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Smulligan KL, Carry P, Smith AC, Esopenko C, Baugh CM, Wilson JC, Howell DR. Cervical spine proprioception and vestibular/oculomotor function: An observational study comparing young adults with and without a concussion history. Phys Ther Sport 2024; 69:33-39. [PMID: 39013262 PMCID: PMC11343652 DOI: 10.1016/j.ptsp.2024.07.002] [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] [Received: 03/13/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To investigate dizziness, vestibular/oculomotor symptoms, and cervical spine proprioception among adults with/without a concussion history. METHODS Adults ages 18-40 years with/without a concussion history completed: dizziness handicap inventory (DHI), visio-vestibular exam (VVE), and head repositioning accuracy (HRA, assesses cervical spine proprioception). Linear regression models were used to assess relationships between (1) concussion/no concussion history group and VVE, HRA, and DHI, and (2) DHI with HRA and VVE for the concussion history group. RESULTS We enrolled 42 participants with concussion history (age = 26.5 ± 4.5 years, 79% female, mean = 1.4± 0.8 years post-concussion) and 46 without (age = 27.0± 3.8 years, 74% female). Concussion history was associated with worse HRA (β = 1.23, 95% confidence interval [CI]: 0.77, 1.68; p < 0.001), more positive VVE subtests (β = 3.01, 95%CI: 2.32, 3.70; p < 0.001), and higher DHI scores (β = 9.79, 95%CI: 6.27, 13.32; p < 0.001) after covariate adjustment. For the concussion history group, number of positive VVE subtests was significantly associated with DHI score (β = 3.78, 95%CI: 2.30, 5.26; p < 0.001) after covariate adjustment, while HRA error was not (β = 1.10, 95%CI: -2.32, 4.51; p = 0.52). CONCLUSIONS Vestibular/oculomotor symptom provocation and cervical spine proprioception impairments may persist chronically (i.e., 3 years) after concussion. Assessing dizziness, vestibular/oculomotor and cervical spine function after concussion may inform patient-specific treatments to address ongoing dysfunction.
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Affiliation(s)
- Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
| | - Patrick Carry
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
| | - Andrew C Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christine M Baugh
- Center for Bioethics and Humanities, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA.
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Smulligan KL, Magliato SN, Keeter CL, Wingerson MJ, Smith AC, Wilson JC, Howell DR. The Diagnostic Utility of Cervical Spine Proprioception for Adolescent Concussion. Clin J Sport Med 2024:00042752-990000000-00202. [PMID: 38953712 DOI: 10.1097/jsm.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE Cervical spine proprioception may be impaired after concussion. Our objective was to determine the diagnostic utility of cervical spine proprioception for adolescent concussion. DESIGN Cross-sectional. SETTING Research laboratory. PARTICIPANTS Adolescents ≤18 days of concussion and uninjured controls. INTERVENTIONS N/A. MAIN OUTCOMES Head repositioning accuracy (HRA) testing, a measure of cervical spine proprioception. The HRA test involved patients relocating their head back to a neutral starting position with eyes closed after maximal cervical spine flexion, extension, and right and left rotations. The overall HRA error score was the mean error (distance from the starting point to self-reported return to neutral) across 12 trials: 3 trials in each direction. We used t-tests to compare group means and logistic regression (outcome = group, predictor = HRA, covariates) to calculate odds ratios. We used a receiver operator characteristic curve to evaluate area under the curve (AUC) and calculate the optimal HRA cutpoint to distinguish concussion from controls. RESULTS We enrolled and tested 46 participants with concussion (age = 15.8 ± 1.3 years, 59% female, mean = 11.3 ± 3.3 days postconcussion) and 83 uninjured controls (age = 16.1 ± 1.4 years, 88% female). The concussion group had significantly worse HRA than controls (4.3 ± 1.6 vs 2.9 ± 0.7 degrees, P < 0.001, Cohen d = 1.19). The univariable HRA model AUC was 0.81 (95% CI = 0.73, 0.90). After adjusting for age, sex, and concussion history, the multivariable model AUC improved to 0.85 (95% CI = 0.77, 0.92). The model correctly classified 80% of participants as concussion/control at a 3.5-degree cutpoint. CONCLUSIONS Adolescents with concussion demonstrated worse cervical spine proprioception than uninjured controls. Head repositioning accuracy may offer diagnostic utility for subacute concussion.
