1
|
Salmon DM, Badenhorst M, Sole G, Sullivan SJ, Register-Mihalik J. The balancing act - Physiotherapists' experiences of managing rugby-related concussion in the community. Physiother Theory Pract 2024; 40:1459-1476. [PMID: 36715056 DOI: 10.1080/09593985.2023.2170195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND New Zealand Rugby (NZR) implemented a concussion management pathway (CMP) to improve management at the community level. Physiotherapists play an important role in the CMP. OBJECTIVE This study explored physiotherapists' experiences in the management of community rugby-related concussion as part of the CMP. METHODS We adopted a pragmatic, descriptive qualitative approach to explore perceptions of twenty-four physiotherapists involved in the CMP. Thematic analysis was used to analyze data. RESULTS Four themes represented participants' experiences: 1) 'walking the tight rope between player welfare and performance' described the balancing act between different attitudes and priorities of the various rugby stakeholders; 2) empowering physiotherapists' authority and responsibilities, described the influence of physiotherapists' authority within the team and concussion management responsibilities; 3) multi-directional communication, described the role of communication between multiple stakeholders; and 4) the influence of context, which included the complexity of concussion, concussion knowledge of the physiotherapists and team, resource support for the physiotherapist, and access to a medical doctor. CONCLUSION Physiotherapists had positive attitudes toward the CMP and are well-positioned to play an active role in the pathway. Priorities of other stakeholders, authority of the physiotherapist and the communication flow influences physiotherapists' ability to optimally manage players with concussion.
Collapse
Affiliation(s)
- Danielle M Salmon
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Sole
- Centre of Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - S John Sullivan
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Johna Register-Mihalik
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
2
|
Jorgensen MP, Safai P, Mainwaring L. An examination of social relations and concussion management via the blue card. Front Sports Act Living 2024; 6:1392809. [PMID: 38887686 PMCID: PMC11180777 DOI: 10.3389/fspor.2024.1392809] [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: 02/28/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction Initially developed by New Zealand Rugby in 2014, the Blue Card initiative in rugby enables match officials to remove athletes from play if they are suspected to have sustained a concussion. Considerable attention has been paid by sport and health advocates to the possibilities and limitations of this initiative in safeguarding athlete health. However, little if any attention has been paid to the well-being of those responsible for administering the Blue Card (i.e., match officials). The aim of this paper was to examine match officials' experiences with and perspectives on implementing the Blue Card initiative in Ontario, Canada, with focused attention on the tensions around their ability to manage games and participants (e.g., athletes, coaches) while attempting to safeguard athlete well-being. Methods Using Relational Coordination Theory (RCT) as a guiding framework and qualitative research method, we highlight the rich accounts of 19 match officials' perspectives and experiences regarding sport-related concussion (SRC) management and the Blue Card protocol. Results Four themes were derived from the data, reflecting latent assumptions embedded within the concussion management process, which include: assumptions of trust, respect, and cooperation; assumptions of shared responsibility; assumptions of shared understanding; and assumptions of harassment-free sport. Discussion Our findings emphasize the need to attend to social relations in concussion management and provide insight into match officials' fraught experiences on the frontlines of concussion management. We identify factors affecting match official well-being and provide considerations for concussion management initiatives designed to improve athlete safety, such as the Blue Card.
Collapse
Affiliation(s)
- Michael P. Jorgensen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Parissa Safai
- Faculty of Health, York University, Toronto, ON, Canada
| | - Lynda Mainwaring
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Bennett H, Fuller J, Debenedictis T, Chalmers S. Ankle sprain, concussion, and anterior cruciate ligament injuries are common and burdensome in sub-elite female Australian football players. J Sci Med Sport 2024:S1440-2440(24)00157-9. [PMID: 38839540 DOI: 10.1016/j.jsams.2024.05.008] [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: 11/22/2023] [Revised: 02/28/2024] [Accepted: 05/16/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES To describe the epidemiology of injuries in sub-elite female Australian Football (AF). DESIGN Prospective cohort. METHODS 424 athletes were tracked across a 12-match season. Injury characteristics (location, severity, mechanism) were reported. Injury incidence (injuries per 1000 h) and injury burden (days absent per 1000 h) were calculated. Severity was considered as the number of days missed between injury onset and return to full training. Incidence was compared using incidence rate ratios, and severity using a Mann-Whitney U test. RESULTS Total injury incidence was 10.8 (95 % confidence interval [CI] = 9.0, 12.8) injuries per 1000 h. Match incidence was 34.6 (95 % CI = 28.0, 42.4) injuries per 1000 h. Ankle sprain injuries (2.2 per 1000 h, 95 % CI = 1.4, 3.1) and concussion (1.6 per 1000 h, 95 % CI = 1.0, 2.5) injuries were the most frequent, followed by anterior cruciate ligament (ACL) injuries (0.9 per 1000 h, 95 % CI = 0.4, 1.6). ACL (40.4 days per 1000 h, 95 % CI = 36.9, 44.1), ankle sprain injuries (31.4 per 1000 h, 95 % CI =28.4, 34.7), and concussion (19.9 per 1000 h, 95 % CI = 17.5, 22.5) injuries were also the most burdensome. There were 78 mild, 34 moderate, and 21 severe injuries. ACL injuries were the most severe injury (56.0 [77.0] in-season days missed). CONCLUSIONS This research describes the first large-scale injury profile of sub-elite female AF, reporting time-loss measures of incidence and burden for many injury types. Ankle sprain injuries, concussions, and ACL injuries are common and burdensome, and should be prioritised for prevention.
Collapse
Affiliation(s)
- Hunter Bennett
- Allied Health and Human Performance, University of South Australia, Australia; Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Australia.
| | - Joel Fuller
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Thomas Debenedictis
- South Australian National Football League, Australia. https://twitter.com/tommyd_90
| | - Samuel Chalmers
- Allied Health and Human Performance, University of South Australia, Australia; Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Australia. https://twitter.com/_samchalmers
| |
Collapse
|
4
|
Salmon D, Badenhorst M, Clark B, Walters S, Sullivan SJ, Sole G. Unintended consequences - A qualitative exploration of baseline testing in community rugby concussion management. J Sci Med Sport 2024:S1440-2440(24)00152-X. [PMID: 38811276 DOI: 10.1016/j.jsams.2024.05.003] [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: 11/15/2023] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Understanding key stakeholders' perceptions around the value of baseline testing, as well as barriers or facilitators experienced as part of the process, may assist with the decision-making process of whether to implement baseline testing in community sport. This study explored coaches', players' and physiotherapists' perceptions of the perceived value, barriers and facilitators of baseline testing as part of New Zealand Rugby's (NZR) community concussion initiative. DESIGN The study employed a pragmatic, qualitative descriptive design. METHODS Semi-structured interviews were used to explore participants' perceptions. In total, 73 individual interviews were conducted. The sample consisted of 36 players, 13 coaches and 24 physiotherapists involved in NZR's concussion management pathway. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. RESULTS In terms of perceived value, baseline testing was reported to play a role in i) facilitating a positive concussion culture; ii) positive perceptions of rugby and player safety and iii) enhancing concussion management as part of the pathway. Barriers and facilitators of the baseline testing process included i) stakeholder buy-in as critical driver of the process and ii) contextual and operational factors. Although contextual and operational challenges exist, these participants, as key stakeholders in the process, perceived the value of baseline testing to be more important than the barriers experienced. CONCLUSIONS The value of baseline testing extends beyond concussion assessment and management, by enhancing community concussion awareness, attitudes and player safety. The findings of this study may assist in the decision-making process around inclusion of pre-season baseline testing in community rugby.
