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Pegoraro N, Rossini B, Giganti M, Brymer E, Monasterio E, Bouchat P, Feletti F. Telemedicine in Sports under Extreme Conditions: Data Transmission, Remote Medical Consultations, and Diagnostic Imaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6371. [PMID: 37510603 PMCID: PMC10380087 DOI: 10.3390/ijerph20146371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/11/2023] [Accepted: 06/17/2023] [Indexed: 07/30/2023]
Abstract
Telemedical technologies provide significant benefits in sports for performance monitoring and early recognition of many medical issues, especially when sports are practised outside a regulated playing field, where participants are exposed to rapidly changing environmental conditions or specialised medical assistance is unavailable. We provide a review of the medical literature on the use of telemedicine in adventure and extreme sports. Out of 2715 unique sport citations from 4 scientific databases 16 papers met the criteria, which included all research papers exploring the use of telemedicine for monitoring performance and health status in extreme environments. Their quality was assessed by a double-anonymised review with a specifically designed four-item scoring system. Telemedicine was used in high-mountain sports (37.5%; n = 6), winter sports (18.7%; n = 3), water sports (25%; n = 4), and long-distance land sports (18.7%; n = 3). Telemedicine was used for data transfer, teleconsulting, and the execution of remote-controlled procedures, including imaging diagnostics. Telemedical technologies were also used to diagnose and treat sport-related and environmentally impacted injuries, including emergencies in three extreme conditions: high mountains, ultraendurance activities, and in/under the water. By highlighting sport-specific movement patterns or physiological and pathological responses in extreme climatic conditions and environments, telemedicine may result in better preparation and development of strategies for an in-depth understanding of the stress of the metabolic, cardiorespiratory, biomechanical, or neuromuscular system, potentially resulting in performance improvement and injury prevention.
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Affiliation(s)
- Nicola Pegoraro
- Dipartimento di Medicina Traslazionale e per la Romagna, Università degli Studi di Ferrara, 44122 Ferrara, Italy
| | - Benedetta Rossini
- Dipartimento di Medicina Traslazionale e per la Romagna, Università degli Studi di Ferrara, 44122 Ferrara, Italy
| | - Melchiore Giganti
- Dipartimento di Medicina Traslazionale e per la Romagna, Università degli Studi di Ferrara, 44122 Ferrara, Italy
| | - Eric Brymer
- Humans Sciences, Faculty of Health, Southern Cross University, Southern Cross Drive, Bilinga, QLD 4225, Australia
| | - Erik Monasterio
- Christchurch School of Medicine, University of Otago, Hillmorton Hospital, Private Bag 4733, Christchurch 8024, New Zealand
| | - Pierre Bouchat
- Psychological Sciences Research Institute, Université Catholique de Louvain, B-1348 Louvain-la-Neuve, Belgium
| | - Francesco Feletti
- Dipartimento di Medicina Traslazionale e per la Romagna, Università degli Studi di Ferrara, 44122 Ferrara, Italy
- Dipartimento Diagnostica per Immagini-Ausl Romagna, U.O. Radiologia-Ospedale S. Maria delle Croci, 48121 Ravenna, Italy
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McLarnon M, Boyce SH, Fisher N, Heron N. 'It's All Downhill from Here': A Scoping Review of Sports-Related Concussion (SRC) Protocols in Downhill Mountain Biking (DHI), with Recommendations for SRC Policy in Professional DMB. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12281. [PMID: 36231582 PMCID: PMC9566347 DOI: 10.3390/ijerph191912281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Downhill mountain biking (DHI) is a form of cycling and does not currently have a specific sports-related concussion (SRC) assessment. OBJECTIVE To review the extent, range and nature of research investigating SRC in DMB, provide a summary of key literature findings relating to its identification and management, and then develop a SRC protocol specific to DMB. DESIGN Scoping review as per recognised methods. SETTING Literature-based. The following databases were searched: MEDLINE, EMBASE, Scopus and Web of Science, with no restrictions on date. Results were limited to the English language. PARTICIPANTS Six articles were included in the review from 64 identified articles. The article had to specifically include an analysis of adult downhill riders for inclusion. OUTCOME MEASURES Study type, study group (amateur/professional), concussion incidence, concussion assessment and recommendations. MAIN RESULTS Concussion incidence was identified as between 5-23%. No study outlined a trackside assessment of cyclists or a protocol for return to play where SRC was identified. Several authors identified that riders often continued to participate despite the presence of a concussion. No sport-specific SRC assessment was determined for DHI, and a SRC assessment was therefore developed. CONCLUSIONS This review illustrates the lack of studies and formal protocol in SRC assessment for DHI. In light of this, we propose a three-stage framework specific to the sport to best identify a concussion and act where appropriate while minimising disruption to competition. This framework involves assessing the cyclist on the 'sideline', a second assessment post-event in the medical room and a third assessment the following day. A SRC consensus meeting specific for DHI is suggested with an identified need for updated guidance from UCI, requiring possible rule changes for the sport.
