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Ransom DM, Ahumada L, Amankwah EK, Katzenstein JM, Goldenberg NA, Bauer TA, Mularoni PP. Effects of Cumulative Head Impact Exposure in Adolescent Male Contact and Collision Sport Student Athletes. J Head Trauma Rehabil 2024; 39:284-292. [PMID: 37862133 DOI: 10.1097/htr.0000000000000915] [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: 10/22/2023]
Abstract
OBJECTIVE This prospective cohort study aimed to investigate the association between head impact exposure (HIE) and neuropsychological sequelae in high school football and ice hockey players over 1 year. SETTING Community sample. PARTICIPANTS A cohort of 52 adolescent American football and ice hockey players were enrolled in the study, with a final study sample of 35 included in analyses. DESIGN The study followed a prospective cohort design, with participants undergoing neuropsychological screening and accelerometer-based measurement of HIE over 1 season. MAIN MEASURES Changes in cognition, emotions, behavior, and reported symptoms were assessed using standardized neuropsychological tests and self-reported questionnaires. RESULTS Cumulative HIE was not consistently associated with changes in cognition, emotions, behavior, or reported symptoms. However, it was linked to an isolated measure of processing speed, showing inconsistent results based on the type of HIE. History of previous concussion was associated with worsened verbal memory recognition (ImPACT Verbal Memory) but not on a more robust measure of verbal memory (California Verbal Learning Test [CVLT]). Reported attention-deficit/hyperactivity disorder history predicted improved neurocognitive change scores. No associations were found between reported history of anxiety/depression or headaches/migraines and neuropsychological change scores. CONCLUSION Overall, our findings do not support the hypothesis that greater HIE is associated with an increase in neuropsychological sequelae over time in adolescent football and ice hockey players. The results align with the existing literature, indicating that HIE over 1 season of youth sports is not consistently associated with significant neuropsychological changes. However, the study is limited by a small sample size, attrition over time, and the absence of performance validity testing for neurocognitive measures. Future studies with larger and more diverse samples, longer follow-up, and integration of advanced imaging and biomarkers are needed to comprehensively understand the relationship between HIE and neurobehavioral outcomes. Findings can inform guidelines for safe youth participation in contact sports while promoting the associated health and psychosocial benefits.
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Affiliation(s)
- Danielle M Ransom
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, Florida (Drs Ransom, Katzenstein, and Mularoni); School of Medicine, Johns Hopkins University, Baltimore, Maryland (Drs Ransom, Ahumada, Amankwah, Katzenstein, Goldenberg, and Mularoni); Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children's Hospital, St Petersburg, Florida (Dr Ahumada); Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, Florida (Drs Amankwah and Goldenberg); and SenseTech, LLC, Denver, Colorado (Dr Bauer)
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Urbanik A, Guz W, Brożyna M, Ostrogórska M. Changes in the central nervous system in football players: an MRI study. Acta Radiol 2024:2841851241248410. [PMID: 38767036 DOI: 10.1177/02841851241248410] [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: 05/22/2024]
Abstract
BACKGROUND Football (soccer) is the world's most popular team sport. PURPOSE To comprehensively examine the brain in football (soccer) players, with the use of magnetic resonance imaging (MRI) techniques. MATERIAL AND METHODS The study involved 65 football players and 62 controls. The MR examinations were performed using MR 1.5-T system (Optima MR 360; GE Medical Systems). The examinations were carried out in the 3D Bravo, CUBE, FSEpropeller, and diffusion-weighted imaging (DWI) sequences. The 1HMRS signal was obtained from the volume of interest in the frontal and occipital lobes on both sides. RESULTS The present study, based on structural MRI, shows some changes in the brains of the group of football players. The findings show asymmetry of the ventricular system in four football players, arachnoid cysts in the parieto-occipital region, and pineal cysts. NAA/Cr concentration in the right frontal lobe was lower in the football players than in the controls, and the Glx/Cr concentration in the right occipital lobe was higher. The apparent diffusion coefficient value is lower in football players in the occipital lobes. CONCLUSION Playing football can cause measurable changes in the brain, known to occur in patients diagnosed with traumatic brain injury. The present findings fill the gap in the literature by contributing evidence showing that playing football may lead to changes in the brain, without clinical symptoms of concussion.
