Medicine and Rehabilitation, University of California at Davis, Davis, California
| | - James R. Clugston
- Departments of Community Health & Family Medicine and Neurology, University of Florida, Gainesville, Florida
| | - MaryBeth Horodyski
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
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Crasta JE, Nebel MB, Svingos A, Tucker RN, Chen HW, Busch T, Caffo BS, Stephens J, Suskauer SJ. Rethinking recovery in adolescent concussions: Network-level functional connectivity alterations associated with motor deficits. Hum Brain Mapp 2023; 44:3271-3282. [PMID: 36999674 PMCID: PMC10171516 DOI: 10.1002/hbm.26280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
Adolescents who are clinically recovered from concussion continue to show subtle motor impairment on neurophysiological and behavioral measures. However, there is limited information on brain-behavior relationships of persistent motor impairment following clinical recovery from concussion. We examined the relationship between subtle motor performance and functional connectivity of the brain in adolescents with a history of concussion, status post-symptom resolution, and subjective return to baseline. Participants included 27 adolescents who were clinically recovered from concussion and 29 never-concussed, typically developing controls (10-17 years); all participants were examined using the Physical and Neurologic Examination of Subtle Signs (PANESS). Functional connectivity between the default mode network (DMN) or dorsal attention network (DAN) and regions of interest within the motor network was assessed using resting-state functional magnetic resonance imaging (rsfMRI). Compared to controls, adolescents clinically recovered from concussion showed greater subtle motor deficits as evaluated by the PANESS and increased connectivity between the DMN and left lateral premotor cortex. DMN to left lateral premotor cortex connectivity was significantly correlated with the total PANESS score, with more atypical connectivity associated with more motor abnormalities. This suggests that altered functional connectivity of the brain may underlie subtle motor deficits in adolescents who have clinically recovered from concussion. More investigation is required to understand the persistence and longer-term clinical relevance of altered functional connectivity and associated subtle motor deficits to inform whether functional connectivity may serve as an important biomarker related to longer-term outcomes after clinical recovery from concussion.
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Affiliation(s)
- Jewel E. Crasta
- Occupational Therapy DivisionThe Ohio State UniversityColumbusOhioUSA
| | - Mary Beth Nebel
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Adrian Svingos
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Robert N. Tucker
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
- Carle Illinois College of MedicineUniversity of Illinois at Urbana‐ChampaignChampaignILUSA
| | - Hsuan Wei Chen
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Tyler Busch
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Brian S. Caffo
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jaclyn Stephens
- Department of Occupational TherapyColorado State UniversityFort CollinsColoradoUSA
| | - Stacy J. Suskauer
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Physical Medicine and RehabilitationJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Roach MH, Aderman MJ, Ross JD, Kelly TF, Malvasi SR, Posner MA, Svoboda SJ, Pasquina PF, Cameron KL. Risk of Upper Extremity Musculoskeletal Injury Within the First Year After a Concussion. Orthop J Sports Med 2023; 11:23259671231163570. [PMID: 37197033 PMCID: PMC10184236 DOI: 10.1177/23259671231163570] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/20/2023] [Indexed: 05/19/2023] Open
Abstract
Background Emerging evidence suggests that athletes and military personnel are at increased risk for lower extremity musculoskeletal injury after a concussion; however, the association between concussion and subsequent upper extremity (UE) musculoskeletal injury is unknown. Purpose To prospectively examine the association between concussion and UE musculoskeletal injury risk within the first year after returning to unrestricted activity. Study Design Cohort study; Level of evidence, 3. Methods A total of 316 cases of concussion 42% (132/316 women) were observed among 5660 Concussion Assessment, Research and Education Consortium participants at the United States Military Academy from May 2015 to June 2018. Active injury surveillance within the cohort was conducted for 12 months after unrestricted return to activity to identify any incident cases of acute UE musculoskeletal injury. Injury surveillance during the follow-up period was also conducted for nonconcussed controls who were matched by sex and competitive sport level. Univariate and multivariable Cox proportional hazards regression models were used to estimate hazard ratios between concussed cases and nonconcussed controls for time to UE musculoskeletal injury. Results During the surveillance period, 19.3% of concussed cases and 9.2% of nonconcussed controls sustained a UE injury. In the univariate model, concussed cases were 2.25 times (95% CI, 1.45-3.51) more likely to sustain a UE injury during the 12-month follow-up period when compared with the nonconcussed controls. In the multivariable model, adjusted for history of concussion, sport level, somatization, and history of UE injury, concussed cases were 1.84 times (95% CI, 1.10-3.07) more likely to sustain a UE injury during the surveillance period compared with nonconcussed controls. Sport level remained an independent risk factor for UE musculoskeletal injury; however, concussion history, somatization, and history of UE injury were not independent risk factors. Conclusion Concussed cases were more than twice as likely to sustain an acute UE musculoskeletal injury within the first 12 months after unrestricted return to activity when compared with nonconcussed controls. The higher hazard of injury remained in the concussed group after adjusting for other potential risk factors.
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Affiliation(s)
- Megan H. Roach
- Extremity Trauma & Amputation Center of Excellence, Defense Health Agency, Falls Church, Virginia, USA
- Department of Clinical Investigations, Womack Army Medical Center, Fort Bragg, North Carolina, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Megan H. Roach, PhD, ATC, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA () (Twitter: @houston_mn)
| | - Michael J. Aderman
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Jeremy D. Ross
- United States Military Academy, West Point, New York, USA
| | - Tim F. Kelly
- United States Military Academy, West Point, New York, USA
| | - Steven R. Malvasi
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Matthew A. Posner
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Steven J. Svoboda
- Medstar Orthopaedic Institute, Washington, District of Columbia, USA
| | - Paul F. Pasquina
- Walter Reed National Military Medical Center, Washington, District of Columbia, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, Maryland, USA
| | - Kenneth L. Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, Maryland, USA
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Buckley TA, Bryk KN, Enrique AL, Kaminski TW, Hunzinger KJ, Oldham JR. Clinical Mental Health Measures and Prediction of Postconcussion Musculoskeletal Injury. J Athl Train 2023; 58:401-407. [PMID: 35788664 PMCID: PMC11220908 DOI: 10.4085/1062-6050-0595.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The rate of lower extremity musculoskeletal injury (LE MSK) is elevated after concussion; however, the underlying mechanism has not been elucidated. Physical characteristics have been investigated despite poorer mental health being a common postconcussion complaint and linked to MSKs. OBJECTIVE To evaluate the role of mental health as a predictor of postconcussion LE MSK. DESIGN Case-control study. SETTING Intercollegiate athletic training facility. PATIENTS OR OTHER PARTICIPANTS A total of 67 National Collegiate Athletic Association Division I student-athletes (n = 39 females) who had been diagnosed with a sport-related concussion. MAIN OUTCOME MEASURE(S) The Brief Symptom Inventory-18, Hospital Anxiety and Depression Scale, and Satisfaction With Life Scale (SWLS) measures were completed at baseline (preseason) and on the day participants were cleared for unrestricted return to play (RTP) after a concussion. Two binary logistic regressions were used to predict postconcussion LE MSK within a year, one for the baseline time point and the second for the RTP time point. A 2 (group: LE MSK, no LE MSK)-by-2 (time: baseline, RTP) repeated-measures analysis of variance compared performance between baseline and RTP. RESULTS Subsequent LE MSKs were sustained by 44 participants (65.7%). The only significant predictor of postconcussion LE MSK was the SWLS score at RTP, with Exp(B) = 0.64, indicating that an increased (improved) SWLS score was associated with a lower LE MSK rate. No significant interactions were present between mental health measures and subsequent MSK (P values = .105-.885). CONCLUSIONS Limited associations were evident between postconcussion LE MSK and scores on commonly used measures of anxiety, depression, and satisfaction with life. Reported increased satisfaction with life was associated with a decreased injury risk, which warrants further attention. Our results suggest that these measures of anxiety, depression, and satisfaction with life have limited value in assisting sports medicine clinicians with determining which student-athletes are at elevated risk of postconcussion LE MSK.