Collapse
Affiliation(s)
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, New Zealand.
| | - Brooke Clark
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, New Zealand
| | | | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| |
Collapse
|
5
|
Peek K, Fraser K, Yearwood GMH, McKay MJ. Women, concussion and disputing an old myth: the game of football is not 'unsuitable for females'. Br J Sports Med 2024; 58:297-298. [PMID: 38331565 DOI: 10.1136/bjsports-2023-107486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Kerry Peek
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Kotryna Fraser
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Gabby M H Yearwood
- Department of Anthropology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marnee J McKay
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Finnegan E, Daly E, Ryan L. Nutritional Considerations of Irish Performance Dietitians and Nutritionists in Concussion Injury Management. Nutrients 2024; 16:497. [PMID: 38398823 PMCID: PMC10891776 DOI: 10.3390/nu16040497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Sport-related concussion incidence has increased in many team-based sports, such as rugby, Gaelic (camogie, hurling, football), and hockey. Concussion disrupts athletes' brain function, causing an "energy crisis" that requires energy and nutrient support to restore function and heal. Performance dietitians and nutritionists play a role in supporting athletes' post-injury nutritional demands. This study aimed to investigate Irish performance dietitians' and nutritionists' knowledge and implementation of nutritional strategies to manage and support athletes' recovery following concussion. In-depth, semi-structured interviews were conducted with seventeen (n = 17) Irish performance dietitians and nutritionists recruited from the Sport and Exercise Nutrition register and other sporting body networks across Ireland. Participants practised or had practised with amateur and/or professional athletes within the last ten years. All interviews and their transcripts were thematically analysed to extract relevant insights. These data provided valuable insights revealing performance dietitians and nutritionists: (1) their awareness of concussion events and (2) their use of nutritional supports for concussion management. Furthermore, the research highlighted their implementation of 'novel nutritional protocols' specifically designed to support and manage athletes' concussion recovery. There was a clear contrast between participants who had an awareness and knowledge of the importance of nutrition for brain recovery after sport-related concussion(s) and those who did not. Participants presenting with a practical understanding mentioned re-emphasising certain foods and supplements they were already recommending to athletes in the event of a concussion. Performance dietitians and nutritionists were keeping up to date with nutrition research on concussions, but limited evidence has prevented them from implementing protocols in practice. Meanwhile, participants mentioned trialling/recommending nutritional protocols, such as carbohydrate reloading, reducing omega-6 intake, and acutely supplementing creatine, omega-3 fish oils high in Docosahexaenoic acid, and probiotics to support brain healing. Performance dietitians' and nutritionists' use of nutrition protocols with athletes following concussion was linked to their knowledge and the limited scientific evidence available. Nutrition implementation, therefore, may be overlooked or implemented with uncertainty, which could negatively affect athletes' recovery following sports-related concussions.
Collapse
Affiliation(s)
| | | | - Lisa Ryan
- Department of Sport, Exercise and Nutrition, Atlantic Technological University (ATU), H91 T8NW Galway, Ireland; (E.F.); (E.D.)
| |
Collapse
|
7
|
Hunzinger KJ, Schussler E. The 50 Most Cited Papers on Rugby since 2000 Reveal a Focus Primarily on Strength and Conditioning in Elite Male Players. JOURNAL OF SPORTS MEDICINE (HINDAWI PUBLISHING CORPORATION) 2023; 2023:6991769. [PMID: 38148987 PMCID: PMC10751173 DOI: 10.1155/2023/6991769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/06/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
We sought to conduct a bibliometric analysis and review of the most cited publications relating to rugby since 2000 in order to identify topics of interest and those that warrant further investigations. Clarivate Web of Science database was used to perform a literature search using the search term "rugby." The top 200 papers by citation count were extracted and reviewed for the inclusion criteria: all subjects were rugby players. The top 50 manuscripts were included for analysis of author, publication year, country of lead authors, institution, journal name and impact factor, topic, participant sex, and level of rugby. The total number of citations was 9,071 (average of 181.4 citations/article), with an average journal impact factor of 7.21; the top article was cited 407 times at the time of analysis. The most frequent publication was the Journal of Strength and Conditioning Research (26%), followed by the British Journal of Sports Medicine (20%) and the Journal of Sports Sciences (18%). Forty-eight (96%) of the manuscripts contained only male subjects, with 1 manuscript including females only and 1 manuscript containing mixed sexes. Thirty-three (66%) of the manuscripts focused on professional rugby players, with the next highest player group being mixed levels (10%). Twenty-eight (56%) concentrated on topics regarding strength and conditioning, 11 (22%) on injury, and 4 (8%) on physiology. Despite rugby being one of the most injurious sports and community players representing the largest component of the player pool, most of the top-cited rugby articles are cohort studies of professional male athletes focused on performance and strength and conditioning, noting the bias in research towards socially relevant topics that may not impact the majority of stakeholders and long-term health of rugby athletes. These findings highlight the need for further research among women and community athletes and on topics in injury prevention.
Collapse
Affiliation(s)
| | - Eric Schussler
- School of Rehabilitation Sciences, Old Dominion University, Norfolk, USA
| |
Collapse
|
8
|
Garcia GGP, Czerniak LL, Lavieri MS, Liebel SW, Van Pelt KL, Pasquina PF, McAllister TW, McCrea MA, Broglio SP. Estimating the Relationship Between the Symptom-Free Waiting Period and Injury Rates After Return-to-Play from Concussion: A Simulation Analysis Using CARE Consortium Data. Sports Med 2023; 53:2513-2528. [PMID: 37610654 DOI: 10.1007/s40279-023-01901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND A key component of return-to-play (RTP) from sport-related concussion is the symptom-free waiting period (SFWP), i.e., the period during which athletes must remain symptom-free before permitting RTP. Yet, the exact relationship between SFWP and post-RTP injury rates is unclear. OBJECTIVE We design computational simulations to estimate the relationship between the SFWP and rates of repeat concussion and non-concussion time-loss injury up to 30 days post-RTP for male and female collegiate athletes across 13 sports. METHODS We leverage N = 735 female and N = 1,094 male post-injury trajectories from the National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research, and Education Consortium. RESULTS With a 6-day SFWP, the mean [95% CI] rate of repeat concussion per 1,000 simulations was greatest in ice hockey for females (20.31, [20.16, 20.46]) and American football for males (24.16, [24.05, 24.28]). Non-concussion time-loss injury rates were greatest in field hockey for females (153.66, [152.59, 154.74]) and wrestling for males (247.34, [246.20, 248.48]). Increasing to a 13-day SFWP, ice hockey for females (18.88, [18.79, 18.98]) and American football for males (23.16, [23.09, 24.22]) exhibit the greatest decrease in repeat concussion rates across all sports within their respective sexes. Field hockey for females (143.24, [142.53, 143.94]) and wrestling for males (237.73, [236.67, 237.90]) exhibit the greatest decrease in non-concussion time-loss injury rates. Males receive marginally smaller reductions in injury rates for increased SFWP compared to females (OR = 1.003, p ≤ 0.002). CONCLUSION Longer SFWPs lead to greater reductions in post-RTP injury rates for athletes in higher risk sports. Moreover, SFWPs should be tailored to sport-specific post-RTP injury risks.
Collapse
Affiliation(s)
- Gian-Gabriel P Garcia
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Lauren L Czerniak
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Mariel S Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Spencer W Liebel
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | | | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
9
|
Stewart W, Buckland ME, Abdolmohammadi B, Affleck AJ, Alvarez VE, Gilchrist S, Huber BR, Lee EB, Lyall DM, Nowinski CJ, Russell ER, Stein TD, Suter CM, McKee AC. Risk of chronic traumatic encephalopathy in rugby union is associated with length of playing career. Acta Neuropathol 2023; 146:829-832. [PMID: 37872234 PMCID: PMC10627955 DOI: 10.1007/s00401-023-02644-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Affiliation(s)
- William Stewart
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK.