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Affiliation(s)
- Andrzej Urbanik
- Department of Radiology, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Wiesław Guz
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Maciej Brożyna
- Institute of Physical Culture Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Monika Ostrogórska
- Department of Radiology, Collegium Medicum, Jagiellonian University, Krakow, Poland
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3
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Palazzolo JM, Goble DJ, Labban JD, Ross SE, Duffy DM, Rhea CK. Differences in pre-season balance among student athletes based on level of contact, age, and sex. Gait Posture 2024; 110:35-40. [PMID: 38479339 DOI: 10.1016/j.gaitpost.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Assessing postural control is important for the assessment of motor function after concussion. Data used for postural control assessment typically do not take the sport played, age, or sex of the athlete into consideration. It is plausible these variables may be significant when making return-to-play decisions. RESEARCH QUESTION This study used the BTrackS database to examine differences in postural control in athletes playing different types of sports and across sex and age. METHODS BTrackS data from 9093 high school to college-aged athletes (aged 14-22 years) were examined employing a One-way ANOVA with a post-hoc test to compare CoP path length between sport types. A moderation analysis was used to test interaction effects of sex and age on a CoP/BMI ratio. RESULTS Significant differences were observed between sport types, F(3,9089) = 42.4, p <.001, η2 = 0.014. Post hoc tests indicated that collision (M = 25.0, SD = 7.6) sport athletes exhibited significantly higher CoP measures compared to the contact (M = 23.4, SD = 7.4), limited contact (M = 22.9, SD = 6.9), and non-contact (M = 23.0, SD = 7.4) athletes. There was no difference between other sport types (p >.20). A significant mean sex difference (Mmale = 0.924, Mfemale = 0.898, p <.001) and a quadratic association with age, (β = -0.042, p <.001) was observed. Further, magnitude of those age differences decreased with age (β = 0.011, p <.001). An interaction of age and sex was significant for linear (β = 0.020, p <.001) and quadratic terms (β = -0.006, p <.001). SIGNIFICANCE Athletes exhibited different postural control when the type of sport, age, and sex was taken into consideration. This data possess clinical significance as this suggests that normative postural control data for collision sport athletes should be derived from data based upon type of sport played, age, and sex of the athlete.
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Affiliation(s)
- John M Palazzolo
- Department of Health and Exercise Sciences, Truman State University, Kirksville, MO, USA.
| | - Daniel J Goble
- Department of Humna Movement Science, Oakland University, Rochester, MI, USA
| | - Jeff D Labban
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Scott E Ross
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Donna M Duffy
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, 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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Dairi I, Brown C, DiGregorio H, Wasfy M, Baggish A, Pitler L, Copen WA, Doyle M, Wu O, Zafonte R, Tenforde AS. A Case Report of Reversible Cognitive Decline in a Former Professional American-Style Football Player: Findings from the Football Players Health Study In-Person Assessments. Curr Sports Med Rep 2023; 22:154-157. [PMID: 37141607 DOI: 10.1249/jsr.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Heather DiGregorio
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | | | | | - Linda Pitler
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - William A Copen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael Doyle
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
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Caccese JB, Bryk KN, Porfido T, Bretzin AC, Peek K, Kaminski TW, Kontos AP, Chrisman SPD, Putukian M, Buckley TA, Broglio SP, McAllister TW, McCrea MA, Pasquina PF, Esopenko C. Cognitive and Behavioral Outcomes in Male and Female NCAA Soccer Athletes across Multiple Years: A CARE Consortium Study. Med Sci Sports Exerc 2023; 55:409-417. [PMID: 36288576 DOI: 10.1249/mss.0000000000003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study was to determine changes in neurocognitive, psychosocial, and balance functioning in collegiate male and female soccer players across three consecutive years of baseline testing compared with a control group of noncontact athletes. METHODS Generalized estimating equations were used to compare changes in annual, preseason baseline measures of neurocognitive function, neurobehavioral and psychological symptoms, and postural stability between collegiate soccer players ( n = 75; 51 [68%] female soccer players) and noncontact athletes ( n = 210; 133 [63%] female noncontact athletes) across three consecutive years. RESULTS Among all participants, the group-time interaction was not significant for any outcome measures. Overall, soccer players reported lower (better) Brief Symptom Inventory 18 Depression ( P = 0.004, Exp(B) = 0.36, 95% confidence interval [CI] = 0.18-0.73), Global Severity Index ( P = 0.006, Exp(B) = 0.53, 95% CI = 0.33-0.84), and Post-Concussion Symptom Scale Symptom Severity ( P < 0.001, Exp(B) = 0.45, 95% CI = 0.22-0.95) scores than noncontact athletes. No other outcome measures were different between soccer players and noncontact athletes. CONCLUSIONS Among collegiate athletes, soccer players report similar or better psychosocial functioning and symptom scores than noncontact athletes. Importantly, neurocognitive functioning, neurobehavioral and psychological symptoms, and postural stability do not worsen over time in collegiate soccer players relative to their noncontact counterparts. Our findings suggest that despite possible exposure to repetitive head impacts, collegiate soccer players do not exhibit changes in observable function and symptoms across multiple seasons.