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Affiliation(s)
| | - Stephen H. Boyce
- Emergency Department, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
- Scottish Institute of Sport, Stirling FK9 5PH, UK
| | - Neil Fisher
- UK Athletics, Birmingham B42 2BE, UK
- British Cycling, Manchester M11 4DQ, UK
| | - Neil Heron
- British Cycling, Manchester M11 4DQ, UK
- Centre for Public Health Research, Queen’s University, Belfast BT7 1NN, UK
- Department of General Practice, Keele University, Newcastle ST5 5BG, UK
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An Investigation into Helmet Use, Perceptions of Sports-Related Concussion, and Seeking Medical Care for Head Injury amongst Competitive Cyclists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052861. [PMID: 35270553 PMCID: PMC8910390 DOI: 10.3390/ijerph19052861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/10/2022]
Abstract
The purpose of this study was to investigate competitive cyclists' helmet use, perceptions of sports-related concussion (SRC), and medical-care-seeking behaviors. A mixed-method approach was used with qualitative and quantitative data presented. The study comprised of a cross-sectional analysis of 405 competitive cyclists who completed an online survey. Results indicated that most participants believed a bicycle helmet protects against SRC (79.5%) and considerable numbers of participants would not seek medical care for potential head injury in scenarios where this would be recommended. It was also discovered that marketing of concussion reduction technology influences cyclists' helmet-purchasing behaviors. With the data presented, it is recommended that governing bodies in cycling need to develop educational resources to address gaps in knowledge regarding SRC amongst cyclists. We also suggest that more independent research on concussion reduction technologies in bicycle helmets is needed, with advertising supported by clear scientific evidence to avoid negatively influencing head injury management and reporting behaviors amongst cyclists.
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Turbans vs. Helmets: A Systematic Narrative Review of the Literature on Head Injuries and Impact Loci of Cranial Trauma in Several Recreational Outdoor Sports. Sports (Basel) 2021; 9:sports9120172. [PMID: 34941810 PMCID: PMC8703542 DOI: 10.3390/sports9120172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 12/28/2022] Open
Abstract
When in public, faith-based mandates require practising Sikh men to wear a turban which may not be covered by hats or caps. This makes it impossible for practising Sikhs to wear helmets and other protective headwear, mandatory in many countries and facilities for engagement in recreational pursuits (e.g., skiing) and on adventure outdoor recreation camps mandatorily run for school groups. The result is often social exclusion and ostracisation in the case of school children. Despite studies into the efficacy of protective helmets in some recreational outdoor activity settings, virtually nothing is known about the protective potential of turbans. This paper systematically reviews the extant literature on head injuries in several recreational outdoor activities and sports sectors (aerial, water, winter, wheeled and animal-based sports) and finds that the extant literature is of limited value when trying to understand the spatial distribution of trauma on the cranial surface. As the data do not permit to make inferences on the protective potential of turbans, future systematic, evidence-based epidemiological studies derived from hospital admissions and forensic examinations are required. Failure to do so perpetuates social exclusion and discrimination of religious grounds without an evidentiary basis for defensible public health measures.
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Head Impact Research Using Inertial Sensors in Sport: A Systematic Review of Methods, Demographics, and Factors Contributing to Exposure. Sports Med 2021; 52:481-504. [PMID: 34677820 DOI: 10.1007/s40279-021-01574-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The number and magnitude of head impacts have been assessed in-vivo using inertial sensors to characterise the exposure in various sports and to help understand their potential relationship to concussion. OBJECTIVES We aimed to provide a comprehensive review of the field of in-vivo sensor acceleration event research in sports via the summary of data collection and processing methods, population demographics and factors contributing to an athlete's exposure to sensor acceleration events. METHODS The systematic search resulted in 185 cohort or cross-sectional studies that recorded sensor acceleration events in-vivo during sport participation. RESULTS Approximately 5800 participants were studied in 20 sports using 18 devices that included instrumented helmets, headbands, skin patches, mouthguards and earplugs. Female and youth participants were under-represented and ambiguous results were reported for these populations. The number and magnitude of sensor acceleration events were affected by a variety of contributing factors, suggesting sport-specific analyses are needed. For collision sports, being male, being older, and playing in a game (as opposed to a practice), all contributed to being exposed to more sensor acceleration events. DISCUSSION Several issues were identified across the various sensor technologies, and efforts should focus on harmonising research methods and improving the accuracy of kinematic measurements and impact classification. While the research is more mature for high-school and collegiate male American football players, it is still in its early stages in many other sports and for female and youth populations. The information reported in the summarised work has improved our understanding of the exposure to sport-related head impacts and has enabled the development of prevention strategies, such as rule changes. CONCLUSIONS Head impact research can help improve our understanding of the acute and chronic effects of head impacts on neurological impairments and brain injury. The field is still growing in many sports, but technological improvements and standardisation of processes are needed.