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Affiliation(s)
- Thomas A. Buckley
- Department of Kinesiology and Applied Physiology and Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
| | - Kelsey N. Bryk
- Department of Kinesiology and Applied Physiology and Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
| | - Alexander L. Enrique
- Department of Kinesiology and Applied Physiology and Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
| | - Thomas W. Kaminski
- Department of Kinesiology and Applied Physiology and Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
| | - Katherine J. Hunzinger
- Department of Kinesiology and Applied Physiology and Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
| | - Jessie R. Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond
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11
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Hunzinger KJ, Radzak KN, Costantini KM, Swanik CB, Buckley TA. Concussion history is associated with increased lower-extremity injury incidence in Reserve Officers' Training Corps cadets. BMJ Mil Health 2023; 169:112-115. [PMID: 33122400 DOI: 10.1136/bmjmilitary-2020-001589] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Concussions have been associated with an increased risk of lower-extremity musculoskeletal injury (LE-MSI) in athletes and US Army soldiers, creating an added economic, physical and social burden. Yet, there is a paucity of evidence on this relationship among Reserve Officers' Training Corps (ROTC) cadets, a group which engages in activities with high-injury risk and will subsequently commission as active duty officers. This study aimed to examine the association between concussions and LE-MSI in ROTC cadets. METHODS 125 (83 were male) Army and Air Force ROTC cadets (19.8±2.0 years) from two large state universities' Army and Air Force ROTC programmes participated in this study. Cadets completed a reliable injury history questionnaire to ascertain the following variables of interest: (1) any concussion history, (2) reported concussions, (3) undiagnosed concussions, and (4) potentially unrecognised concussion history and LE-MSI history (eg, ankle sprain, knee sprain or muscle strain). Data were analysed using a χ2 test for association and binary logistic regression to determine ORs. RESULTS Cadets with any concussion history (n=42) had a significantly (p=0.035) higher association with LE-MSI (OR 2.47, 95% CI 1.05 to 5.83) than those without. Cadets who had a reported concussion (n=33) had a significantly (p=0.026) higher association with LE-MSI (OR 2.95, 95% CI 1.11 to 7.84) compared to cadets without. CONCLUSIONS ROTC cadets with a history of diagnosed concussion were more likely to have suffered an LE-MSI than cadets without a concussion history. ROTC cadre should be aware of this relationship and incorporate injury prevention protocols.
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Affiliation(s)
- Katherine J Hunzinger
- Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
- Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - K N Radzak
- Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - K M Costantini
- Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - C B Swanik
- Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
- Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - T A Buckley
- Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
- Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
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Buckley TA, Chandran A, Mauntel TC, Kerr ZY, Brown DW, Boltz AJ, Herman DC, Hall EE, Lynall RC. Lower Extremity Musculoskeletal Injuries After Concussion in Collegiate Student-Athletes. Am J Sports Med 2023; 51:511-519. [PMID: 36255302 DOI: 10.1177/03635465221125155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An association has been identified between concussion and lower extremity musculoskeletal injury (LEMSKI) after return to sports participation. However, the collegiate student-athlete studies have relied on relatively small single-institution studies, which limits generalizability. PURPOSE To assess odds of, and time to, LEMSKI after concussion in US collegiate athletes, using the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). STUDY DESIGN Descriptive epidemiology study. METHODS Data from the NCAA ISP during the 2010-2011 through 2019-2020 athletic seasons were considered for analysis. Frequency distributions were examined for details related to the initial and subsequent injuries (injuries to bone, bursa, joint, ligament, muscle, or tendon). Multivariable logistic regression models and random-effects Poisson regression models examined odds of time loss (TL) and non-time loss (NTL) LEMSKI after concussion, as well as the time interval between initial concussion and subsequent LEMSKI in a single athletic season, or initial musculoskeletal injury (MSKI) and subsequent LEMSKI in a single athletic season. Analyses were performed separately for football and other sports. RESULTS A total of 31,556 initial injuries were recorded (football: 11,900; other sports: 19,656), which were followed by 0 or 1 injury in the same season. Overall, first injury type was not a significant predictor of subsequent LEMSKI, although certain contrasts yielded significant estimates. In football, the odds of NTL LEMSKI were higher after concussion than after upper extremity MSKI (UEMSKI; adjusted odds ratio [ORAdj], 1.56; 95% CI, 1.06-2.31). In football, the odds of TL LEMSKI were lower after concussion than after UEMSKI (ORAdj, 0.71; 95% CI, 0.51-0.99). No other significant effect estimates were observed for football or other sports. CONCLUSION First injury type, either concussion or upper extremity, was not associated with an elevated risk of LEMSKI. Specifically, the results of this study did not identify an elevated odds of LEMSKI after a concussion. However, the authors observed greater odds of NTL LEMSKI and lower odds of TL LEMSKI in football.
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Affiliation(s)
- Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA.,Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention Inc, Indianapolis, Indiana, USA
| | - Timothy C Mauntel
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Derek W Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adrian J Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel C Herman
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Davis, California, USA
| | - Eric E Hall
- Department of Exercise Science, Elon University, Elon, North Carolina, USA
| | - Robert C Lynall
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
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DuPlessis D, Lam E, Xie L, Reed N, Wright FV, Biddiss E, Scratch SE. Multi-domain assessment of sports-related and military concussion recovery: A scoping review. Phys Ther Sport 2023; 59:103-114. [PMID: 36528003 DOI: 10.1016/j.ptsp.2022.11.010] [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: 06/09/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This review explores the literature on multi-domain assessments used in concussion recovery, to inform evidence-based and ecologically valid return-to-play. It asks: What simultaneous, dynamic multi-domain paradigms are used to assess recovery of youth and adults following concussion? METHODS Five databases were searched (CINAHL, EMBASE, MEDLINE, PsycInfo, SPORTDiscus) until September 30, 2021. Records were limited to those published in peer-reviewed journals, in English, between 2002 and 2021. Included studies were required to describe the assessment of concussion recovery using dynamic paradigms (i.e., requiring sport-like coordination) spanning multiple domains (i.e., physical, cognitive, socio-emotional functioning) simultaneously. RESULTS 7098 unique articles were identified. 64 were included for analysis, describing 36 unique assessments of 1938 concussed participants. These assessments were deconstructed into their constituent tasks: 13 physical, 17 cognitive, and one socio-emotional. Combinations of these "building blocks" formed the multi-domain assessments. Forty-six studies implemented level walking with a concurrent cognitive task. The most frequently implemented cognitive tasks were 'Q&A' paradigms requiring participants to answer questions aloud during a physical task. CONCLUSIONS A preference emerged for dual-task assessments, specifically combinations of level walking and Q&A tasks. Future research should balance ecological validity and clinical feasibility in multi-domain assessments, and work to validate these assessments for practice.
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Affiliation(s)
- Danielle DuPlessis
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Emily Lam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Lucy Xie
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada; Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada.
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Lower-Extremity Neuromuscular Function Following Concussion: A Preliminary Examination. J Sport Rehabil 2023; 32:31-39. [PMID: 35894887 DOI: 10.1123/jsr.2022-0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/03/2022] [Accepted: 05/21/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT Neuromuscular function is altered acutely following concussion and theoretically linked to the subsequent postconcussion musculoskeletal injury risk. Existing research has only examined voluntary muscle activation, limiting mechanistic understanding. Therefore, our study aimed to examine voluntary and involuntary muscle activation between college-aged, concussed individuals when symptom-free and healthy matched controls. DESIGN Prospective, cross-sectional cohort laboratory study. METHODS Concussed and healthy participants (n = 24; 58% male, age: 19.3 [1.1] y, mass: 70.3 [16.4] kg, height: 177.3 [12.7] cm) completed the superimposed burst (SB) neuromuscular assessment on their dominant limb within 72 hours after self-reporting asymptomatic (22.4 [20.2] d postinjury). Unnormalized and bodyweight-normalized quadriceps maximal voluntary isometric contraction torque (in newton meters), unnormalized and bodyweight-normalized electrically stimulated SB torque, pain (numeric 1-10) during SB, and the central activation ratio (in percentage) were assessed via the SB. Parametric and nonparametric analyses, 95% confidence intervals (95% CIs), and Hedges g (parametric) and Spearman ρ (nonparametric) effect sizes were used to examine group differences (α = .05). RESULTS The maximal voluntary isometric contraction torque (concussed: 635.60 N·m [300.93] vs control: 556.27 N·m [182.46]; 95% CI, -131.36 to 290.02; P = .443; d = 0.33), SB torque (concussed: 203.22 N·m [97.17], control: 262.85 N·m [159.07]; 95% CI, -171.22 to 51.97; P = .280; d = -0.47), and central activation ratio (concussed: 72.16% [17.16], control: 70.09% [12.63]; 95% CI, -10.68 to 14.83; P = .740; d = 0.14) did not differ between the concussed and control groups regardless of bodyweight normalization (P ≥ .344). Pain during the SB was significantly higher with a medium effect for participants with a concussion versus healthy controls (concussed: median = 7, control: median = 5; P = .046; ρ = -0.42). DISCUSSION These findings suggest concussed participants do not have statistically altered voluntary or involuntary quadricep neuromuscular function once asymptomatic compared with controls. Therefore, the elevated postconcussion musculoskeletal injury risk may not be attributed to lower-extremity muscle activation. Concussed participants displayed greater pain perception during the SB, which suggests somatosensory or perception changes requiring further examination.