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Affiliation(s)
- Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
| | - Samantha N Magliato
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
| | - Carson L Keeter
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Mathew J Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
| | - Andrew C Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
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Girard-Côté L, Gallais B, Gagnon C, Roussel MP, Morin M, Hébert LJ, Monckton D, Leduc-Gaudet JP, Gouspillou G, Marcangeli V, Duchesne E. Resistance training in women with myotonic dystrophy type 1: a multisystemic therapeutic avenue. Neuromuscul Disord 2024; 40:38-51. [PMID: 38824906 DOI: 10.1016/j.nmd.2024.05.009] [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: 10/05/2023] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024]
Abstract
Myotonic dystrophy type 1 (DM1) is a hereditary disease characterized by muscular impairments. Fundamental and clinical positive effects of strength training have been reported in men with DM1, but its impact on women remains unknown. We evaluated the effects of a 12-week supervised strength training on physical and neuropsychiatric health. Women with DM1 performed a twice-weekly supervised resistance training program (3 series of 6-8 repetitions of squat, leg press, plantar flexion, knee extension, and hip abduction). Lower limb muscle strength, physical function, apathy, anxiety and depression, fatigue and excessive somnolence, pain, and patient-reported outcomes were assessed before and after the intervention, as well as three and six months after completion of the training program. Muscle biopsies of the vastus lateralis were also taken before and after the training program to assess muscle fiber growth. Eleven participants completed the program (attendance: 98.5 %). Maximal hip and knee extension strength (p < 0.006), all One-Repetition Maximum strength measures (p < 0.001), apathy (p = 0.0005), depression (p = 0.02), pain interference (p = 0.01) and perception of the lower limb function (p = 0.003) were significantly improved by training. Some of these gains were maintained up to six months after the training program. Strength training is a good therapeutic strategy for women with DM1.
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Affiliation(s)
- Laura Girard-Côté
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada
| | - Benjamin Gallais
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; ÉCOBES - Research and Transfer, Cegep de Jonquière, Jonquière, Quebec, Canada
| | - Cynthia Gagnon
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; CHU Sherbrooke Research Center, and Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Pier Roussel
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; Department of Fundamental Sciences, University of Quebec at Chicoutimi, Saguenay, Quebec, Canada
| | - Marika Morin
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada
| | - Luc J Hébert
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Capitale-Nationale Integrated University Health and Social Services Center, Quebec, Quebec, Canada; Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Darren Monckton
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, UK
| | - Jean-Philippe Leduc-Gaudet
- Research Group in Cellular Signaling, Department of Medical Biology, University of Quebec at Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Gilles Gouspillou
- Département des sciences de l'activité physique, Faculté des sciences, University of Quebec at Montréal (UQAM), Montréal, Quebec, Canada
| | - Vincent Marcangeli
- Département des sciences de l'activité physique, Faculté des sciences, University of Quebec at Montréal (UQAM), Montréal, Quebec, Canada
| | - Elise Duchesne
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Capitale-Nationale Integrated University Health and Social Services Center, Quebec, Quebec, Canada; CHU de Québec - Université Laval Research Center, Québec, Québec, Canada.
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Chou TY, Huang YL, Leung W, Brown CN, Kaminski TW, Norcross MF. Does prior concussion lead to biomechanical alterations associated with lateral ankle sprain and anterior cruciate ligament injury? A systematic review and meta-analysis. Br J Sports Med 2023; 57:1509-1515. [PMID: 37648411 DOI: 10.1136/bjsports-2023-106980] [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] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To determine whether individuals with a prior concussion exhibit biomechanical alterations in balance, gait and jump-landing tasks with and without cognitive demands that are associated with risk of lateral ankle sprain (LAS) and anterior cruciate ligament (ACL) injury. DESIGN Systematic review and meta-analysis. DATA SOURCES Five electronic databases (Web of Science, Scopus, PubMed, SPORTDiscus and CiNAHL) were searched in April 2023. ELIGIBILITY CRITERIA Included studies involved (1) concussed participants, (2) outcome measures of spatiotemporal, kinematic or kinetic data and (3) a comparison or the data necessary to compare biomechanical variables between individuals with and without concussion history or before and after a concussion. RESULTS Twenty-seven studies were included involving 1544 participants (concussion group (n=757); non-concussion group (n=787)). Individuals with a recent concussion history (within 2 months) had decreased postural stability (g=0.34, 95% CI 0.20 to 0.49, p<0.001) and slower locomotion-related performance (g=0.26, 95% CI 0.11 to 0.41, p<0.001), both of which are associated with LAS injury risk. Furthermore, alterations in frontal plane kinetics (g=0.41, 95% CI 0.03 to 0.79, p=0.033) and sagittal plane kinematics (g=0.30, 95% CI 0.11 to 0.50, p=0.002) were observed in individuals approximately 2 years following concussion, both of which are associated with ACL injury risk. The moderator analyses indicated cognitive demands (ie, working memory, inhibitory control tasks) affected frontal plane kinematics (p=0.009), but not sagittal plane kinematics and locomotion-related performance, between the concussion and non-concussion groups. CONCLUSION Following a recent concussion, individuals display decreased postural stability and slower locomotion-related performance, both of which are associated with LAS injury risk. Moreover, individuals within 2 years following a concussion also adopt a more erect landing posture with greater knee internal adduction moment, both of which are associated with ACL injury risk. While adding cognitive demands to jump-landing tasks affected frontal plane kinematics during landing, the altered movement patterns in locomotion and sagittal plane kinematics postconcussion persisted regardless of additional cognitive demands. PROSPERO REGISTRATION NUMBER CRD42021248916.