- Department of Neuropathology, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK.
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Bobak Abdolmohammadi
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Andrew J Affleck
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Victor E Alvarez
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Shannon Gilchrist
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Bertrand R Huber
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
- National Center for PTSD, VA Boston Healthcare, Boston, MA, 02130, USA
| | - Edward B Lee
- Translational Neuropathology Research Laboratory, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Christopher J Nowinski
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Concussion Legacy Foundation, Boston, MA, 02115, USA
| | - Emma R Russell
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Thor D Stein
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Catherine M Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Ann C McKee
- Alzheimer's Disease Research Center and Chronic Traumatic Encephalopathy Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, 02130, USA
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Bedford Healthcare System, Bedford, MA, 01730, USA
- National Center for PTSD, VA Boston Healthcare, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| |
Collapse
|
10
|
Serner A, Araújo J, Beasley I, Boyce SH, Byrne A, Börjesson M, Geertsema L, Grimm K, Massey A. Video review of the frequency and assessment of head impacts during the FIFA Arab Cup 2021 TM. SCI MED FOOTBALL 2023; 7:331-336. [PMID: 36063104 DOI: 10.1080/24733938.2022.2120629] [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] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
We used injury spotters and video footage review to establish the frequency of head impacts, their characteristics, and the subsequent medical assessment during the FIFA Arab Cup 2021TM. Six defined video signs of potential concussion based on an international consensus were used. A total of 88 head impacts were observed, with a median of 2 (IQR 1.5-4, range 0-7) head impacts per match, of which 44 (50%) resulted in on-pitch medical assessment. The median assessment duration was 51s (IQR 34-65s, range 19-262s). The most common mechanism was head-to-head contact (27% of all impacts and 43% of impacts with medical assessment). Seven head impacts showed video signs of potential concussion: six had one sign and one had two signs. The concussion substitution was used in three incidents. Head impacts during the FIFA Arab Cup were common and a median of 1 head impact per game required an on-pitch medical assessment. Only 8% of the head impacts showed any video sign of potential concussion, and only 3% resulted in a concussion substitution. The medical on-pitch assessments appeared too short (<1 min) to allow an appropriate assessment of all head impacts, indicating a need for further evaluation. Further standardisation of the injury spotter's role in football is recommended.
Collapse
Affiliation(s)
- Andreas Serner
- Fédération Internationale de Football Association, Zurich, Switzerland
| | - Joao Araújo
- Sporting Clube de Portugal, Lisbon, Portugal
| | - Ian Beasley
- Centre for Sport and Exercise Medicine, Queen Mary College, University of London, London UK
| | - Stephen H Boyce
- Emergency Department, Glasgow Royal Infirmary, Scottish Football Association, Scottish Institute of Sport, Stirling UK
| | - Alan Byrne
- The Football Association of Ireland, National Sports Campus, Dublin, Ireland
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Center for Health and Performance, Sahlgrenska Academy, Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Katharina Grimm
- Fédération Internationale de Football Association, Zurich, Switzerland
| | - Andrew Massey
- Fédération Internationale de Football Association, Zurich, Switzerland
| |
Collapse
|
11
|
Malcolm D. Some problems of research exploring sex differences in sport-related concussions: a narrative review. Res Sports Med 2023:1-10. [PMID: 37856512 DOI: 10.1080/15438627.2023.2271604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
This narrative review scrutinizes research exploring sex-based differences in experiences of sport-related concussion. The article argues that the limitations of epidemiological studies identifying the greater incidence and severity of concussion among females require that these findings are read with caution. It secondly argues that the dominant explanations for these data are based on and extend historical tendencies to "other" female participation in sport and construct male experiences as the "norm". Finally, the article critiques policy recommendations related to these research findings, arguing that they are likely to embed rather than challenge sex inequality in sport, and that they are both impractical and unethical. While this commentary builds on a broader body of work advocating greater sex/gender equality in sports science research, the prominence of social concerns about concussions in sport makes the broader implications of the focus on sex and sport-related concussion particularly problematic and thus in need of redress.
Collapse
Affiliation(s)
- Dominic Malcolm
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| |
Collapse
|
12
|
Salmon DM, Chua J, Brown JC, Clacy A, Kerr ZY, Walters S, Keung S, Sullivan SJ, Register-Mihalik J, Whatman C, Sole G, Badenhorst M. Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System. BMJ Open Sport Exerc Med 2023; 9:e001722. [PMID: 37860152 PMCID: PMC10582854 DOI: 10.1136/bmjsem-2023-001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
There is a growing concern around concussions in rugby union, at all levels of the game. These concerns highlight the need to better manage and care for players. However, consistency around concussion-related responsibilities of stakeholders across the community rugby system remains challenging. Taking a systems thinking approach, this pragmatic, qualitative descriptive study explored key stakeholder groups within New Zealand's community rugby system's perceptions of their own and others' concussion-related responsibilities. Participants included players from schools and clubs, coaches, parents, team leads and representatives from four provincial unions. A total of 155 participants (67 females and 88 males) were included in the study. Focus groups and individual interviews were conducted. Thematic content analysis was used to analyse data. Thirty concussion-related responsibilities were identified. These responsibilities were contained within four themes: (1) policies and support (responsibilities which influence policy, infrastructure, human or financial resources); (2) rugby culture and general management (responsibilities impacting players' welfare and safety, attitudes and behaviour, including education, injury reporting and communication); (3) individual capabilities (responsibilities demonstrating knowledge and confidence managing concussion, leadership or role/task shifting) and (4) intervention following a suspected concussion (immediate responsibilities as a consequence of a suspected concussion). The need for role clarity was a prominent finding across themes. Additionally, injury management initiatives should prioritise communication between stakeholders and consider task-shifting opportunities for stakeholders with multiple responsibilities. How concussions will realistically be managed in a real-world sports setting and by whom needs to be clearly defined and accepted by each stakeholder group. A 'framework of responsibilities' may act as a starting point for discussion within different individual community rugby contexts on how these responsibilities translate to their context and how these responsibilities can be approached and assigned among available stakeholders.
Collapse
Affiliation(s)
- Danielle M Salmon
- Safety and Welfare, New Zealand Rugby, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Jason Chua
- Safety and Welfare, New Zealand Rugby, Wellington, New Zealand
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - James C Brown
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda Clacy
- School of Law & Society, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Simon Walters
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Sierra Keung
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - S John Sullivan
- Safety and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Johna Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Sole
- School of Physiotherapy, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
13
|
Musko PA, Demetriades AK. Are Sex Differences in Collegiate and High School Sports-Related Concussion Reflected in the Guidelines? A Scoping Review. Brain Sci 2023; 13:1310. [PMID: 37759911 PMCID: PMC10526868 DOI: 10.3390/brainsci13091310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Sport-related concussion (SRC) is a common sport injury. Females are participating in sports at increasing rates, and there is growing awareness that female athletes may be more vulnerable to SRC. Objectives: We aimed to identify sex differences in epidemiology, clinical manifestation and assessment of SRC and examine how these relate to the 6th International Conference on Concussion in Sport (ICCS). Methods: We conducted a scoping review of the Medline database and identified 58 studies examining the effects of sex on SRC in collegiate and high school athletes that were written in English and published in a peer-reviewed journal between March 2012 and March 2022. Results: We found that female athletes suffer higher rates of concussion in sex-comparable sports, in particular soccer. Female athletes experience more somatic symptoms-headache/migraine/sleep disturbance-and may take longer to recover from concussion. Sex differences were also identified regarding some aspects of sideline concussion assessment with the Sport Concussion Assessment Tool. Conclusions: Females are at greater risk and experience SRC differently than males; this is mostly likely due to a combination of biomechanical factors, differences in neck musculature and hormonal and social factors. Sex differences are not widely addressed by the 6th ICSS, which informs many sports' concussion protocols.