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15
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DuPlessis D, Lam E, Hotze F, Khan A, Al-Hakeem H, McFarland S, Hickling A, Hutchison M, Wright FV, Reed N, Biddiss E, Scratch SE. R2Play development: Fostering user-driven technology that supports return-to-play decision-making following pediatric concussion. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1051579. [PMID: 36545131 PMCID: PMC9760755 DOI: 10.3389/fresc.2022.1051579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
Objective To design a multi-domain return-to-play assessment system (R2Play) for youth athletes with concussion. Methods The R2Play system was developed using an overarching user-centered approach, the Design Thinking Framework, and research activities included: 1) structured brainstorming within our research team, 2) interviews with clinician and youth sports coaches, 3) building a testable prototype, and 4) interface testing through cognitive walkthroughs with clinician partners. Results Clinician and coach participants provided feedback on the R2Play concept, which was integrated into the design process and provided future directions for research. Examples of feedback-driven design choices included reducing assessment time, increasing ecological validity by adding in background noise, and developing youth-friendly graphical results screens. Following refinement based on stakeholder feedback, the R2Play system was outlined in detail and a testable prototype was developed. It is made up of two parts: a clinician tablet, and a series of tablet "buttons" that display numbers and letters. Youth athletes run between the buttons to connect a "trail" in ascending alphanumeric order, 1-A-2-B, etc. Their performance across a series of levels of increasing difficulty is logged on the clinician tablet. Initial testing with five clinicians showed the system's interface to have excellent usability with a score of 81% (SD = 8.02) on the System Usability Scale. Conclusion Through this research, a prototype of the R2Play system was innovated and evaluated by clinician and coach stakeholders. Initial usability was excellent and directions for future iterations were highlighted. Outcomes suggest the potential benefits of using technologies to assist in complex clinical assessment, as well as utilizing a user-centered approach to design.
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Affiliation(s)
- Danielle DuPlessis
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emily Lam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Temerty Faculty of Medicine, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Fanny Hotze
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Ajmal Khan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Hiba Al-Hakeem
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Stephanie McFarland
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Andrea Hickling
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Faculty of Medicine, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Faculty of Medicine, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Shannon E. Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Correspondence: Shannon Scratch
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16
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LaGoy AD, Sinnott AM, Eagle SR, Beckner ME, Conkright WR, Proessl F, Williams J, Dretsch MN, Flanagan SD, Nindl BC, Lovalekar M, Germain A, Ferrarelli F, Connaboy C. Combined effects of time-of-day and simulated military operational stress on perception-action coupling performance. Chronobiol Int 2022; 39:1485-1497. [PMID: 36131615 DOI: 10.1080/07420528.2022.2125405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Perception-action coupling, the ability to 'read and react' to the environment, is essential for military personnel to operate within complex and unpredictable environments. Exposure to military operational stressors (e.g., caloric restriction, sleep loss, physical exertion), including around-the-clock operations, may compromise perception-action coupling, thereby impacting performance and safety. We examined the combined effects of simulated military operational stress (SMOS) and time-of-day on perception-action coupling. Fifty-seven active duty and reservist military personnel (45 M; 26.4 ± 5.6 years) completed a 5-day SMOS protocol that included two consecutive days of caloric restriction, and sleep restriction, and disruption. Participants completed a tablet-based perception-action coupling task (PACT) that involves perceiving whether virtual balls fit through virtual apertures. Familiarization occurred on day 0. Eight trials across day 1 (18:00, 22:00), 2 (04:00, 18:00, 22:00) and 3 (04:00, 18:00, 22:00) were analyzed. Mixed models were run to examine the interactive and main effects of day, and time-of-day on PACT response speed and accuracy outcomes. PACT response speed and accuracy outcomes improved at 18:00 and 22:00, whereas performance at 04:00 deteriorated across days. Perception-action coupling performance was resilient to SMOS, except in the early morning when the circadian drive for sleep is high, and the effects of sleep loss are more prominent.
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Affiliation(s)
- Alice D LaGoy
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Aaron M Sinnott
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn R Eagle
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meaghan E Beckner
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William R Conkright
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Felix Proessl
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Justin Williams
- Sleep and Behavioral Neuroscience Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael N Dretsch
- US Army Medical Research Directorate-West, Walter Reed Army Institute for Research, Joint Base Lewis-McCord, Washington, USA
| | - Shawn D Flanagan
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bradley C Nindl
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mita Lovalekar
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christopher Connaboy
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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17
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Clarke AC, Middleton KJ, Gretgrix H, Pearce AJ. Effects of concussion on technical performance in professional Australian Football. SCI MED FOOTBALL 2022:1-6. [PMID: 35839520 DOI: 10.1080/24733938.2022.2103177] [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: 10/17/2022]
Abstract
There is limited research on the on-field performance of previously concussed athletes. The aim of this exploratory study was to investigate athlete technical performance pre- and post-concussion in Australian Football. Using publicly available data, male athletes who sustained a concussion during the 2016-19 professional Australian Football League seasons were analysed across five games pre- and post-concussion (concussion events n=41, age 25.4 ± 3.5 years; control n=39, age 25.2 ± 3.6 years). Mean technical performance metrics (goals, time-on-ground percentage, kicks, ground ball and disposal efficiency, contested marks) over the five games pre- and post-concussion, as well as within-athlete performance variability measures (standard deviation and coefficient of variation) were analysed. Results showed no significant group-by-time interactions, nor effect of time (pre-post) for any technical performance metric. Similarly, the within-athlete standard deviation and coefficient of variation of technical performance metrics showed no group-by-time interaction, nor effect for time. This retrospective study has shown that athlete performance averaged over five games is not affected post-concussion in elite men's Australian Football. Further prospective studies controlling for contextual match factors based on opposition and environmental conditions may be required to identify potential in-game technical performance changes following return-to-play from concussion.