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Affiliation(s)
- Tsung-Yeh Chou
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Yu-Lun Huang
- Department of Physical Education and Sport, National Taiwan Normal University, Taipei, Taiwan
| | - Willie Leung
- Department of Health Sciences and Human Performance, The University of Tampa, Tampa, Florida, USA
| | - Cathleen N Brown
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Marc F Norcross
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
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McLoughlin J. Concussion Rehabilitation and the Application of Ten Movement Training Principles. Cureus 2023; 15:e46520. [PMID: 37927640 PMCID: PMC10625311 DOI: 10.7759/cureus.46520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Concussion awareness continues to grow in all aspects of healthcare, including the areas of prevention, acute care, and ongoing rehabilitation. Most of the concussion research to date has focussed on the challenges around screening and diagnosing what can be a complex mix of brain impairments that overlay with additional pre-existing comorbidities. While we expect further progress in concussion diagnosis, progress also continues to be made around proactive rehabilitation, with the emergence of interventions that can enhance the recovery process, maximise function and independence with a return to study, work, and play. Traditionally, optimal multimodal assessments of concussion have treated the physical, cognitive, and psychological domains of brain injury separately, which supports diagnosis, and informs appropriate follow-up care. Due to the complex nature of brain injury, multimodal assessments direct care toward professionals from many different disciplines including medicine, physiotherapy, psychology, neuropsychology, ophthalmology, and exercise physiology. In addition, these professionals may work in different fields such as sports, neurorehabilitation, vestibular, musculoskeletal, community, vocational, and general practice clinical settings. Rehabilitation interventions for concussions employed in practice are also likely to use a blend of theoretical principles from motor control, cognitive, and psychological sciences. This scale of diversity can make information dissemination, collaboration, and innovation challenging. The Ten Movement Training Principles (MTPs) have been proposed as a usable and relevant concept to guide and support clinical reasoning in neurorehabilitation. When applied to concussion rehabilitation, these same 10 principles provide a comprehensive overview of key rehabilitation strategies for current and future practice. Future collaborations can use these training principles to support clinical and research innovations including the rapid rise of technologies in this growing field of rehabilitation practice.
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Affiliation(s)
- James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, AUS
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Cheever K, Nedimyer AK, Dewig D, Register-Mihalik JK, Kossman MK. The Identification and Comparison of Factors Affecting Musculoskeletal and Concussion Injury Disclosure. J Athl Train 2023; 58:563-572. [PMID: 36252227 PMCID: PMC10496445 DOI: 10.4085/1062-6050-0291.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Despite the increased risk of musculoskeletal (MSK) injury after a concussion, little is known about the determinants of such a risk. Moreover, the authors of previous reports of increased risk of MSK injury after a concussion have neglected to account for the high level of undisclosed concussions. OBJECTIVE To explore the association between the intention to disclose a possible concussion and the intention to disclose an MSK injury. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS One hundred seven National Collegiate Athletic Association Division I athletes (females = 79%, age = 19.4 ± 1.4 years). MAIN OUTCOME MEASURE(S) Online survey exploring determinants such as injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding concussive and MSK injury disclosure. RESULTS A significant association between high intention to disclose a concussion and high intention to disclose an MSK injury (χ2 = 19.276, P < .001, Cramer V = 0.482) was observed. Spearman rank correlations suggested no correlation between concussion nondisclosure (25%) and MSK injury nondisclosure (52%). Multivariate binomial regressions indicated that perceived social norms were the strongest determinant (β = 1.365, P = .002) of high intention to disclose concussion, while attitudes toward MSK injury (β = 1.067, P = .005) and perceived social norms (β = 1.099, P = .013) were the strongest determinants of high intention to report MSK injury. CONCLUSIONS Individuals with high intention to report concussion symptoms also demonstrated high intention to report MSK injury. Strong positive associations were seen between known determinants of intention to disclose concussion and adapted versions of those same determinant domains in intention to disclose MSK injury. As those with high intention to disclose concussion also displayed high intention to disclose MSK injury, intention to disclose injuries generally may play a role in explaining the increase in MSK injury after a concussion.
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Affiliation(s)
- Kelly Cheever
- Applied Biomechanics Laboratory, Department of Kinesiology, University of Texas at San Antonio
| | - Aliza K. Nedimyer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill
| | - Derek Dewig
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill
- STAR Heel Performance Laboratory, University of North Carolina at Chapel Hill
- Motion Science Institute, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Melissa K. Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg
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The association between size and symmetry of the lumbar multifidus muscle, and injuries in adolescent rugby union players. Phys Ther Sport 2023; 60:98-103. [PMID: 36753830 DOI: 10.1016/j.ptsp.2023.02.001] [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: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to investigate the association between size and symmetry of the lumbar multifidus muscle, and season injuries in adolescent rugby union players. DESIGN Prospective longitudinal cohort study. SETTING Pre-season assessment of the size (cross-sectional area) of the lumbar multifidus (L2-5) muscles using ultrasound imaging. PARTICIPANTS Seventy-one adolescent rugby union players (aged 15-18 years). MAIN OUTCOME MEASURES "Time-loss" injuries were recorded during the season and divided into four injury regions (head and neck, upper limb, trunk and lower limb). RESULTS Thirty-nine injuries were recorded during the season. Players who sustained an upper limb injury during the season had smaller lumbar multifidus muscles at the L5 vertebral level (effect size = 0.7, p = 0.03) and asymmetry in muscle size at the L2 (p = 0.05) and L5 (p = 0.04) in the pre-season. There was no association between size of the lumbar multifidus muscle and other injuries (p > 0.05). CONCLUSION Lumbar multifidus muscle size and symmetry may impact lumbopelvic control which may increase the risk of sustaining an upper limb injury during rugby union. Future research should aim to identify whether lumbar multifidus muscle size is a modifiable risk factor for rugby union injuries to guide future intervention programs.