Collapse
Affiliation(s)
- Patryk A. Musko
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | | |
Collapse
|
14
|
Kolstad AT, Eliason PH, Galarneau JM, Black AM, Hagel BE, Emery CA. Protective equipment in youth ice hockey: are mouthguards and helmet age relevant to concussion risk? Br J Sports Med 2023; 57:571-577. [PMID: 36918257 PMCID: PMC10176392 DOI: 10.1136/bjsports-2022-105585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To compare the incidence rates and odds of concussion between youth ice hockey players based on mouthguard use and helmet age. MATERIALS AND METHODS Within a 5-year longitudinal cohort (2013/2014 to 2017/2018) of male and female ice hockey players (ages 11-18; n=3330 players) in Alberta (Canada), we analysed the relationship of equipment and concussion in both a prospective cohort and nested case (concussion) control (acute musculoskeletal injury) approach. The prospective cohort included baseline assessments documenting reported mouthguard use (yes/sometimes, no use), helmet age (newer/<2 years old, older/≥2 years old) and important covariables (weight, level of play, position of play, concussion history, body checking policy), with weekly player participation throughout the season. The nested case-control component used injury reports to document equipment (mouthguard use, helmet age) and other information (eg, mechanism and type of injury) for the injury event. Multivariable mixed effects negative binomial regression (prospective cohort, incidence rate ratios (IRRs)) and multivariable mixed effects logistic regression (nested case-control, odds ratios (OR)) examined the association between equipment and concussion. RESULTS Players who reported wearing a mouthguard had a 28% lower concussion rate (IRR=0.72, 95% CI 0.56 to 0.93) and 57% lower odds of concussion (OR=0.43, 95% CI 0.27 to 0.70) compared with non-wearers. There were no associations in the concussion rate (IRR=0.94, 95% CI 0.75 to 1.15) and odds (OR=1.16, 95% CI 0.73 to 1.86) between newer and older helmets. CONCLUSIONS Wearing a mouthguard was associated with a lower concussion rate and odds. Policy mandating use should be considered in youth ice hockey. More research is needed to identify other helmet characteristics (eg, quality, fit) that could lower concussion risk.
Collapse
Affiliation(s)
- Ash T Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Brent E Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
15
|
Henley S, Andrews K, Kabaliuk N, Draper N. Soft-shell headgear in rugby union: a systematic review of published studies. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-023-01058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Abstract
Objectives
To review the rate of soft-shell headgear use in rugby union, consumer knowledge of the protection potential of soft-shell headgear, incidence of concussion reported in rugby headgear studies, and the capacity of soft-shell headgear to reduce acceleration impact forces.
Design
A systematic search was conducted in July and August 2021 using the databases SPORT Discus, PubMed, MEDLINE, CINAHL (EBSCO), Scopus, and Science Direct. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this systematic review was registered on PROSPERO (registration number: CRD42021239595).
Outcome measures
Rates of headgear use, reports of estimated protection of headgear against head injury, incidence of concussion and magnitude of impact collisions with vs. without headgear, impact attenuation of headgear in lab studies.
Results
Eighteen studies were identified as eligible: qualitative (N = 4), field (N = 7), and lab (N = 7). Qualitative studies showed low rates of headgear use and varying understanding of the protection afforded by headgear. Field studies showed negligible association of headgear use with reduced impact magnitude in headgear vs. non-headgear cohorts. Lab studies showed increased energy attenuation for thicker headgear material, poorer performance of headgear after repetitive impacts and increased drop heights, and promising recent results with headgear composed of viscoelastic polymers.
Conclusions
Rates of adoption of soft-shell headgear remain low in rugby and any association between its use and reduction in acceleration impact forces remains unclear. Lab results indicating improved impact attenuation need to be validated in the field. Further headgear-related research is needed with youth and female rugby players.
Collapse
|
16
|
Broglio SP, Perkins SM, Riggen L, Stemper BD, Shah A, McAllister TW, McCrea M. Similar Concussion Rates in Spring Football and Preseason: Findings From the Concussion Assessment, Research and Education Consortium. J Athl Train 2023; 58:220-223. [PMID: 35724362 PMCID: PMC10176843 DOI: 10.4085/1062-6050-0132.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Increasing attention has been directed toward identifying aspects of football participation for targeted policy change that reduces the concussion risk. Prior researchers evaluated concussion risks during the preseason and regular seasons, leaving the spring season largely unexplored. DESIGN In this nationally representative observational investigation of 19 National Collegiate Athletic Association Division I collegiate football programs, we assessed concussion rates and head impact exposures during the preseason, regular season, and spring practices from 2014 to 2019. All participating programs recorded the incidence of concussions, and a subset (n = 6) also measured head impact exposures. RESULTS Analyses by time of year and session type indicated that concussion rates and head impact exposures during all practice sessions and contact practices were higher in the spring and preseason than those in the regular season (P < .05). Concussion rates during the spring season and preseason were statistically similar. CONCLUSIONS We identified comparable concussion risks in the spring season and preseason, highlighting the need for targeted policy interventions to protect athlete health and safety.
Collapse
Affiliation(s)
| | | | - Larry Riggen
- Department of Biostatistics, Indiana University, Indianapolis
| | | | - Alok Shah
- Medical College of Wisconsin, Milwaukee
| | | | | | | |
Collapse
|
17
|
Trikha R, Greig DE, Shi BY, Schroeder GG, Chernoff DJ, Jones KJ, Kremen TJ. Multicenter Analysis of the Epidemiology of Injury Patterns and Return to Sport in Collegiate Gymnasts. Orthop J Sports Med 2023; 11:23259671231154618. [PMID: 36860774 PMCID: PMC9969444 DOI: 10.1177/23259671231154618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/08/2022] [Indexed: 03/03/2023] Open
Abstract
Background Gymnastics requires intense year-round upper and lower extremity strength training typically starting from an early age. As such, the injury patterns observed in these athletes may be unique. Purpose To characterize the types of injuries and provide return-to-sport data in male and female collegiate gymnasts. Study Design Descriptive epidemiology study. Methods A conference-specific injury database was utilized to perform a retrospective review of injuries for male and female National Collegiate Athletic Association (NCAA) Division I gymnasts within the Pacific Coast Conference between 2017 and 2020 (N = 673 gymnasts). Injuries were stratified by anatomic location, sex, time missed, and injury diagnoses. Relative risk (RR) was used to compare results between sexes. Results Of the 673 gymnasts, 183 (27.2%) experienced 1093 injuries during the study period. Injuries were sustained in 35 of 145 male athletes (24.1%) as compared with 148 of 528 female athletes (28.0%; RR, 0.86 [95% CI, 0.63-1.19]; P = .390). Approximately 66.1% (723/1093) of injuries occurred in a practice setting, compared with 84 of 1093 injuries (7.7%) occurring during competition. Overall, 417 of 1093 injuries (38.2%) resulted in no missed time. Shoulder injuries and elbow/arm injuries were significantly more common in male versus female athletes (RR, 1.99 [95% CI, 1.32-3.01], P = .001; and RR, 2.08 [95% CI, 1.05-4.13], P = .036, respectively). In total, 23 concussions affected 21 of 673 athletes (3.1%); 6 concussions (26.1%) resulted in the inability to return to sport during the same season. Conclusion For the majority of musculoskeletal injuries, the gymnasts were able to return to sport during the same season. Male athletes were more likely to experience shoulder and elbow/arm injuries, likely because of sex-specific events. Concussions occurred in 3.1% of the gymnasts, highlighting the need for vigilant monitoring. This analysis of the incidence and outcomes of injuries observed in NCAA Division I gymnasts may guide injury prevention protocols as well as provide important prognostic information.