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Affiliation(s)
- Anthea C Clarke
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Kane J Middleton
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Hannah Gretgrix
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Alan J Pearce
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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18
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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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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Corrine N Seehusen
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Patrick M Carry
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Gregory A Walker
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah E Reinking
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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19
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Smulligan KL, Wilson JC, Howell DR. INCREASED RISK OF MUSCULOSKELETAL INJURIES AFTER CONCUSSION. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Romeas T, Greffou S, Allard R, Forget R, McKerral M, Faubert J, Gagnon I. Dynamic Visual Stimulations Produced in a Controlled Virtual Reality Environment Reveals Long-Lasting Postural Deficits in Children With Mild Traumatic Brain Injury. Front Neurol 2021; 12:596615. [PMID: 34899549 PMCID: PMC8654728 DOI: 10.3389/fneur.2021.596615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
Motor control deficits outlasting self-reported symptoms are often reported following mild traumatic brain injury (mTBI). The exact duration and nature of these deficits remains unknown. The current study aimed to compare postural responses to static or dynamic virtual visual inputs and during standard clinical tests of balance in 38 children between 9 and 18 years-of-age, at 2 weeks, 3 and 12 months post-concussion. Body sway amplitude (BSA) and postural instability (vRMS) were measured in a 3D virtual reality (VR) tunnel (i.e., optic flow) moving in the antero-posterior direction in different conditions. Measures derived from standard clinical balance evaluations (BOT-2, Timed tasks) and post-concussion symptoms (PCSS-R) were also assessed. Results were compared to those of 38 healthy non-injured children following a similar testing schedule and matched according to age, gender, and premorbid level of physical activity. Results highlighted greater postural response with BSA and vRMS measures at 3 months post-mTBI, but not at 12 months when compared to controls, whereas no differences were observed in post-concussion symptoms between mTBI and controls at 3 and 12 months. These deficits were specifically identified using measures of postural response in reaction to 3D dynamic visual inputs in the VR paradigm, while items from the BOT-2 and the 3 timed tasks did not reveal deficits at any of the test sessions. PCSS-R scores correlated between sessions and with the most challenging condition of the BOT-2 and as well as with the timed tasks, but not with BSA and vRMS. Scores obtained in the most challenging conditions of clinical balance tests also correlated weakly with BSA and vRMS measures in the dynamic conditions. These preliminary findings suggest that using 3D dynamic visual inputs such as optic flow in a controlled VR environment could help detect subtle postural impairments and inspire the development of clinical tools to guide rehabilitation and return to play recommendations.
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Affiliation(s)
- Thomas Romeas
- Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada.,Institut National du Sport du Québec, Montréal, QC, Canada
| | - Selma Greffou
- Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada
| | - Remy Allard
- Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada
| | - Robert Forget
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal - IURDPM, Montréal, QC, Canada
| | - Michelle McKerral
- Department of Psychology, Université de Montréal and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal - IURDPM, Montréal, QC, Canada
| | - Jocelyn Faubert
- Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada
| | - Isabelle Gagnon
- Montreal Children's Hospital, McGill University Health Center, McGill University, Montréal, QC, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
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21
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Eagle SR, Kontos AP, Connaboy C. Association of impulsivity, physical development, and mental health to perceptual-motor control after concussion in adolescents. Eur J Sport Sci 2021; 22:1889-1897. [PMID: 34781850 DOI: 10.1080/17461391.2021.2003869] [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: 10/19/2022]
Abstract
HIGHLIGHTS After SRC, adolescents had deficits in action boundary perception accuracy, while reporting higher depression symptoms and impulsivity, including attention and cognitive instability components.Certain domains of impulsivity were predictive of action boundary perception accuracy and each perception actualization measure in the concussed group.ADD/ADHD history, anxiety scores, and physical development ratings were also significant predictors of perceptual-motor accuracy and actualization time.
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Affiliation(s)
- Shawn R Eagle
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony P Kontos
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chris Connaboy
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
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22
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Drop Landing Biomechanics in Individuals With and Without a Concussion History. J Appl Biomech 2021; 37:450-457. [PMID: 34504042 DOI: 10.1123/jab.2021-0097] [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: 03/18/2021] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022]
Abstract
Research has identified an increased risk of lower extremity injury postconcussion, which may be due to aberrant biomechanics during dynamic tasks. The purpose of this study was to compare the drop landing biomechanics between individuals with and without a concussion history. Twenty-five individuals with and 25 without a concussion history were matched on age (±3 y), sex, and body mass index (±1 kg/m2). Three-dimensional landing biomechanics were recorded to obtain dependent variables (peak vertical ground reaction force, loading rate, knee flexion angle and external moment, knee abduction angle and external moment, and knee flexion and abduction angle at ground contact). A 1-way multivariate analysis of variance compared outcomes between groups. There was no difference in drop landing biomechanics between individuals with and without a concussion history (F10,39 = 0.460, P = .877, Wilk Λ= .918). There was an effect of time since concussion on knee flexion characteristics. Time since most recent concussion explained a significant amount of variation in both peak (ΔR2 = .177, β = -0.305, ΔP = .046) and initial ground contact (ΔR2 = .292, β = -0.204, ΔP = .008) knee flexion angle after covarying for sex and body mass index. Therefore, time since concussion should be considered when evaluating biomechanical patterns.
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23
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Howell DR, Seehusen CN, Walker GA, Reinking S, Wilson JC. Neuromuscular training after concussion to improve motor and psychosocial outcomes: A feasibility trial. Phys Ther Sport 2021; 52:132-139. [PMID: 34482050 DOI: 10.1016/j.ptsp.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the feasibility of an 8-week neuromuscular training program initiated upon return-to-play clearance following concussion. DESIGN Feasibility trial. SETTING A single sports medicine center. PARTICIPANTS We approached n = 54 patients; n = 32 agreed to participate (59%). N = 27 participants returned for their second visit at return-to-play clearance (84%) and were randomized to neuromuscular training (n = 13) or standard-of-care (n = 14). MAIN OUTCOME MEASURES Participants completed three assessments: within 14 days post-concussion, immediately after return-to-play clearance, and 8-weeks following return-to-play clearance. The intervention aimed to achieve positive neuromuscular adaptations and occurred 2x/week for 8 weeks under supervision. RESULTS N = 2 participants randomized to the intervention elected not to participate, both due to schedule conflicts (e.g., time required to meet with the study team). Participants began the intervention an average of 11 days after return-to-play clearance, the majority (91%) completed >75% of training sessions, and training sessions lasted an average of 18.2 ± 4.8 min. One participant stopped the intervention after 7 training sessions due to time availability. CONCLUSION It is feasible to initiate a neuromuscular training program for most athletes shortly after returning to play following concussion. Clinicians and researchers may consider this approach to mitigate the increased musculoskeletal injury risk for concussion patients returning to sports.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
| | | | - Gregory A Walker
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Reinking
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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24
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Avedesian JM, Singh H, Diekfuss JA, Myer GD, Grooms DR. Loss of Motor Stability After Sports-Related Concussion: Opportunities for Motor Learning Strategies to Reduce Musculoskeletal Injury Risk. Sports Med 2021; 51:2299-2309. [PMID: 34339041 DOI: 10.1007/s40279-021-01527-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
Current best practices to direct recovery after sports-related concussion (SRC) typically require asymptomatic presentation at both rest and during a graduated exercise progression, and cognitive performance resolution. However, this standard of care results in a significantly elevated risk for musculoskeletal (MSK) injury after return-to-sport (RTS). The elevated risk is likely secondary to, in part, residual neurophysiological and dual-task motor stability deficits that remain despite RTS. These deficits present as a loss of autonomous control of gait and posture and an increased need for cognition for motor stability. Thus, the incorporation of strategies that can enhance motor stability and restore autonomous control of gait and posture during SRC recovery and RTS progression may facilitate a reduction of the elevated risk of secondary MSK injury. We provide a theoretical framework for the application of motor learning principles to restore autonomous gait and postural stability after SRC via incorporation, or targeted manipulation, of external focus, enhanced expectations, autonomy support, practice schedule variability, and dual-task strategies during rehabilitation and RTS training.
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Affiliation(s)
- Jason M Avedesian
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA.