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A rehabilitation program to increase balance and mobility in ataxia of Charlevoix-Saguenay: An exploratory study. PLoS One 2022; 17:e0279406. [PMID: 36576926 PMCID: PMC9797069 DOI: 10.1371/journal.pone.0279406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/06/2022] [Indexed: 12/29/2022] Open
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is characterized by balance impairment and mobility limitations, which both increase the risk of falling. The objective of this study was to explore the effects of a rehabilitation program aimed at increasing trunk and lower limb motor control on balance and walking abilities, and accomplishment of activities of daily living. In this exploratory study, a group-supervised rehabilitation program was performed three times a week for 8 weeks (two sessions at a rehabilitation gym and one pool session). Outcome measures included the Ottawa Sitting Scale, Berg Balance Scale, modified Activities-specific Balance Confidence Scale, 30-Second Chair Stand Test, 10-Meter Walk Test, Barthel Index, and Scale for the Assessment and Rating of Ataxia. Significant improvements in balance, trunk control, maximal and self-selected walking speed difference, ataxia severity and accomplishment of specific activities of daily living were noted for the whole group at the end of the program. At the individual level, all participants improved beyond the standard error of measurement in at least two outcome measures. Also, most participants reported many perceived improvements related to balance, posture and functional mobility. This study provides encouraging results on the effects of a rehabilitation program for ambulatory people with ARSACS. Group intervention could have a positive impact on their daily lives and improve the health care service offered to this population. Future studies with larger sample sizes including control groups and other forms of ataxia are necessary to validate our results to generalize them.
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Sports-related concussion: assessing the comprehension, collaboration, and contribution of chiropractors. Chiropr Man Therap 2022; 30:60. [PMID: 36575458 PMCID: PMC9793635 DOI: 10.1186/s12998-022-00471-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
Over the last 2 decades, sports-related concussion (SRC) awareness and management have evolved from an emphasis on complete cognitive and physical rest to evidence-based protocols and interventions. Chiropractors are primary care providers with exposure to athletes and teams in collision sports and, in addition, manage patients with concussion-like symptoms including neck pain, dizziness, and headache. With SRC frequently occurring in the absence of a medical practitioner, the role of allied health practitioners like chiropractors should be emphasised when it comes to the recognition, assessment, and management of SRC. This commentary discusses the potential contribution of chiropractors in SRC and the specific role their expertise in the cervical spine may play in symptom evaluation and management. A PubMed and Google scholar review of the chiropractic SRC literature suggests that the chiropractic profession appears under-represented in concussion research in athletic populations compared to other medical and allied health fields. This includes an absence of chiropractic clinicians with a focus on SRC participating in the Concussion in Sport Group (CISG) and the International Consensus Conferences on Concussion. Furthermore, with evolving evidence suggesting the importance of cervicogenic manifestations in SRC, there is an opportunity for chiropractors to participate in SRC diagnosis and management more fully and contribute scientifically to an area of specialised knowledge and training. With a dearth of chiropractic orientated SRC science, clinical SRC expertise, and clinical chiropractic representation in the CISG; it is incumbent on chiropractic clinicians and scientists to take up this opportunity through meaningful contribution and involvement in the SRC field.
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Cheever K, King J, Kawata K. The association between contact sport exposure and cervical sensorimotor dysfunction: a scoping review of implications for future musculoskeletal injury risk. Chiropr Man Therap 2022; 30:50. [PMID: 36434725 PMCID: PMC9701076 DOI: 10.1186/s12998-022-00458-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While morphological changes to the cervical spine have been observed for over 40 years in response to contact sport participation, little is known about the secondary effects of the cervical impairment on future musculoskeletal injury and disability. OBJECTIVES AND DESIGN A scoping review was performed to discuss the relationship between contact sport participation and morphological changes to the cervical spine. Moreover, the correlation between morphological changes in the musculoskeletal structures of the cervical spine and resultant deficits in cervical sensorimotor and neuromotor function are discussed. Lastly, how alterations in cervical sensorimotor function may affect overall risk of musculoskeletal injury is discussed. METHODS The scientific literature was searched in PubMed, Sport Discus, and Web of Science pertaining to contact-sport athletes and/or cervical pathology and the cervicocephalic network. The Asksey and O'Malley's framework and PRISMA for Scoping Reviews were used to conduct and report the following review. Included articles were grouped into three categories: (1) Morphological changes to the cervical spine in contact sport athletes. (2) The role of the neuromotor pathways of the cervical spine in maintenance of postural tone and coordination of the extremities. (3) The correlation between altered cervical sensorimotor function and a resultant increase in musculoskeletal injury risk. RESULTS Our search identified 566 documents, of which 405 underwent full-text screening, resulting in 54 eligible studies for the review. Widespread cervical sensorimotor dysfunction was observed in contact sport athletes. Independently, cervical sensorimotor function was demonstrated to play a critical role in postural control and limb coordination. However, limited research exists exploring the interaction between contact sport participation and altered cervical sensorimotor function, as well as an associated increase in musculoskeletal injury risk. CONCLUSIONS Limited evidence exists linking cervical injury and/or observed deficits in cervical sensorimotor and neuromotor function to musculoskeletal injury risk. Longitudinal studies combining imaging measures (e.g., MRI, DEXA), cervical functional test, and prospective injury risk are needed to further explore the correlation between resultant cervical sensorimotor deficits following contact sport impacts and future musculoskeletal injury risk.