Collapse
Affiliation(s)
- Rishi Trikha
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA.,Rishi Trikha, MD, UCLA Orthopaedic Surgery, 1225 15th Street,
Suite 2100, Santa Monica, CA 90404, USA (
)
| | - Danielle E. Greig
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Brendan Y. Shi
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Grant G. Schroeder
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel J. Chernoff
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Thomas J. Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
18
|
Cordingley DM, Cornish SM. Efficacy of aerobic exercise following concussion: a narrative review. Appl Physiol Nutr Metab 2023; 48:5-16. [PMID: 36423352 DOI: 10.1139/apnm-2022-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Concussion is a type of mild traumatic brain injury which results in symptoms within the physical, cognitive, emotional, and sleep domains. Historically, guidelines established by expert opinion have recommended rest during the initial stages of recovery following a concussion until symptom resolution. However, recent recommendations have shifted to advise an initial period of 24-48 h of rest immediately following concussion with the gradual introduction of light-to-moderate intensity aerobic exercise thereafter. Given the relatively recent transition in recommendations, the aim of this review is to provide an overview of the current literature on the efficacy of aerobic exercise following concussion. The current literature is limited to studies assessing the impact of standardized aerobic exercise following concussion. Upon review, literature suggests participating in aerobic exercise below the point of symptom exacerbation is safe in both the acute and chronic post-concussion symptom stages of recovery and does not delay time to medical clearance. Future large-scale randomized controlled trials assessing the impact of aerobic exercise and differences between males and females would help support the current evidence suggesting aerobic exercise could improve time to recovery following concussion and identify any sex differences in response. As well, future studies with the purpose of identifying optimal aerobic exercise volume and intensity in the treatment of concussion could improve the specificity of the current guidelines.
Collapse
Affiliation(s)
- Dean M Cordingley
- Pan Am Clinic Foundation, Winnipeg, MB R3M 3E4 Canada
- Applied Health Sciences, Winnipeg, MB R3T 2N2, Canada
| | - Stephen M Cornish
- Applied Health Sciences, Winnipeg, MB R3T 2N2, Canada
- Faculty of Kinesiology and Recreation Management, Winnipeg, MB R3T 2N2, Canada
- Centre for Aging, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| |
Collapse
|
19
|
Bussey MD, Pinfold J, Romanchuk J, Salmon D. Anticipatory head control mechanisms in response to impact perturbations: An investigation of club rugby players with and without a history of concussion injury. Phys Ther Sport 2023; 59:7-16. [PMID: 36442352 DOI: 10.1016/j.ptsp.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The primary objective of this study was to examine rugby players anticipatory and compensatory head control during predictable and unpredictable impact events. METHODS An observational cross-sectional study design. Fifty-one (17_healthy 34_concussion) male rugby players were exposed to external predictable and unpredictable impact perturbations at mid-chest level. Surface EMG of the upper-trapezius (UT), splenius-capitis (Spl) and sternocleidomastoid (Scm) was recorded and analysed across three temporal epochs typical for anticipatory and compensatory postural control. Synchronized sagittal head-kinematics were measured from high-speed video (500 fps). Nonparametric tests were used to examine within and between group effects. RESULTS Anticipatory head control was evident in predictable conditions, expressed by early posterior head displacement and activation of the Spl. Compared to unpredictable conditions, muscle amplitudes were significantly lower, as was head acceleration. Compared to Healthy, the Concussion athletes lacked early activation of the Spl, exhibited delayed anticipatory head adjustments and experienced higher head accelerations in predictable conditions. CONCLUSION Rugby players with concussion injuries have significant deficits in cervical spinal motor control. The concussed motor control strategy leads to higher inertial head accelerations and delayed anticipatory head displacements. Effects may persist for two or more years following injury, which may indicate re-injury vulnerability in these athletes.
Collapse
Affiliation(s)
- Melanie D Bussey
- School of Physical Education Sport and Exercise Sciences, University of Otago, New Zealand.
| | - Jayden Pinfold
- School of Physical Education Sport and Exercise Sciences, University of Otago, New Zealand; Hawke's Bay Rugby, New Zealand.
| | - Janelle Romanchuk
- School of Physical Education Sport and Exercise Sciences, University of Otago, New Zealand; New Zealand Rugby, New Zealand.
| | | |
Collapse
|
20
|
Russell ER, Mackay DF, Lyall D, Stewart K, MacLean JA, Robson J, Pell JP, Stewart W. Neurodegenerative disease risk among former international rugby union players. J Neurol Neurosurg Psychiatry 2022; 93:1262-1268. [PMID: 36195436 PMCID: PMC9669247 DOI: 10.1136/jnnp-2022-329675] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/09/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Autopsy studies of former contact sports athletes, including soccer and rugby players, frequently report chronic traumatic encephalopathy, a neurodegenerative pathology associated with traumatic brain injury. Nevertheless, little is known about the risk of neurodegenerative disease in these populations. We hypothesised that neurodegenerative disease risk would be higher among former elite rugby union players than the general population. METHODS We conducted a retrospective cohort study accessing national electronic records on death certification, hospital admissions and dispensed prescriptions for a cohort of 412 male Scottish former international rugby union players and 1236 members of the general population, matched to former players by age, sex and area socioeconomic status. Mortality and incident neurodegenerative disease diagnoses among former rugby players were then compared with the matched comparison group. RESULTS Over a median 32 years follow-up from study entry at age 30 years, 121 (29.4%) former rugby players and 381 (30.8%) of the matched comparison group died. All-cause mortality was lower among former rugby players until 70 years of age with no difference thereafter. During follow-up, 47 (11.4%) former rugby players and 67 (5.4%) of the comparison group were diagnosed with incident neurodegenerative disease (HR 2.67, 95% CI 1.67 to 4.27, p<0.001). CONCLUSIONS This study adds to our understanding of the association between contact sports participation and the risk of neurodegenerative disease. While further research exploring this interaction is required, in the meantime strategies to reduce exposure to head impacts and head injuries in sport should be promoted.