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA.
| | - Harjiv Singh
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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25
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Caccese JB, Santos FV, Yamaguchi FK, Buckley TA, Jeka JJ. Persistent Visual and Vestibular Impairments for Postural Control Following Concussion: A Cross-Sectional Study in University Students. Sports Med 2021; 51:2209-2220. [PMID: 33881749 DOI: 10.1007/s40279-021-01472-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine how concussion may impair sensory processing for control of upright stance. METHODS Participants were recruited from a single university into 3 groups: 13 participants (8 women, 21 ± 3 years) between 2 weeks and 6 months post-injury who initiated a return-to-play progression (under physician management) by the time of testing (recent concussion group), 12 participants (7 women, 21 ± 1 years) with a history of concussion (concussion history group, > 1 year post-injury), and 26 participants (8 women, 22 ± 3 years) with no concussion history (control group). We assessed sensory reweighting by simultaneously perturbing participants' visual, vestibular, and proprioceptive systems and computed center of mass gain relative to each modality. The visual stimulus was a sinusoidal translation of the visual scene at 0.2 Hz, the vestibular stimulus was ± 1 mA binaural monopolar galvanic vestibular stimulation (GVS) at 0.36 Hz, the proprioceptive stimulus was Achilles' tendon vibration at 0.28 Hz. RESULTS The recent concussion (95% confidence interval 0.078-0.115, p = 0.001) and the concussion history (95% confidence interval 0.056-0.094, p = 0.038) groups had higher gains to the vestibular stimulus than the control group (95% confidence interval 0.040-0.066). The recent concussion (95% confidence interval 0.795-1.159, p = 0.002) and the concussion history (95% confidence interval 0.633-1.012, p = 0.018) groups had higher gains to the visual stimulus than the control group (95% confidence interval 0.494-0.752). There were no group differences in gains to the proprioceptive stimulus or in sensory reweighting. CONCLUSION Following concussion, participants responded more strongly to visual and vestibular stimuli during upright stance, suggesting they may have abnormal dependence on visual and vestibular feedback. These findings may indicate an area for targeted rehabilitation interventions.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W. 10th Avenue, Columbus, OH, 43210, USA.
| | | | - Felipe K Yamaguchi
- Department of Kinesiology & Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713, USA
| | - Thomas A Buckley
- Department of Kinesiology & Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713, USA
| | - John J Jeka
- Department of Kinesiology & Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713, USA
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26
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Diagnosed concussion is associated with increased risk for lower extremity injury in community rugby players. J Sci Med Sport 2021; 24:368-372. [DOI: 10.1016/j.jsams.2020.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/04/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022]
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Longitudinal Vestibular and Oculomotor Impairments Among Amateur Athletes 1 Year Following Sport-Related Concussion: A Prospective Follow-Up. J Head Trauma Rehabil 2021; 37:E55-E64. [PMID: 33741825 DOI: 10.1097/htr.0000000000000667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate (i) the presence of vestibular and oculomotor impairments and (ii) the self-perceived effects of concussion-associated dizziness on health-related quality of life among amateur athletes 6 months and 1 year following sport-related concussion compared with nonconcussed, control athletes. DESIGN Prospective, matched-cohort study. SETTING Clinical assessment laboratory. PARTICIPANTS Amateur athletes who were diagnosed with sport-related concussion within 1 week of injury, and sex-, age-, and activity-matched nonconcussed, control athletes. MAIN MEASURES Participants were evaluated 6 months and 1 year following sport-related concussion and enrollment in the longitudinal study using the Vestibular and Oculo-Motor Screening and the Dizziness Handicap Inventory. We performed multivariate analyses of variance and chi-square analyses to compare concussion and control group scores at each study assessment. RESULTS Forty-seven participants with concussion and 47 control participants completed the study. The concussion group reported similar mean symptom provocation scores on the Vestibular and Oculo-Motor Screening and exhibited a similar near-point convergence distance compared with the control group at the 6-month and 1-year study assessments. The concussion and control groups had similar perceptions of the effects of dizziness on their health-related quality of life at both study assessments. CONCLUSION Meaningful differences in vestibular and oculomotor symptom provocation and self-perceived effects of dizziness on everyday life were not observed between concussed and nonconcussed, control athletes 6 months and 1 year following sport-related concussion.
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28
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Chmielewski TL, Tatman J, Suzuki S, Horodyski M, Reisman DS, Bauer RM, Clugston JR, Herman DC. Impaired motor control after sport-related concussion could increase risk for musculoskeletal injury: Implications for clinical management and rehabilitation. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:154-161. [PMID: 33188963 PMCID: PMC7987572 DOI: 10.1016/j.jshs.2020.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 05/29/2023]
Abstract
This review presents a conceptual framework and supporting evidence that links impaired motor control after sport-related concussion (SRC) to increased risk for musculoskeletal injury. Multiple studies have found that athletes who are post-SRC have higher risk for musculoskeletal injury compared to their counterparts. A small body of research suggests that impairments in motor control are associated with musculoskeletal injury risk. Motor control involves the perception and processing of sensory information and subsequent coordination of motor output within the central nervous system to perform a motor task. Motor control is inclusive of motor planning and motor learning. If sensory information is not accurately perceived or there is interference with sensory information processing and cognition, motor function will be altered, and an athlete may become vulnerable to injury during sport participation. Athletes with SRC show neuroanatomic and neurophysiological changes relevant to motor control even after meeting return to sport criteria, including a normal neurological examination, resolution of symptoms, and return to baseline function on traditional concussion testing. In conjunction, altered motor function is demonstrated after SRC in muscle activation and force production, movement patterns, balance/postural stability, and motor task performance, especially performance of a motor task paired with a cognitive task (i.e., dual-task condition). The clinical implications of this conceptual framework include a need to intentionally address motor control impairments after SRC to mitigate musculoskeletal injury risk and to monitor motor control as the athlete progresses through the return to sport continuum.
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Affiliation(s)
| | | | - Shuhei Suzuki
- TRIA Orthopedic Center, Bloomington, MN 55431, USA; ATP Tour Inc., Ponte Vedra Beach, FL 32082, USA
| | - MaryBeth Horodyski
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32607, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32611, USA
| | - James R Clugston
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL 32603, USA
| | - Daniel C Herman
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32607, USA
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29
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Lee BJ, Blueitt D, Hannon J, Goto S, Garrison JC. MOVEMENT PATTERNS DIFFER BETWEEN ATHLETES AFTER SPORT-RELATED CONCUSSION COMPARED TO HEALTHY CONTROLS DURING JUMP LANDING TASK. J Athl Train 2021; 56:1306-1312. [PMID: 33626137 DOI: 10.4085/533-20] [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 A relationship between a positive history of sport-related concussion (SRC) and lower extremity (LE) injury has been well established in the literature. OBJECTIVE The purpose of this study was to determine if biomechanical differences exist during a double limb jump landing (DLJ) between athletes who had been released for return to play after SRC and healthy matched controls (Healthy). DESIGN Cross-Sectional Study Setting: Health system-based Outpatient Sports Medicine Center Participants: 21 participants (16.33±12.7 days out from being released to return to sport after SRC) (age: 15.38±1.77; height: 169.23±8.59; mass: 63.43±7.39) were compared to 21 age, sex, activity-matched healthy controls (age: 15.36±1.73; height: 169.92±11.1; mass: 65.62±12.08). No significant differences existed between groups for descriptive data. MAIN OUTCOME MEASURE(S) Biomechanical performance during DLJ was assessed using Motion Capture System and force plates. The average of five consecutive trials was used to calculate lower extremity joint kinetic and kinematics. Variables of interest included internal knee extension moment, internal varus moment, and total sagittal plane knee displacement for both the dominant and non-dominant limbs. Independent t-tests were performed to examine the differences between SRC and Healthy groups for variables of interest. RESULTS The SRC group demonstrated greater internal knee extension moments on their dominant (KEDomDiff=-.028±.009; p=.003) and non-dominant (KENonDomDiff=-.018±.007, p=.019) limbs. The SRC group also demonstrated greater internal varus moments on their dominant (VDomDiff=.012±.004, p=.005) and non-dominant (VNonDomDiff=.010±.003, p=.005) limbs. For sagittal plane knee displacement, the SRC group demonstrated less knee flexion displacement on their dominant (DispDomDiff=-12.56±4.67, p=.011) but not their non-dominant limb (DispNonDomDiff=-8.30±4.91, p=.099). CONCLUSIONS Athletes who have been released for return to sport after SRC land in greater knee valgus compared to healthy matched controls.