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Affiliation(s)
- Kelly Cheever
- Applied Biomechanics Laboratory, Department of Kinesiology, College of Health, Community and Policy, University of Texas at San Antonio, One UTSA Cir, San Antonio, TX, 78429, USA.
| | - Jeffery King
- grid.30760.320000 0001 2111 8460Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI USA
| | - Keisuke Kawata
- grid.411377.70000 0001 0790 959XDepartment of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN USA ,grid.411377.70000 0001 0790 959XProgram in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN USA
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Dizziness Is Associated With Neck/Shoulder Pain Following Pediatric Concussion. Clin J Sport Med 2022; 32:e562-e567. [PMID: 36315824 DOI: 10.1097/jsm.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/19/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association between dizziness and neck/shoulder pain after concussion and if differences in postural stability and oculomotor function exist among patients reporting dizziness with or without concurrent neck/shoulder pain. DESIGN Cross sectional. SETTING Sports medicine clinic. PATIENTS Pediatric patients ≤14 days post concussion. INTERVENTIONS N/A. OUTCOME MEASURES Patients completed the Health and Behavior Inventory (HBI) symptom rating and separately rated neck/shoulder pain (scale 0-3; 0 = no pain). We grouped patients by HBI dizziness rating (0 = not-dizzy; 1-3 = dizzy) and compared neck/shoulder pain ratings between the groups. We then compared oculomotor and postural stability outcomes between dizzy patients with and without neck/shoulder pain. RESULTS We included 153 patients: dizzy (n = 100; age = 14.6 ± 2.2 years; 48% female) and not-dizzy (n = 53, age = 14.4 ± 3.1 years; 38% female). The dizzy group reported significantly higher neck/shoulder pain (1.4 ± 1.1 vs 0.5 ± 0.9 points, P < 0.001) and total symptom score (25.7 ± 11.2 vs 11.7 ± 9.3 points, P < 0.001) than the not-dizzy group. After adjusting for total symptom score and preinjury anxiety, depression, and migraines, dizziness was associated with higher odds of neck/shoulder pain (odds ratio = 1.9, 95% CI, 1.2-3.0; P = 0.004). No differences were observed between dizzy patients with and without neck/shoulder pain for near point of convergence (10.0 ± 7.5 vs 8.5 ± 6.7 cm, P = 0.43), modified Balance Error Scoring System (8.9 ± 5.5 vs 6.8 ± 4.7 errors, P = 0.09), or tandem gait (single-task: 26.0 ± 12.3 vs 24.2 ± 11.9 seconds, P = 0.56; dual-task: 35.1 ± 14.3 vs 35.6 ± 18.6 seconds, P = 0.90). CONCLUSIONS In concussion patients experiencing dizziness, evaluating neck/shoulder pain may help identify individuals who would benefit from cervical spine rehabilitation. However, other potential causes of dizziness should also be evaluated to facilitate timely recovery.
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Brown DA, Leung FT, Evans K, Grant G, Hides JA. Cervical spine characteristics differ in competitive combat athletes compared with active control participants. Musculoskelet Sci Pract 2022; 61:102614. [PMID: 35763910 DOI: 10.1016/j.msksp.2022.102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Injury to the head and neck are common in combat sport athletes. Impairments of the cervical spine have been found in some athletes who participate in sports with high forces and collisions. There is a lack of research on the effects of combat sports on the cervical spine. OBJECTIVE The primary study aim was to investigate differences in cervical spine characteristics between combat athletes and a similarly aged active control group. The secondary aim was to investigate the relationship between symptom-based outcome measures and characteristics of the cervical spine. DESIGN Cross-sectional. METHOD 40 male adult combat sport athletes and 40 male adult control participants were recruited from 4 combat sport clubs and a university campus, Australia. Cervical spine assessments were conducted at a private physiotherapy clinic. The Neck Disability Index and the Post-Concussion Symptom Scale were used as symptom-based outcome measures. RESULTS Combat sport athletes had a reduced range of cervical motion, but greater isometric strength and endurance compared with a control group (p < 0.05). The Neck Disability Index and Post-Concussion Symptom Scale were negatively correlated with cervical spine range of motion and isometric strength, meaning that higher scores correlated with a reduction in function. CONCLUSIONS Differences were observed in characteristics of the cervical spine in combat sport athletes compared with a control group. Higher symptom-based outcome scores correlated with reduced range of motion and strength of cervical spine muscles. Further investigation to establish clinical cut-off scores for functional impairment may be warranted.