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Craven P, Hansroth J, Quedado KD, Goode CS, Dragan S, Monseau A, Balcik B, Chill N, Findley SW. Lessons on Mass Gatherings Learned From the 2019 Union Cycliste Internationale Mountain Bike World Cup. Cureus 2021; 13:e14275. [PMID: 33954076 PMCID: PMC8092131 DOI: 10.7759/cureus.14275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Union Cycliste Internationale (UCI) Mountain Bike World Cup in 2019 provided unique challenges for effective prehospital care. While on-site medical care has demonstrated improved outcomes along with reduced emergency department and emergency medical services (EMS) utilization, this aspect has not been well documented in the literature with respect to rural mass gathering events (MGEs). Conducted at a large mass gathering event in a geographically isolated area, this study aimed to assess the medical needs at this specific event and will hopefully assist in future coordination of similar events. All patients who were treated at the event clinic were included in the analysis. Primary investigators collected and recorded data while providing care. We believe the on-site clinic was successful in reducing barriers to healthcare by improving access, streamlining the treatment process, and optimizing resource utilization. This benefit extended to race participants, support staff, spectators, and the local EMS system.
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Affiliation(s)
- Paul Craven
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Joseph Hansroth
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Kimberly D Quedado
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Christopher S Goode
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Shane Dragan
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Aaron Monseau
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Brenden Balcik
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Nicholas Chill
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Scott W Findley
- Emergency Medicine, West Virginia University School of Medicine, Morgantown, USA
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Petrone N, Candiotto G, Marzella E, Uriati F, Carraro G, Bäckström M, Koptyug A. Feasibility of using a novel instrumented human head surrogate to measure helmet, head and brain kinematics and intracranial pressure during multidirectional impact tests. J Sci Med Sport 2019; 22 Suppl 1:S78-S84. [PMID: 31272916 DOI: 10.1016/j.jsams.2019.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 04/29/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Aim of the work is to present the feasibility of using an Instrumented Human Head Surrogate (IHHS-1) during multidirectional impacts while wearing a modern ski helmet. The IHHS-1 is intended to provide reliable and repeatable data for the experimental validation of FE models and for the experimental evaluation of modern helmets designed to enhance the degree of protection against multidirectional impacts. DESIGN The new IHHS-1 includes 9 triaxial MEMS accelerometers embedded in a silicone rubber brain, independently molded and presenting lobes separation and cerebellum, placed into an ABS skull filled with surrogate cerebrospinal fluid. A triaxial MEMS gyroscope is placed at the brain center of mass. Intracranial pressure can be detected by eight pressure sensors applied to the skull internal surface along a transversal plane located at the brain center of mass and two at the apex. Additional MEMS sensors positioned over the skull and the helmet allow comparison between outer and inner structure kinematics and surrogate CSF pressure behavior. METHODS The IHHS-1 was mounted through a Hybrid III neck on a force platform and impacted with a striker connected to a pendulum tower, with the impact energies reaching 24J. Impact locations were aligned with the brain center of mass and located in the back (sagittal axis), right (90° from sagittal axis), back/right (45°), and front right (135°) locations. Following dynamic data were collected: values of the linear accelerations and angular velocities of the brain, skull and helmet; intracranial pressures inside the skull. RESULTS Despite the relatively low intensity of impacts (HIC at skull max value 46), the skull rotational actions reached BrIC values of 0.33 and angular accelerations of 5216rad/s2, whereas brain angular acceleration resulted between 1,44 and 2,1 times lower with similar values of BrIC. CONCLUSIONS The IHHS-1 is a physical head surrogate that can produce repeatable data for the interpretation of inner structures behavior during multidirectional impacts with or without helmets of different characteristics.
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Affiliation(s)
- Nicola Petrone
- Department of Industrial Engineering, University of Padova, Italy.
| | | | - Edoardo Marzella
- Department of Industrial Engineering, University of Padova, Italy
| | - Federico Uriati
- Department of Industrial Engineering, University of Padova, Italy
| | - Giovanni Carraro
- Department of Industrial Engineering, University of Padova, Italy
| | | | - Andrey Koptyug
- SportsTech Research Centre, Mid Sweden University, Sweden
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