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Affiliation(s)
- Bobby Jean Lee
- Sports Physical Therapy Clinical Specialist and Clinical Outcomes Research Clinician Texas Health Sports Medicine, Fort Worth, TX, , @BJLeeSportsPT
| | - Damond Blueitt
- Physician, Orthopedic Specialty Associates, Fort Worth, TX,
| | - Joseph Hannon
- Program Manager of Sports Medicine Research, Texas Health Sports Medicine, Fort Worth, TX, , @JosephHannon_PT
| | - Shiho Goto
- Clinical Biomechanist, Texas Health Sports Medicine, Fort Worth, TX, , @Shiho_Goto
| | - J Craig Garrison
- Director of Sports Medicine Research, Texas Health Sports Medicine, Fort Worth, TX, , @CraigGarrison10
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Monseau AJ, Balcik BJ, Roberts L, Andrews R, Sharon MJ. Initially concealed concussion lowers in-game performance of NCAA Division I football players: a case series. PHYSICIAN SPORTSMED 2021; 49:51-56. [PMID: 32345080 DOI: 10.1080/00913847.2020.1763145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Many athletes conceal concussion symptoms to continue to play. If athletes and coaches knew that performance drops significantly after a concussion, in turn hurting the team, athletes may be more prone to report concussion symptoms. The objective of our research was to report three cases that support this performance decline after an undisclosed concussion. Methods: This is a case series of three NCAA Division I football players who did not immediately report their concussions. The play in which the concussion occurred was identified via video review then the players' pre and post-injury performance grades, as scored by their position coaches, were recorded. Additional data regarding their performance in other games and their concussion assessments were also recorded. Results: Three injuries were identified and reviewed. Player 1 had a pre-injury performance score of 76/100 with a post-injury score of 47/100. This was a drop of 29 points for a decrease in his in-game performance by 38%. Player 2 had a pre-injury score of 100/100 with a post-injury score of 60/100. This was a drop of 40 points or a 40% decrease in his in-game performance. Player 3 had a pre-injury score of 67/100 and a post-injury score of 43/100 for a drop of 24 points or a 36% decrease in his in-game performance. Conclusions: We reported three college football players who suffered concussions but did not immediately disclose their symptoms. Each had a marked decrease in performance grades after their concussion. If the performance effect of a concussion can be quantified, athletes and coaches may begin to change their mind-set that a concussion can be 'played through.' This case series should serve as a first step in quantifying concussion effects on performance.
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Affiliation(s)
- Aaron J Monseau
- Department of Emergency Medicine, School of Medicine, West Virginia University , Morgantown, WV, USA
| | - Brenden J Balcik
- Department of Emergency Medicine, School of Medicine, West Virginia University , Morgantown, WV, USA
| | - Luke Roberts
- School of Medicine, West Virginia University , Morgantown, WV, USA
| | - Reed Andrews
- School of Medicine, West Virginia University , Morgantown, WV, USA
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31
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Single- Versus Dual-Task Functional Movement Paradigms: A Biomechanical Analysis. J Sport Rehabil 2021; 30:774-785. [PMID: 33494045 DOI: 10.1123/jsr.2020-0310] [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] [Received: 07/07/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Laboratory-based movement assessments are commonly performed without cognitive stimuli (ie, single-task) despite the simultaneous cognitive processing and movement (ie, dual task) demands required during sport. Cognitive loading may critically alter human movement and be an important consideration for truly assessing functional movement and understanding injury risk in the laboratory, but limited investigations exist. OBJECTIVE To comprehensively examine and compare kinematics and kinetics between single- and dual-task functional movement among healthy participants while controlling for sex. DESIGN Cross-sectional study. SETTING Laboratory. Patients (or Other Participants): Forty-one healthy, physically active participants (49% female; 22.5 ± 2.1 y; 172.5 ± 11.9 cm; 71.0 ± 13.7 kg) enrolled in and completed the study. INTERVENTION(S) All participants completed the functional movement protocol under single- and dual-task (subtracting by 6s or 7s) conditions in a randomized order. Participants jumped forward from a 30-cm tall box and performed (1) maximum vertical jump landings and (2) dominant and (3) nondominant leg, single-leg 45° cuts after landing. MAIN OUTCOME MEASURES The authors used mixed-model analysis of variances (α = .05) to compare peak hip, knee, and ankle joint angles (degrees) and moments (N·m/BW) in the sagittal and frontal planes, and peak vertical ground reaction force (N/BW) and vertical impulse (Ns/BW) between cognitive conditions and sex. RESULTS Dual-task resulted in greater peak vertical ground reaction force compared with single-task during jump landing (mean difference = 0.06 N/BW; 95% confidence interval [CI], 0.01 to 0.12; P = .025) but less force during dominant leg cutting (mean difference = -0.08 N/BW; 95% CI, -0.14 to -0.02; P = .015). Less hip-flexion torque occurred during dual task than single task (mean difference = -0.09 N/BW; 95% CI, -0.17 to -0.02). No other outcomes were different between single and dual task (P ≥ .053). CONCLUSIONS Slight, but potentially important, kinematic and kinetic differences were observed between single- and dual-task that may have implications for functional movement assessments and injury risk research. More research examining how various cognitive and movement tasks interact to alter functional movement among pathological populations is warranted before clinical implementation.
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32
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Upper-Extremity Perceptual-Motor Training Improves Whole-Body Reactive Agility Among Elite Athletes With History of Sport-Related Concussion. J Sport Rehabil 2021; 30:844-849. [PMID: 33418536 DOI: 10.1123/jsr.2020-0337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/25/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Sport-related concussion (SRC) elevates risk for subsequent injury, which may relate to impaired perceptual-motor processes that are potentially modifiable. OBJECTIVE To assess a possible upper-extremity (UE) training effect on whole-body (WB) reactive agility performance among elite athletes with history of SRC (HxSRC) and without such history of SRC. DESIGN Cohort study. SETTING Residential training center. PARTICIPANTS Elite athletes (12 males and 8 females), including 10 HxSRC and 10 without such history of SRC. INTERVENTION One-minute training sessions completed 2 to 3 times per week over a 3-week period involved verbal identification of center arrow direction for 10 incongruent and 10 congruent flanker test trials with simultaneous reaching responses to deactivate illuminated buttons. MAIN OUTCOME MEASURES Pretraining and posttraining assessments of UE and WB reactive responses included flanker test conflict effect (incongruent minus congruent reaction time) and WB lateral average asymmetry derived from reaction time, speed, acceleration, and deceleration in opposite directions. Discrimination was assessed by receiver operating characteristic analysis, and training effect was assessed by repeated-measures analysis of variance. RESULTS Pretraining discrimination between HxSRC and without such history of SRC was greatest for conflict effect ≥80 milliseconds and WB lateral average asymmetry ≥18%. Each athlete completed 6 training sessions, which improved UE mean reaction time from 767 to 646 milliseconds (P < .001) and reduced mean conflict effect from 96 to 53 milliseconds (P = .039). A significant group × trial interaction was evident for WB lateral average asymmetry (P = .004), which was reduced from 24.3% to 12.5% among those with HxSRC. CONCLUSIONS Suboptimal perceptual-motor performance may represent a subtle long-term effect of concussion that is modifiable through UE training, which appears to improve WB reactive capabilities.
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33
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Biese KM, Stamm JM, Wichman DM, Hetzel SJ, Post EG, Bell DR. Association of lower extremity injuries and injury mechanism with previous concussion history in adolescent athletes. Phys Ther Sport 2021; 48:76-82. [PMID: 33387901 DOI: 10.1016/j.ptsp.2020.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Determine the association between concussion and subsequent contact, non-contact, and overuse lower extremity (LE) injuries in a cohort of adolescent athletes. Secondarily, to identify this association between males and females. STUDY DESIGN Cross-sectional. SETTING Summer athletic events with participants ages 12-18. MAIN OUTCOME Anonymous survey included sport-related injuries (injury month/year) and participants classified injuries as a contact, non-contact, overuse injury, or concussion. Multivariable logistic regression analyses were used to examine associations between a concussion event and a subsequent LE injury while controlling for age and any previous LE injury. RESULTS A concussion was reported in 219 athletes (Female = 96, 44%) and were matched with 219 non-concussed athletes (438 total participants). Concussion was not association with a specific injury mechanism but was significant for any subsequent LE injury (OR = 1.58 95%CI = [1.03-2.41]; p < 0.05). Concussed females were more likely to report any subsequent LE injury compared to non-concussed female athletes (2.49[1.31, 4.74]; p < 0.01). This relationship was not observed between concussed and non-concussed males (1.11[0.62-1.99]; p > 0.5). CONCLUSION A history of concussion was associated with any subsequent LE injury, but not associated with a specific mechanism of injury. The association with concussion and a subsequent LE injury was different between males and females.