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Affiliation(s)
- Daniel A Brown
- School of Health Science and Social Work, 170 Kessels Rd, Nathan, Griffith University, Brisbane, QLD, 4111, Australia.
| | - Felix T Leung
- School of Health Science and Social Work, 170 Kessels Rd, Nathan, Griffith University, Brisbane, QLD, 4111, Australia.
| | - Kerrie Evans
- Faculty of Medicine and Health, 75 East Street, Lidcombe, The University of Sydney, NSW, 2141, Australia; Healthia Limited, Australia, 25 Montpelier Road, Bowen Hills, QLD, 4006, Australia.
| | - Gary Grant
- School of Pharmacy and Pharmacology, 1 Parklands Dr, Southport, Griffith University, Gold Coast, QLD, 4215, Australia.
| | - Julie A Hides
- School of Health Science and Social Work, 170 Kessels Rd, Nathan, Griffith University, Brisbane, QLD, 4111, Australia.
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Leung FT, Mendis MD, Franettovich Smith MM, Rahmann A, Treleaven J, Hides JA. Sensorimotor system changes in adolescent rugby players post-concussion: A prospective investigation from the subacute period through to return-to-sport. Musculoskelet Sci Pract 2022; 57:102492. [PMID: 34922255 DOI: 10.1016/j.msksp.2021.102492] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/26/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The pathophysiology of concussion is complex. Altered sensorimotor function post-concussion may contribute to the wide range of symptoms and impairments reported. There is currently limited evidence documenting changes in sensorimotor function during the recovery period. The aim of this study was to investigate the effect of concussion on the sensorimotor system in adolescents post-concussion using a multifaceted approach. STUDY DESIGN Prospective nested case-control study. METHODS A total of 285 male adolescent rugby players underwent assessment of sensorimotor function during preseason. Players who sustained a concussion during the season and control players, matched for age and playing position, were assessed in the subacute period (3-5 days) and after return-to-sport (3 weeks). Tests of sensorimotor function included balance, cervical spine and vestibulo-ocular function, and measurement of the size and contraction of lumbopelvic muscles (ultrasound imaging). RESULTS Twenty-three players (8%) sustained a concussion. Of these, 20 players were assessed during the subacute period and 17 players following return-to-sport. The prevalence of vestibulo-ocular dysfunction increased from 38.9% to 72.2% during the subacute period and dysfunction was present in 83.3% of players after return-to-sport (p = 0.01). Changes in lumbar multifidus muscle size (p = 0.002) and thickness (p = 0.05) at the L5 vertebral level were observed. No statistically significant changes in balance, cervical spine proprioception, or contraction of lumbopelvic muscles were found (p > 0.05). CONCLUSION Changes in sensorimotor function were observed in the subacute period post-concussion, with some persisting after return-to-sport. Using symptom-based criteria for return-to-sport may not adequately reflect the sequelae of concussion on the sensorimotor system.
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Affiliation(s)
- Felix T Leung
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD, 4111, Australia.
| | - M Dilani Mendis
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD, 4111, Australia
| | | | - Ann Rahmann
- School of Allied Health, Australian Catholic University, Banyo, QLD, 4014, Australia
| | - Julia Treleaven
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia
| | - Julie A Hides
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD, 4111, Australia; Mater Back Stability Research Clinic, Mater Health Services, South Brisbane, QLD, 4101, Australia
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Vestibular and oculomotor function in male combat sport athletes. J Sci Med Sport 2022; 25:524-528. [DOI: 10.1016/j.jsams.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/13/2022] [Accepted: 02/13/2022] [Indexed: 11/23/2022]
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15
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Trunk muscle size and function in volleyball players with and without injuries to the head, neck and upper limb. Phys Ther Sport 2021; 54:1-7. [PMID: 34922033 DOI: 10.1016/j.ptsp.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate trunk muscle size and function in elite and community volleyball players with and without a history of head, neck or upper limb injury. DESIGN Cross-sectional observational study. SETTING Volleyball training camp or training sessions. PARTICIPANTS 86 volleyball players (elite = 29; community = 57). MAIN OUTCOME MEASURES Information regarding history of head, neck or upper limb injuries was collected by self-report questionnaires. Trunk muscle size (multifidus, transversus abdominis, internal oblique and quadratus lumborum) and voluntary contraction (multifidus, transversus abdominis, internal oblique) were assessed using ultrasound imaging. RESULTS For trunk muscle size, no significant differences were found between elite and community volleyball players with and without a history of injury (all p > 0.05). A significant difference was found for voluntary contraction of the multifidus and transversus abdominis muscles for elite and community volleyball players with and without a history of injury (all p < 0.05). CONCLUSION A difference in trunk muscle contraction but no change in trunk muscle size in players with a history of head, neck or upper limb injuries may represent an altered muscle recruitment pattern rather than a deficiency in trunk muscle strength. Prospective studies are required to determine if these adaptations are compensatory (and protective) or predispose players to further injuries.
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Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review. Ann Biomed Eng 2021; 49:2693-2715. [PMID: 34258718 DOI: 10.1007/s10439-021-02831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.