Collapse
Affiliation(s)
- Emma R Russell
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, UK
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Katy Stewart
- Hampden Sports Clinic, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John A MacLean
- Hampden Sports Clinic, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - William Stewart
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, UK .,Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
21
|
Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, Aries M, Bashford T, Bell MJ, Bodien YG, Brett BL, Büki A, Chesnut RM, Citerio G, Clark D, Clasby B, Cooper DJ, Czeiter E, Czosnyka M, Dams-O’Connor K, De Keyser V, Diaz-Arrastia R, Ercole A, van Essen TA, Falvey É, Ferguson AR, Figaji A, Fitzgerald M, Foreman B, Gantner D, Gao G, Giacino J, Gravesteijn B, Guiza F, Gupta D, Gurnell M, Haagsma JA, Hammond FM, Hawryluk G, Hutchinson P, van der Jagt M, Jain S, Jain S, Jiang JY, Kent H, Kolias A, Kompanje EJO, Lecky F, Lingsma HF, Maegele M, Majdan M, Markowitz A, McCrea M, Meyfroidt G, Mikolić A, Mondello S, Mukherjee P, Nelson D, Nelson LD, Newcombe V, Okonkwo D, Orešič M, Peul W, Pisică D, Polinder S, Ponsford J, Puybasset L, Raj R, Robba C, Røe C, Rosand J, Schueler P, Sharp DJ, Smielewski P, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Temkin N, Tenovuo O, Theadom A, Thomas I, Espin AT, Turgeon AF, Unterberg A, Van Praag D, van Veen E, Verheyden J, Vyvere TV, Wang KKW, Wiegers EJA, Williams WH, Wilson L, Wisniewski SR, Younsi A, Yue JK, Yuh EL, Zeiler FA, Zeldovich M, Zemek R. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol 2022; 21:1004-1060. [PMID: 36183712 PMCID: PMC10427240 DOI: 10.1016/s1474-4422(22)00309-x] [Citation(s) in RCA: 188] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023]
Abstract
Traumatic brain injury (TBI) has the highest incidence of all common neurological disorders, and poses a substantial public health burden. TBI is increasingly documented not only as an acute condition but also as a chronic disease with long-term consequences, including an increased risk of late-onset neurodegeneration. The first Lancet Neurology Commission on TBI, published in 2017, called for a concerted effort to tackle the global health problem posed by TBI. Since then, funding agencies have supported research both in high-income countries (HICs) and in low-income and middle-income countries (LMICs). In November 2020, the World Health Assembly, the decision-making body of WHO, passed resolution WHA73.10 for global actions on epilepsy and other neurological disorders, and WHO launched the Decade for Action on Road Safety plan in 2021. New knowledge has been generated by large observational studies, including those conducted under the umbrella of the International Traumatic Brain Injury Research (InTBIR) initiative, established as a collaboration of funding agencies in 2011. InTBIR has also provided a huge stimulus to collaborative research in TBI and has facilitated participation of global partners. The return on investment has been high, but many needs of patients with TBI remain unaddressed. This update to the 2017 Commission presents advances and discusses persisting and new challenges in prevention, clinical care, and research. In LMICs, the occurrence of TBI is driven by road traffic incidents, often involving vulnerable road users such as motorcyclists and pedestrians. In HICs, most TBI is caused by falls, particularly in older people (aged ≥65 years), who often have comorbidities. Risk factors such as frailty and alcohol misuse provide opportunities for targeted prevention actions. Little evidence exists to inform treatment of older patients, who have been commonly excluded from past clinical trials—consequently, appropriate evidence is urgently required. Although increasing age is associated with worse outcomes from TBI, age should not dictate limitations in therapy. However, patients injured by low-energy falls (who are mostly older people) are about 50% less likely to receive critical care or emergency interventions, compared with those injured by high-energy mechanisms, such as road traffic incidents. Mild TBI, defined as a Glasgow Coma sum score of 13–15, comprises most of the TBI cases (over 90%) presenting to hospital. Around 50% of adult patients with mild TBI presenting to hospital do not recover to pre-TBI levels of health by 6 months after their injury. Fewer than 10% of patients discharged after presenting to an emergency department for TBI in Europe currently receive follow-up. Structured follow-up after mild TBI should be considered good practice, and urgent research is needed to identify which patients with mild TBI are at risk for incomplete recovery. The selection of patients for CT is an important triage decision in mild TBI since it allows early identification of lesions that can trigger hospital admission or life-saving surgery. Current decision making for deciding on CT is inefficient, with 90–95% of scanned patients showing no intracranial injury but being subjected to radiation risks. InTBIR studies have shown that measurement of blood-based biomarkers adds value to previously proposed clinical decision rules, holding the potential to improve efficiency while reducing radiation exposure. Increased concentrations of biomarkers in the blood of patients with a normal presentation CT scan suggest structural brain damage, which is seen on MR scanning in up to 30% of patients with mild TBI. Advanced MRI, including diffusion tensor imaging and volumetric analyses, can identify additional injuries not detectable by visual inspection of standard clinical MR images. Thus, the absence of CT abnormalities does not exclude structural damage—an observation relevant to litigation procedures, to management of mild TBI, and when CT scans are insufficient to explain the severity of the clinical condition. Although blood-based protein biomarkers have been shown to have important roles in the evaluation of TBI, most available assays are for research use only. To date, there is only one vendor of such assays with regulatory clearance in Europe and the USA with an indication to rule out the need for CT imaging for patients with suspected TBI. Regulatory clearance is provided for a combination of biomarkers, although evidence is accumulating that a single biomarker can perform as well as a combination. Additional biomarkers and more clinical-use platforms are on the horizon, but cross-platform harmonisation of results is needed. Health-care efficiency would benefit from diversity in providers. In the intensive care setting, automated analysis of blood pressure and intracranial pressure with calculation of derived parameters can help individualise management of TBI. Interest in the identification of subgroups of patients who might benefit more from some specific therapeutic approaches than others represents a welcome shift towards precision medicine. Comparative-effectiveness research to identify best practice has delivered on expectations for providing evidence in support of best practices, both in adult and paediatric patients with TBI. Progress has also been made in improving outcome assessment after TBI. Key instruments have been translated into up to 20 languages and linguistically validated, and are now internationally available for clinical and research use. TBI affects multiple domains of functioning, and outcomes are affected by personal characteristics and life-course events, consistent with a multifactorial bio-psycho-socio-ecological model of TBI, as presented in the US National Academies of Sciences, Engineering, and Medicine (NASEM) 2022 report. Multidimensional assessment is desirable and might be best based on measurement of global functional impairment. More work is required to develop and implement recommendations for multidimensional assessment. Prediction of outcome is relevant to patients and their families, and can facilitate the benchmarking of quality of care. InTBIR studies have identified new building blocks (eg, blood biomarkers and quantitative CT analysis) to refine existing prognostic models. Further improvement in prognostication could come from MRI, genetics, and the integration of dynamic changes in patient status after presentation. Neurotrauma researchers traditionally seek translation of their research findings through publications, clinical guidelines, and industry collaborations. However, to effectively impact clinical care and outcome, interactions are also needed with research funders, regulators, and policy makers, and partnership with patient organisations. Such interactions are increasingly taking place, with exemplars including interactions with the All Party Parliamentary Group on Acquired Brain Injury in the UK, the production of the NASEM report in the USA, and interactions with the US Food and Drug Administration. More interactions should be encouraged, and future discussions with regulators should include debates around consent from patients with acute mental incapacity and data sharing. Data sharing is strongly advocated by funding agencies. From January 2023, the US National Institutes of Health will require upload of research data into public repositories, but the EU requires data controllers to safeguard data security and privacy regulation. The tension between open data-sharing and adherence to privacy regulation could be resolved by cross-dataset analyses on federated platforms, with the data remaining at their original safe location. Tools already exist for conventional statistical analyses on federated platforms, however federated machine learning requires further development. Support for further development of federated platforms, and neuroinformatics more generally, should be a priority. This update to the 2017 Commission presents new insights and challenges across a range of topics around TBI: epidemiology and prevention (section 1 ); system of care (section 2 ); clinical management (section 3 ); characterisation of TBI (section 4 ); outcome assessment (section 5 ); prognosis (Section 6 ); and new directions for acquiring and implementing evidence (section 7 ). Table 1 summarises key messages from this Commission and proposes recommendations for the way forward to advance research and clinical management of TBI.