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Affiliation(s)
| | - Kelsey N Bryk
- Interdisciplinary Biomechanics and Movement Science Program and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Tara Porfido
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Abigail C Bretzin
- Penn Injury Science Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, AUSTRALIA
| | - Thomas W Kaminski
- Interdisciplinary Biomechanics and Movement Science Program and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, WA
| | - Margot Putukian
- Major League Soccer, New York, NY (previously Princeton University, Princeton, NJ)
| | - Thomas A Buckley
- Interdisciplinary Biomechanics and Movement Science Program and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI
| | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul F Pasquina
- Uniformed Services University of the Health Science and Walter Reed National Military Medical Center, Bethesda, MD
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
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Oldham JR, Howell D, Lanois C, Berkner P, Iverson GL, Mannix R, Meehan W. Neurocognitive functioning and symptoms across levels of collision and contact in male high school athletes. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328469. [PMID: 35477889 DOI: 10.1136/jnnp-2021-328469] [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: 11/15/2021] [Accepted: 04/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We sought to determine whether male collision sport athletes perform worse on computerised neurocognitive assessments and report higher symptom burdens than athletes in contact (but not collision) sports and athletes in non-contact sports. METHODS This cross-sectional study used data collected by the Massachusetts Concussion Management Coalition on high school boys who underwent computerised neurocognitive testing between 2009 and 2018. We divided sports participation in three different sport types: (1) collision, (2) contact, non-collision and (3) non-contact. Our outcomes included the four computerised neurocognitive composite scores (verbal memory, visual memory, visual motor speed and reaction time) and the total symptom score. The independent variable was sport type (collision, contact, non-contact), adjusted for age, concussion history and comorbidities. RESULTS Of the 92 979 athletes (age: 15.59±2.08 years) included in our study, collision sport athletes performed minimally but significantly worse than other athletes on neurocognitive composite scores (verbal memory: β=-1.64, 95% CI -1.85 to -1.44; visual memory: β=-1.87, 95% CI -2.14 to -1.60; visual motor speed: β=-2.12, 95% CI -2.26 to -1.97; reaction time: β=0.02, 95% CI 0.02 to 0.02). Collision and contact sport athletes also had slightly but significantly lower total symptom scores (collision: 3.99±7.17; contact: 3.78±6.81; non-contact: 4.32±7.51, p<0.001, η2=0.001) than non-contact sport athletes. CONCLUSION There are minimal observed differences in performance on neurocognitive assessments between collision sport, contact sport and non-contact sport athletes. The repetitive subconcussive head impacts associated with collision sport participation do not appear to negatively affect self-reported symptoms or neurocognitive functioning in current youth athletes.
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Affiliation(s)
- Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David Howell
- Children's Hospital Colorado Sports Medicine Center, Aurora, Colorado, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Corey Lanois
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Paul Berkner
- University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Rebekah Mannix
- Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - William Meehan
- Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
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Smeha N, Kalkat R, Sergio LE, Hynes LM. Sex-related differences in visuomotor skill recovery following concussion in working-aged adults. BMC Sports Sci Med Rehabil 2022; 14:72. [PMID: 35443693 PMCID: PMC9022305 DOI: 10.1186/s13102-022-00466-6] [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: 09/07/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The ability to perform visually-guided motor tasks requires the transformation of visual information into programmed motor outputs. When the guiding visual information does not align spatially with the motor output, the brain processes rules to integrate somatosensory information into an appropriate motor response. Performance on such rule-based, "cognitive-motor integration" tasks is affected in concussion. Here, we investigate the relationship between visuomotor skill performance, concussion history, and sex during the course of a post-concussion management program. METHODS Fifteen acutely concussed working-aged adults, 11 adults with a history of concussion, and 17 healthy controls all completed a recovery program over the course of 4 weeks. Prior to, mid-way, and following the program, all participants were tested on their visuomotor skills. RESULTS We observed an overall change in visuomotor behaviour in all groups, as participants completed the tasks faster and more accurately. Specifically, we observed significant visuomotor skill improvement between the first and final sessions in participants with a concussion history compared to no-concussion-history controls. Notably, we observed a stronger recovery of these skills in females. CONCLUSIONS Our findings indicate that (1) concussion impairs visuomotor skill performance, (2) the performance of complex, rule-based tasks showed improvement over the course of a recovery program, and (3) stronger recovery in females suggests sex-related differences in the brain networks controlling skilled performance, and the effect of injury on these networks.
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Affiliation(s)
- Nicole Smeha
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,Centre for Vision Research, York University, Toronto, Canada
| | - Ravneet Kalkat
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada. .,York University Sport Medicine Team, York University, Toronto, Canada. .,Centre for Vision Research, York University, Toronto, Canada.
| | - Loriann M Hynes
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,York University Sport Medicine Team, York University, Toronto, Canada
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