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Harper B, Aron A, John E. The role of pre-season health characteristics as injury risk factors in female adolescent soccer players. J Phys Ther Sci 2021; 33:439-443. [PMID: 34083885 PMCID: PMC8165364 DOI: 10.1589/jpts.33.439] [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: 01/08/2021] [Accepted: 02/27/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Determine if female adolescent soccer players with a history of concussion, impaired K-D scores, and pre-season subjective complaints of neck pain, dizziness, and headache were predisposed to additional risk of musculoskeletal or concussive injury during 10-weeks of competitive play. [Participants and Methods] Twenty-three female high school soccer athletes provided concussion history and reported pre-season subjective complaints. K-D testing was performed pre and postseason. During the 10-week season, all injuries, preventing participation in practice or game, were recorded. [Results] Six reported a history of concussion. Of those six, three injuries were reported, including two concussions and a hamstring strain. Baseline K-D scores were worse in athletes that had two or more pre-season subjective factors compared to those that did not have any. Moderate positive correlations were found between a history of concussion and the number of injuries and a history of concussion and K-D post-test scores. [Conclusion] Findings indicate that pre-season subjective factors of neck pain, dizziness and headache, history of concussion, and K-D potentially increased injury risk. Combining pre-season metrics both at baseline and during the course of the season may assist in better injury risk screening in-season or indicate suboptimal function due to cumulative effects.
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Affiliation(s)
- Brent Harper
- Department of Physical Therapy, Crean College of Health
& Behavioral Sciences, Rinker Health Science Campus in Irvine, Chapman University:
9401 Jeronimo Rd, Irvine, CA 92618, USA
| | - Adrian Aron
- Department of Physical Therapy, Radford University,
USA
| | - Emmanuel John
- Department of Physical Therapy, Crean College of Health
& Behavioral Sciences, Rinker Health Science Campus in Irvine, Chapman University:
9401 Jeronimo Rd, Irvine, CA 92618, USA
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Cheever K, McDevitt J, Phillips J, Kawata K. The Role of Cervical Symptoms in Post-concussion Management: A Systematic Review. Sports Med 2021; 51:1875-1891. [PMID: 33891292 DOI: 10.1007/s40279-021-01469-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with cervicogenic symptoms following a concussion have shown a disproportionate rate of delayed symptom resolution. However, the prevalence of cervicogenic symptoms in the acute stages following a concussion and the percentage of those patients who continue on to suffer delayed symptom resolution is poorly described in the literature. OBJECTIVES To provide a comprehensive report on the clinical prevalence, diagnostic methods, and potential treatment options for cervicogenic symptoms that are elicited during acute and chronic phases following a concussion. METHODS Electronic searches were conducted in PubMed, SPORTDiscus, ICL, CINAHL and PEDro, from inception to May 2020, to identify original research articles on concussion involving cervicogenic symptoms. We assessed each included article for risk of bias, methodological quality, level of evidence and evidence quality. The articles were categorized into three topics: (1) prevalence of post-concussion cervicogenic symptoms; (2) diagnostic testing for cervicogenic symptoms, and (3) treatment techniques for cervicogenic symptoms. RESULTS The initial review resulted in 1443 abstracts, of which 103 abstracts met the inclusion criteria of our research. After the review of full text, 80 articles were excluded, which resulted in a total of 23 articles for this systematic review. Prevalence of cervicogenic symptoms in the acute stages ranged from 7 to 69% and increased to 90% in patients experiencing persistent post-concussive symptoms. Neck pain at initial evaluation increased risk of developing persistent post-concussive symptoms (PPCS) by 2.58-6.38 times. Patient-reported outcome measures (e.g., Neck Disability Index, Dizziness Handicap Inventory, and Rivermead Post-Concussion Questionnaire) can identify patients with cervicogenic symptoms that should be further differentiated by clinical testing. Lastly, treatment using graded cervical manual therapy has shown to reduce time to symptom resolution and medical clearance. CONCLUSIONS Cervicogenic symptoms are prevalent in the acute and chronic stages following concussion, which if not diagnosed appropriately increase the likelihood of PPCS. Several clinical tests are available to help differentiate cervicogenic symptoms; however, lack of awareness and hesitation by practitioners limits their use. More randomized controlled trials are necessary to evaluate the effectiveness of cervical specific treatment programs for PPCS.
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Affiliation(s)
- Kelly Cheever
- Department of Kinesiology, College for Health, Community and Policy, University of Texas at San Antonio, One UTSA cir, San Antonio, TX, 78429, USA.
| | - Jane McDevitt
- Depart of Health and Rehabilitation Science, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Jacqueline Phillips
- Department of Kinesiology, College of Public, Health Temple University, Philadelphia, PA, USA
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
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Cheever K, McDevit J, Wright WG, Tierney R. Differences in cervical kinesthesia between amateur athletes with and without a history of contact sport participation. Brain Inj 2021; 35:404-410. [PMID: 33523714 DOI: 10.1080/02699052.2021.1878551] [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: 10/22/2022]
Abstract
Objective: Identify cervical sensorimotor function differences between amateur athletes with and without a history of contact sport participation. A secondary aim of the study was to explore the association between neck reposition error and previously identified injury risk factors.Design: Cross-sectional.Participants: 27 amateur campus recreation sport athletes with a history of contact sport participation and 20 amateur campus recreation sport athletes with no history of contact sport.Main Outcome Measures: Baseline signs and symptoms (S/S) number and severity, Neck Disability Index, total neck reposition error, maximum reposition error, cervical range of motion, and cervical isometric strength were then compared between independent factor groups (contact vs. non-contact).Results: Amateur sport athletes with a history of contact sport exposure exhibited 25.2% more total neck reposition error and 24.6% more maximum neck reposition error than athletes with no history of contact sport participation. S/S number (r2 = .12, F(2,44) = 6.2, p = .017) and S/S severity (r2 = .14, F(2,44) = 5.6, p = .02) were significantly correlated with total neck reposition error.Conclusions: Athletes with a history of contact sport participation exhibited greater cervical spine reposition error. The degree to which these sensory position-sense deficits increase risk of injury and long-term quality of life is unknown, but should be explored in future studies.