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Affiliation(s)
- Kevin M Biese
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Julie M Stamm
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel M Wichman
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott J Hetzel
- Department of Biostatistics and Medical Information, University of Wisconsin-Madison, Madison, WI, USA
| | - Eric G Post
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA
| | - David R Bell
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
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Büttner F, Howell D, Severini G, Doherty C, Blake C, Ryan J, Delahunt E. Using functional movement tests to investigate the presence of sensorimotor impairment in amateur athletes following sport-related concussion: A prospective, longitudinal study. Phys Ther Sport 2020; 47:105-113. [PMID: 33242699 DOI: 10.1016/j.ptsp.2020.10.012] [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] [Received: 08/16/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To longitudinally investigate the presence of sensorimotor impairments in amateur athletes following sport-related concussion using two functional movement tests. DESIGN Prospective, longitudinal study. SETTING Human movement analysis laboratory. PARTICIPANTS Athletes who presented to a hospital emergency department and were diagnosed with sport-related concussion, and sex-, age-, and activity-matched non-concussed, control athletes. Concussed participants were assessed within one-week following sport-related concussion, upon clearance to return-to-sporting activity (RTA), and two weeks after RTA. Control participants were assessed at an initial time-point and approximately two and four weeks following their initial study assessment. MAIN OUTCOMES MEASURES At each laboratory assessment, participants completed two functional movement tests: the Star Excursion Balance Test to evaluate anterior reach distance (normalised for leg length) and fractal dimension (centre of pressure path complexity), and the Multiple Hop Test to evaluate corrective postural strategies and time-to-stabilisation. RESULTS Fifty concussed athletes and 50 control athletes completed the study. There were no significant differences at any study assessment between the concussion and control group on the Star Excursion Balance Test anterior reach distance or fractal dimension (centre of pressure path complexity). During the Multiple Hop Test, the concussion group used a significantly greater number of corrective postural strategies than the control group one-week following sport-related concussion and upon clearance to RTA, but not two weeks following RTA. CONCLUSION Recently concussed athletes made a greater number of corrective postural strategies than control participants during the Multiple Hop Test upon clearance to RTA but not two weeks after RTA. The Multiple Hop Test may offer a clinically useful tool for practitioners to examine the recovery of subtle sensorimotor impairments and related RTA readiness.
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Affiliation(s)
- Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - David Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.
| | - Giacomo Severini
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland; Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland; UCD Centre for Biomedical Engineering, University College Dublin, Dublin, Ireland.
| | - Cailbhe Doherty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - John Ryan
- Emergency Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Eamonn Delahunt
- Institute for Sport & Health, University College Dublin, Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
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Dual-Task Gait Stability after Concussion and Subsequent Injury: An Exploratory Investigation. SENSORS 2020; 20:s20216297. [PMID: 33167407 PMCID: PMC7663806 DOI: 10.3390/s20216297] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022]
Abstract
Persistent gait alterations can occur after concussion and may underlie future musculoskeletal injury risk. We compared dual-task gait stability measures among adolescents who did/did not sustain a subsequent injury post-concussion, and uninjured controls. Forty-seven athletes completed a dual-task gait evaluation. One year later, they reported sport-related injuries and sport participation volumes. There were three groups: concussion participants who sustained a sport-related injury (n = 8; age =15.4 ± 3.5 years; 63% female), concussion participants who did not sustain a sport-related injury (n = 24; 14.0 ± 2.6 years; 46% female), and controls (n = 15; 14.2 ± 1.9 years; 53% female). Using cross-recurrence quantification, we quantified dual-task gait stability using diagonal line length, trapping time, percent determinism, and laminarity. The three groups reported similar levels of sports participation (11.8 ± 5.8 vs. 8.6 ± 4.4 vs. 10.9 ± 4.3 hours/week; p = 0.37). The concussion/subsequent injury group walked slower (0.76 ± 0.14 vs. 0.65 ± 0.13 m/s; p = 0.008) and demonstrated higher diagonal line length (0.67 ± 0.08 vs. 0.58 ± 0.05; p = 0.02) and trapping time (5.3 ± 1.5 vs. 3.8 ± 0.6; p = 0.006) than uninjured controls. Dual-task diagonal line length (hazard ratio =1.95, 95% CI = 1.05–3.60), trapping time (hazard ratio = 1.66, 95% CI = 1.09–2.52), and walking speed (hazard ratio = 0.01, 95% CI = 0.00–0.51) were associated with subsequent injury. Dual-task gait stability measures can identify altered movement that persists despite clinical concussion recovery and is associated with future injury risk.
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Morris A, Cassidy B, Pelo R, Fino NF, Presson AP, Cushman DM, Monson NE, Dibble LE, Fino PC. Reactive Postural Responses After Mild Traumatic Brain Injury and Their Association With Musculoskeletal Injury Risk in Collegiate Athletes: A Study Protocol. Front Sports Act Living 2020; 2:574848. [PMID: 33345138 PMCID: PMC7739642 DOI: 10.3389/fspor.2020.574848] [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: 06/21/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Deficits in neuromuscular control are widely reported after mild traumatic brain injury (mTBI). These deficits are speculated to contribute to the increased rate of musculoskeletal injuries after mTBI. However, a concrete mechanistic connection between post-mTBI deficits and musculoskeletal injuries has yet to be established. While impairments in some domains of balance control have been linked to musculoskeletal injuries, reactive balance control has received little attention in the mTBI literature, despite the inherent demand of balance recovery in athletics. Our central hypothesis is that the high rate of musculoskeletal injuries after mTBI is in part due to impaired reactive balance control necessary for balance recovery. The purpose of this study is to (1) characterize reactive postural responses to recover balance in athletes with recent mTBI compared to healthy control subjects, (2) determine the extent to which reactive postural responses remain impaired in athletes with recent mTBI who have been cleared to return to play, and (3) determine the relationship between reactive postural responses and acute lower extremity musculoskeletal injuries in a general sample of healthy collegiate athletes. Methods: This two-phase study will take place at the University of Utah in coordination with the University of Utah Athletics Department. Phase 1 will evaluate student-athletes who have sustained mTBI and teammate-matched controls who meet all the inclusion criteria. The participants will be assessed at multiple time points along the return-to-play progress of the athlete with mTBI. The primary outcome will be measures of reactive postural response derived from wearable sensors during the Push and Release (P&R) test. In phase 2, student-athletes will undergo a baseline assessment of postural responses. Acute lower extremity musculoskeletal injuries for each participant will be prospectively tracked for 1 year from the date of first team activity. The primary outcomes will be the measures of reactive postural responses and the time from first team activity to lower extremity injury. Discussion: Results from this study will further our understanding of changes in balance control, across all domains, after mTBI and identify the extent to which postural responses can be used to assess injury risk in collegiate athletes.
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Affiliation(s)
- Amanda Morris
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Benjamin Cassidy
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Ryan Pelo
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Nora F Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Daniel M Cushman
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Nicholas E Monson
- Department of Orthopaedic Surgery Operations, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
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Perceptual-Cognitive Function and Unplanned Athletic Movement Task Performance: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207481. [PMID: 33066649 PMCID: PMC7602452 DOI: 10.3390/ijerph17207481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
The performance of choice-reaction tasks during athletic movement has been demonstrated to evoke unfavorable biomechanics in the lower limb. However, the mechanism of this observation is unknown. We conducted a systematic review examining the association between (1) the biomechanical and functional safety of unplanned sports-related movements (e.g., jumps/runs with a spontaneously indicated landing leg/cutting direction) and (2) markers of perceptual–cognitive function (PCF). A literature search in three databases (PubMed, ScienceDirect and Google Scholar) identified five relevant articles. The study quality, rated by means of a modified Downs and Black checklist, was moderate to high (average: 13/16 points). Four of five papers, in at least one parameter, found either an association of PCF with task safety or significantly reduced task safety in low vs. high PCF performers. However, as (a) the outcomes, populations and statistical methods of the included trials were highly heterogeneous and (b) only two out of five studies had an adequate control condition (pre-planned movement task), the evidence was classified as conflicting. In summary, PCF may represent a factor affecting injury risk and performance during unplanned sports-related movements, but future research strengthening the evidence for this association is warranted.