Collapse
Affiliation(s)
- Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Mathew Abrams
- International Neuroinformatics Coordinating Facility, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Åkerlund
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Nada Andelic
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marcel Aries
- Department of Intensive Care, Maastricht UMC, Maastricht, Netherlands
| | - Tom Bashford
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Michael J Bell
- Critical Care Medicine, Neurological Surgery and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yelena G Bodien
- Department of Neurology and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - András Büki
- Department of Neurosurgery, Faculty of Medicine and Health Örebro University, Örebro, Sweden
- Department of Neurosurgery, Medical School; ELKH-PTE Clinical Neuroscience MR Research Group; and Neurotrauma Research Group, Janos Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| | - Randall M Chesnut
- Department of Neurological Surgery and Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, Universita Milano Bicocca, Milan, Italy
- NeuroIntensive Care, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, Italy
| | - David Clark
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Betony Clasby
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Endre Czeiter
- Department of Neurosurgery, Medical School; ELKH-PTE Clinical Neuroscience MR Research Group; and Neurotrauma Research Group, Janos Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| | - Marek Czosnyka
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance and Department of Neurology, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Véronique De Keyser
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Ramon Diaz-Arrastia
- Department of Neurology and Center for Brain Injury and Repair, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Thomas A van Essen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurosurgery, Medical Center Haaglanden, The Hague, Netherlands
| | - Éanna Falvey
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco and San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Anthony Figaji
- Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA, Australia
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, OH, USA
| | - Dashiell Gantner
- School of Public Health and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Guoyi Gao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine
| | - Joseph Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Benjamin Gravesteijn
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fabian Guiza
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Deepak Gupta
- Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Mark Gurnell
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - Gregory Hawryluk
- Section of Neurosurgery, GB1, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Hutchinson
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Swati Jain
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Ji-yao Jiang
- Department of Neurosurgery, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hope Kent
- Department of Psychology, University of Exeter, Exeter, UK
| | - Angelos Kolias
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Erwin J O Kompanje
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marc Maegele
- Cologne-Merheim Medical Center, Department of Trauma and Orthopedic Surgery, Witten/Herdecke University, Cologne, Germany
| | - Marek Majdan
- Institute for Global Health and Epidemiology, Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Amy Markowitz
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Michael McCrea
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Ana Mikolić
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - David Nelson
- Section for Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lindsay D Nelson
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Virginia Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - David Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matej Orešič
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Wilco Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - Dana Pisică
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Louis Puybasset
- Department of Anesthesiology and Intensive Care, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino IRCCS for Oncology and Neuroscience, Genova, Italy, and Dipartimento di Scienze Chirurgiche e Diagnostiche, University of Genoa, Italy
| | - Cecilie Røe
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - David J Sharp
- Department of Brain Sciences, Imperial College London, London, UK
| | - Peter Smielewski
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, UCSD School of Medicine, La Jolla, CA, USA
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth University Hospital and University of Glasgow, Glasgow, UK
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences Leiden University Medical Center, Leiden, Netherlands
| | - Nino Stocchetti
- Department of Pathophysiology and Transplantation, Milan University, and Neuroscience ICU, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nancy Temkin
- Departments of Neurological Surgery, and Biostatistics, University of Washington, Seattle, WA, USA
| | - Olli Tenovuo
- Department of Rehabilitation and Brain Trauma, Turku University Hospital, and Department of Neurology, University of Turku, Turku, Finland
| | - Alice Theadom
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Ilias Thomas
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Abel Torres Espin
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dominique Van Praag
- Departments of Clinical Psychology and Neurosurgery, Antwerp University Hospital, and University of Antwerp, Edegem, Belgium
| | - Ernest van Veen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Thijs Vande Vyvere
- Department of Radiology, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences (MOVANT), Antwerp University Hospital, and University of Antwerp, Edegem, Belgium
| | - Kevin K W Wang
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Eveline J A Wiegers
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - W Huw Williams
- Centre for Clinical Neuropsychology Research, Department of Psychology, University of Exeter, Exeter, UK
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Stephen R Wisniewski
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Frederick A Zeiler
- Departments of Surgery, Human Anatomy and Cell Science, and Biomedical Engineering, Rady Faculty of Health Sciences and Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario, ON, Canada
| | | |
Collapse
|
22
|
Bussey MD, Davidson P, Salmon D, Romanchuk J, Tong D, Sole G. Influence of the frame of reference on head acceleration events recorded by instrumented mouthguards in community rugby players. BMJ Open Sport Exerc Med 2022; 8:e001365. [PMID: 36249488 PMCID: PMC9557771 DOI: 10.1136/bmjsem-2022-001365] [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] [Accepted: 09/17/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives To highlight the need for standardisation in the communication of head impact telemetry from instrumented mouthguards (iMG). The purpose of this study is to examine how the frame of reference for reporting head acceleration events (HAE) may affect the interpretation of head impacts recorded from iMGs in community rugby players. Methods An analytical investigation of 825 video verified HAEs recorded from male community players during 5 rugby match exposures. HAEs were captured with an iMG, known to be reliable and valid for this purpose. The linear and angular head acceleration at the centre of mass (head_CG) was calculated from filtered iMG accelerometer and gyroscope data, and the location of impact was estimated. The iMG and head_CG data were examined for systematic bias, geometric differences and the degree of concordance. Finally, mixed model analyses were fitted to assess the differences in peak resultant acceleration (PLA) by impact locations and directions of head motion while controlling for intra-athlete correlations. Results The degree of concordance between the iMG versus head_CG measures varied by impact location. The mixed model confirmed differences in the PLA by location (F(8,819) = 16.55, p<0.001) and by direction of head motion (F(5,417) = 7.78, p<0.001). Conclusion The head acceleration reported at the iMG is not proportional to measurements that have been transformed to the head_CG. Depending on the impact location and direction of head motion, the acceleration measured at the iMG may overestimate, underestimate or miss entirely the PLA with respect to the head_CG. We recommend standardising the reporting of iMG data within the head_CG frame of reference.
Collapse
Affiliation(s)
- Melanie Dawn Bussey
- School of Physical Education Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Peter Davidson
- School of Physical Education Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | | | - Janelle Romanchuk
- School of Physical Education Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand,New Zealand Rugby, Dunedin, New Zealand
| | - Darryl Tong
- Department of Oral Diagnostic and Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Gisela Sole
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| |
Collapse
|
23
|
Salmon DM, Badenhorst M, Falvey É, Kerr ZY, Brown J, Walters S, Sole G, Sullivan SJ, Whatman C, Register-Mihalik J, Murphy I. Time to expand the circle of care - General practitioners' experiences of managing concussion in the community. J Sports Sci 2022; 40:2102-2117. [PMID: 36399490 DOI: 10.1080/02640414.2022.2130586] [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: 11/19/2022]
Abstract
New Zealand Rugby (NZR) implemented a concussion management pathway (CMP), aimed at improving management at community level. General Practitioners (GPs) played a large role in the design of this process. The objective of this study was to explore GPs' perceptions of barriers and facilitators of the CMP and rugby-related concussion management in the community. A descriptive qualitative approach using interviews and focus groups was employed. Four themes were derived: i) GPs' existing knowledge and confidence around concussion management; ii) Operational resources: time, remuneration and pathway guidance; iii) Standardising concussion care and iv) Expanding the circle of care - the need for multi-disciplinary healthcare team. These themes described how GP's concussion knowledge, and the efficiency and availability of operational resources affected their experience and ability to fulfil their tasks within the CMP. GPs found NZR's CMP especially valuable, as it provided guidance and structure. Expanding the role of other healthcare providers was seen as critical to reduce the burden on GPs, while also delivering a more holistic experience to improve clinical outcomes. Addressing the identified barriers and expanding the network of care will help to improve the ongoing development of NZR's CMP, while supporting continued engagement with all stakeholders.