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38
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Avedesian JM, Covassin T, Dufek JS. Landing Biomechanics in Adolescent Athletes With and Without a History of Sports-Related Concussion. J Appl Biomech 2020; 36:313-318. [PMID: 32736340 DOI: 10.1123/jab.2020-0034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/07/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022]
Abstract
Recent evidence suggests previously concussed athletes are at greater risk for lower-extremity (LE) injuries than are controls. However, little is known regarding the influence of sports-related concussion (SRC) on landing biomechanics that may provide a mechanistic rationale for LE injury risk. The purpose of this investigation was to examine LE drop-landing biomechanics in adolescent athletes with and without a previous SRC history. Participants included 10 adolescent athletes with an SRC history and 11 controls from multiple sports. Three-dimensional kinematic and kinetic data associated with LE injury risk were analyzed across 5 trials for 30- and 60-cm landing heights. Multivariate analyses indicated group differences in landing patterns from the 30- (P = .041) and 60-cm (P = .015) landing heights. Follow-up analyses indicated that concussed adolescent athletes demonstrated significantly less ankle dorsiflexion and knee flexion versus controls when performing drop landings. Our findings suggest that previously concussed adolescent athletes complete drop-landing maneuvers with ankle and knee joint kinematic patterns that suggest greater risk for LE injury. While limitations such as sport variety and explicit LE injury history are present, the results of this study provide a possible biomechanical rationale for the association between SRC and LE injury risk.
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Reilly N, Prebor J, Moxey J, Schussler E. Chronic impairments of static postural stability associated with history of concussion. Exp Brain Res 2020; 238:2783-2793. [DOI: 10.1007/s00221-020-05934-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/24/2020] [Indexed: 01/20/2023]
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40
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A Proposal for Complex Gait Evaluation Using Dual-Task Gait Termination Time. J Sport Rehabil 2020; 30:525-530. [PMID: 32963127 DOI: 10.1123/jsr.2020-0080] [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: 02/18/2020] [Revised: 08/02/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Gait termination time (GTT) has been used to predict falls in older adults but has not been explored in the sport rehabilitation setting. The incorporation of a concurrent cognitive task as a complex measure of gait in this clinical population could lead to better health-related outcomes. OBJECTIVE To compare the effect of planned and unplanned gait termination with and without a concurrent cognitive task on reaction time (RT), gait velocity, and GTT. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Twenty young adults (females 60.0%, age 20.1 [0.9] y, height 169.5 [8.8] cm, mass 67.4 [10.8] kg). INTERVENTION Participants completed 6 planned and 6 unplanned gait termination trials on an instrumented gait mat with and without a cognitive task. MAIN OUTCOME MEASURES The authors measured RT (s), gait velocity (m/s), GTT (s), and normalized GTT (s2/m). A 2 (motor) × 2 (cognitive) repeated-measures analysis of variance (α = .05) was used; significant interaction effects were explored using Bonferroni-corrected t tests (α < .008). RESULTS Participants walked more slowly during dual-task trials compared with single-task trials (F1,19 = 4.401, P = .050). Participants walked significantly more slowly with a cognitive task during planned (P < .001, mean difference = -0.184 m/s, 95% CI, -0.256 to -0.111) and unplanned (P = .001, mean difference = -0.111 m/s, 95% CI, -0.173 to -0.050) gait termination. Participants walked significantly more slowly (P < .001, mean difference = -0.142 m/s, 95% CI, -0.210 to -0.075) when performing the most difficult task, unplanned termination with a cognitive task, than when performing the least difficult task, planned termination with no cognitive task. We observed a cognitive task main effect such that adding a cognitive task increased RT (F1,19 = 16.375, P = .001, mean difference = -0.118 s, 95% CI, -0.178 to -0.057) and slowed normalized GTT (F1,19 = 5.655, P = .028, mean difference = -0.167 s2/m, 95% CI, -0.314 to -0.020). CONCLUSIONS Overall, participants displayed more conservative gait strategies and slower RT, normalized GTT, and gait velocity as task difficulty increased. More investigation is needed to truly understand the clinical meaningfulness of these measures in athletic injuries.
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Eagle SR, Kontos AP, Sinnott A, Beckner M, Nindl BC, Flanagan SD, Lovalekar M, Connaboy C. Utility of a novel perceptual-motor control test for identification of sport-related concussion beyond current clinical assessments. J Sports Sci 2020; 38:1799-1805. [PMID: 32412332 DOI: 10.1080/02640414.2020.1756675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Clinically feasible metrics, that can inform the concussion recovery decision making process by evaluating a unique domain beyond current testing domains (e.g., balance, neurocognition, symptoms, vestibular/ocular function) are still in need. The purpose of this study was to compare perceptual-motor control in adolescent athletes ≤21 days of sport-related concussion and healthy controls and evaluate the association of perceptual-motor control to the outcomes of commonly-used sport-related concussion clinical assessments. Athletes (age: 12-18 years) with sport-related concussion (n = 48) and healthy controls (n = 24) completed the Perception-Action Coupling Task (PACT), whose outcomes are mean reaction, movement, initiation, response time, and accuracy. ImPACT outcomes are verbal/visual memory scores, motor processing speed, and reaction time. Vestibular-Ocular Motor Screen (VOMS) outcomes are symptoms from: smooth pursuit, horizontal/vertical saccades, near-point of convergence, horizontal/vestibular ocular-reflex, and visual motion sensitivity. CONCUSSED demonstrated ~5% deficit in overall perceptual-motor accuracy during PACT compared to CONTROLS (p = 0.03). PACT accuracy negatively correlated with smooth pursuits(r = -0.29), and horizontal (r = -0.35)/vertical (r = -0.30) saccades. The C5.0 decision tree determined PACT accuracy was the most relevant predictor of sport-related concussion when no visual motion sensitivity symptoms were reported and Visual Memory was >66. Perceptual-motor control tests may complement current sport-related concussion assessments when neurocognition and vestibular/ocular motor system are not grossly impaired.
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Affiliation(s)
- Shawn R Eagle
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh , Pittsburgh, PA, USA.,UPMC Sports Medicine Concussion Program/Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, PA, USA
| | - Anthony P Kontos
- UPMC Sports Medicine Concussion Program/Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, PA, USA
| | - Aaron Sinnott
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh , Pittsburgh, PA, USA
| | - Meaghan Beckner
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh , Pittsburgh, PA, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh , Pittsburgh, PA, USA
| | - Shawn D Flanagan
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh , Pittsburgh, PA, USA
| | - Mita Lovalekar
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh , Pittsburgh, PA, USA
| | - Chris Connaboy
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh , Pittsburgh, PA, USA
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Effect of a Concussion on Anterior Cruciate Ligament Injury Risk in a General Population. Sports Med 2020; 50:1203-1210. [PMID: 31970718 DOI: 10.1007/s40279-020-01262-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent studies indicate concussion increases risk of musculoskeletal injury in specific groups of patients. The purpose of this study was to determine the odds of anterior cruciate ligament (ACL) injury after concussion in a population-based cohort. METHODS International Classification of Diseases, 9th and 10th Revision (ICD-9, ICD-10) codes relevant to the diagnosis and treatment of a concussion and ACL tear were utilized to search the Rochester Epidemiology Project (REP) between 2000 and 2017. A total of 1653 unique patients with acute, isolated ACL tears were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion within 3 years prior to the ACL injury. Cases were matched by age, sex, and REP availability date to patients without an ACL tear (1:3 match), resulting in 4959 controls. The medical records of the matched control patients were reviewed to determine history of concussion. RESULTS 39 patients with a concussion suffered an ACL injury up to 3 years after the concussion. The rate of prior concussion was higher in ACL-injured cases (2.4%) compared to matched controls with no ACL injury (1.5%). This corresponds to an odds ratio of 1.6 (95% CI 1.1-2.4; p = 0.015). CONCLUSIONS Although activity level could not be assessed, there are increased odds of ACL injury after concussion in a general population. Based on the evidence of increased odds of musculoskeletal injury after concussion, standard clinical assessments should consider concussion symptom resolution as well as assessment of neuromuscular factors associated with risk of injuries.
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