Collapse
Affiliation(s)
- Danielle M Salmon
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Éanna Falvey
- World Rugby House, Pembroke Street Lower, Dublin.,College of Medicine & Health, University College Cork, Cork, Ireland
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Newzeland
| | - S John Sullivan
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Johna Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ian Murphy
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| |
Collapse
|
24
|
Schulze KJ, Robinson M, MacKenzie HM, Dickey JP. Association of Preexisting Mental Health Conditions With Increased Initial Symptom Count and Severity Score on SCAT5 When Assessing Concussion. Orthop J Sports Med 2022; 10:23259671221123581. [PMID: 36157090 PMCID: PMC9490471 DOI: 10.1177/23259671221123581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Mental health conditions, such as depression, anxiety, and learning disabilities, are associated with symptoms that can overlap with those seen in persons with concussion. While concussion screening tools such as the Sport Concussion Assessment Tool–5th Edition (SCAT5) quantify the number of symptoms and symptom severity, it is not known whether these outcomes differ among individuals with concurrent mental health conditions compared with those without them. Purpose: To determine whether, during initial concussion assessment, individuals with a self-reported mental health condition have a significantly different number of self-reported concussion symptoms or symptom severity compared with those without a self-reported mental health condition (controls). Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was performed on consecutive patients aged ≥13 years who underwent post-concussion assessment at the Fowler Kennedy Sport Medicine Clinic between May 2018 and March 2020 (N = 765). Most participants did not self-report a mental health condition (n = 606; 79.2%). Participants with a self-reported mental health condition (n = 159) were classified as having a learning disability (n = 14; 8.8%), anxiety (n = 62; 39.0%), depression (n = 20; 12.6%), or multiple conditions (≥2 conditions: n = 63; 39.6%). Each participant with a mental health condition was matched with 2 control participants (overall pool, n = 318) based on age, sex, student status, and sport-related risk. Mann-Whitney U tests were used to determine the statistical significance of differences between each subgroup and their matched controls for the self-reported number of concussion symptoms and symptom severity as measured using the SCAT5. Results: The anxiety and multiple-conditions subgroups had a significantly greater number of reported symptoms than their corresponding control subgroups (median, 17 vs 15 [P = .004] and 18 vs 14.5 [P < .001], respectively). Additionally, the SCAT5 symptom severity score was significantly greater in the anxiety and multiple-conditions subgroups than their corresponding controls (median, 49 vs 34.5 [P = .018] and 62 vs 32 [P < .001], respectively). Conclusion: During initial concussion assessment, both the number of concussion-related symptoms and the symptom severity were greater in study participants with anxiety and multiple mental health conditions than participants without these conditions.
Collapse
Affiliation(s)
| | - Michael Robinson
- Faculty of Health Science, Lawson Health Research Institute, Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
| | - Heather M MacKenzie
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
| | - James P Dickey
- School of Kinesiology, Western University, London, Ontario, Canada
| |
Collapse
|
25
|
Sideline Assessment of Concussion. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
26
|
Balance and Cognition in Male Collegiate Lacrosse Players. Motor Control 2022; 27:217-227. [PMID: 36257607 DOI: 10.1123/mc.2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/28/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022]
Abstract
Concussion screening among collegiate lacrosse athletes is a major safety priority. Although attention has been directed at concussion management following injury, less is known about the association between cognition and balance during preseason screening. The purpose of the study was to assess the relationship between balance and neurocognition among collegiate male lacrosse players and to examine predictive determinants of postural stability. Participants included a convenience sample of 49 male collegiate Division 3 lacrosse players who completed a demographic survey and performed the immediate postconcussion test (ImPACT) and instrumented Sensory Organization Test (SOT). There was a significant association between balance SOT performance and both verbal memory (r = .59, p < .01) and visual motor speed scores (r = .43, p < .05). Significant correlations between verbal memory and SOT Conditions 2, 5, and 6 were also noted (all p < .05). Verbal memory predicted 33% of the variance in the SOT composite balance score (p < .001). Our results indicate a significant relationship exists between postural stability and both verbal memory and visual processing speed among collegiate male lacrosse players and supports vestibulocortical associations. Findings warrant ongoing performance and executive function tracking and can serve as a conduit for integrated sensorimotor and dual-task training.
Collapse
|
27
|
Powell D, Stuart S, Godfrey A. Wearables in rugby union: A protocol for multimodal digital sports-related concussion assessment. PLoS One 2021; 16:e0261616. [PMID: 34936689 PMCID: PMC8694415 DOI: 10.1371/journal.pone.0261616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Pragmatic challenges remain in the monitoring and return to play (RTP) decisions following suspected Sports Related Concussion (SRC). Reliance on traditional approaches (pen and paper) means players readiness for RTP is often based on self-reported symptom recognition as a marker for full physiological recovery. Non-digital approaches also limit opportunity for robust data analysis which may hinder understanding of the interconnected nature and relationships in deficit recovery. Digital approaches may provide more objectivity to measure and monitor impairments in SRC. Crucially, there is dearth of protocols for SRC assessment and digital devices have yet to be tested concurrently (multimodal) in SRC rugby union assessment. Here we propose a multimodal protocol for digital assessment in SRC, which could be used to enhance traditional sports concussion assessment approaches. Methods We aim to use a repeated measures observational study utilising a battery of multimodal assessment tools (symptom, cognitive, visual, motor). We aim to recruit 200 rugby players (male n≈100 and female n≈100) from University Rugby Union teams and local amateur rugby clubs in the North East of England. The multimodal battery assessment used in this study will compare metrics between digital methods and against traditional assessment. Conclusion This paper outlines a protocol for a multimodal approach for the use of digital technologies to augment traditional approaches to SRC, which may better inform RTP in rugby union. Findings may shed light on new ways of working with digital tools in SRC. Multimodal approaches may enhance understanding of the interconnected nature of impairments and provide insightful, more objective assessment and RTP in SRC. Clinical trial registration NCT04938570. https://clinicaltrials.gov/ct2/results?cond=NCT04938570&term=&cntry=&state=&city=&dist=
Collapse
Affiliation(s)
- Dylan Powell
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Sam Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
- * E-mail:
| |
Collapse
|
28
|
Anxiety and Depression during COVID-19 in Elite Rugby Players: The Role of Mindfulness Skills. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211940. [PMID: 34831693 PMCID: PMC8617933 DOI: 10.3390/ijerph182211940] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/20/2022]
Abstract
The COVID-19 pandemic created stressors that raised the likelihood of elite athletes experiencing mental health problems. Understanding how individual traits promote resilience is key to offering treatments specific to this population. This prospective study explores the relationship between mindfulness skills, resilience, and athletic identity on anxiety and depression. The initial assessment was during the first UK lockdown April–May 2020 (T1), and the second during the return to competition July-August 2020 (T2). The sample was 160 elite rugby players. Measures included: Personal Health Questionnaire-9, General Anxiety Disorder-7, Cognitive Affective Mindfulness Scale, Connor-Davidson Resilience Scale, and Athletic Identity Measurement. The prevalence of anxiety and depression was profiled with descriptive statistics, and relationships between variables with bi-variate correlations and forward stepwise regression modelling. Depression decreased significantly between lock down (T1) and return to competition (T2) (MT1 = 4.20, MT2 = 3.24, p < 0.01), with no significant change in anxiety. Significant correlations were found between mindfulness, resilience, and anxiety and depression (≤0.001). Regression showed that mindfulness (T1) predicted lower anxiety and depression during the return to competition (T2) after controlling for baseline mental health symptoms. Returning to competition after lockdown was associated with a reduction in depression but not anxiety. Mindfulness skills potentially confer protection against anxiety and depression.
Collapse
|