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Affiliation(s)
- Kelly Cheever
- Department of Kinesiology, College of Health, Community and Policy, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Jane McDevit
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - W Geoffrey Wright
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA.,Neuromotor Science Program, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Ryan Tierney
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
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Clinical Changes in Cervical Neuromuscular Control Following Subconcussive Impacts. J Sport Rehabil 2020; 30:467-474. [PMID: 33075749 DOI: 10.1123/jsr.2020-0228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/09/2020] [Accepted: 08/09/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Increased injury rates following concussive injury have been attributed to decreased neuromuscular coordination frequently documented following a concussion. However, altered integration between the vestibular system and oculomotor pathways following impacts at subconcussive thresholds implicate all sports-related impacts not just those at a concussive threshold in future musculoskeletal injury. While, several studies have explored the utility of vestibular and oculomotor clinical testing to detect altered neuromuscular control and then correlated those alterations to future injury risk, no research has explored the use of cervical clinical tests in the same capacity. OUTCOME MEASURES Cervical joint position error test, Neck Disability Index and head acceleration. INTERVENTIONS Soccer headers, fatigue protocol, soccer headers + fatigue. OBJECTIVE To explore the clinical utility of a novel clinical approach to measuring changes in cervical neuromuscular control following subconcussive impacts in a controlled lab environment. PARTICIPANTS 40 current female colligate club soccer athletes were recruited. Inclusion criteria included between the age of 18 and 25 and a minimum of 4-year soccer heading experience. SETTING Laboratory. Design: A repeated-measures design with 4 groups was utilized to test the hypothesis. RESULTS A 65%, 54%, and 49% increased error was observed following the soccer heading, fatigue only, and soccer heading + fatigue interventions, respectively. Meanwhile, the controls saw a 6% decrease in neck position error. Concussion: While, cervical joint position error testing was sensitive to decreased neuromuscular coordination following soccer heading, it was not specific enough to rule out an exercise effect in the absence of subconcussive impacts. Further research is warranted to explore the clinical utility and specificity of cervical joint position error testing to measured alterations in supraspinal processing following subconcussive impacts, and how these alterations may lead to decreased coordination and movement of the body during sports-related task.
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Serpell BG, Waddington G, McGrath B, Cook CJ. Is There a Link between Stress and Cognition, and Capacity to Execute Motor Skill? Med Sci Sports Exerc 2020; 52:2365-2372. [PMID: 33064410 DOI: 10.1249/mss.0000000000002397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to examine the link between stress (measured via salivary cortisol and testosterone), cognition (measured via pupillometry, with greater pupil constriction and reduced pupil constriction latency associated with increased attention and improved information processing), and motor skill capacity (measured via somatosensory processing). METHODS Twenty-five professional rugby players participated in this study. Saliva samples were collected upon waking, before pupillometry and somatosensory processing testing, and after testing. Testing times varied for participants; however, it was always in the morning, and the order of testing was randomized. RESULTS Very small differences in hormone concentrations were seen across the morning (effect size = 0.01). Moderate to large differences in left eye pupil constriction for direct (left eye) versus consensual (right eye) stimulus were also seen (P < 0.01; effect size = 0.51 to 1.04). No differences for pupil constriction latency were seen for direct versus consensual stimulus. Some positive weak to moderate relationships were seen for testosterone and pupil constriction latency (r = 0.37 to 0.39, P < 0.05). Moderate to strong inverse relationships were seen for hormones with left eye pupil constriction difference between direct and consensual stimulus, and for pre- to posttest testosterone-to-cortisol ratio decline with left eye pupil constriction for direct and consensual stimulus (r = 0.41 to 0.52, P < 0.05). Weak to moderate inverse relationships for testosterone-to-cortisol ratio decline and somatosensory processing were seen (r = 0.36 to 0.47, P < 0.05). CONCLUSION Stress may affect ability to receive information and ability to execute motor tasks. Thus, stress may compromise ability to make appropriate objective decisions and consequently execute skill/task behavior. Strategies to help mitigate negative stress responses are noted.
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Affiliation(s)
| | | | - Braden McGrath
- Human Factors and Behavioral Neurobiology Department, Embry-Riddle Aeronautical University, Daytona Beach, FL
| | - Christian J Cook
- Human Performance, Sport and Physiology Group, Brain-Behaviour Research Group, Biomedical Discipline School of Science and Technology, University of New England, Armidale, AUSTRALIA
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Schwab LM, McGhee D, Franettovich Smith MM, Mendis MD, Hides J. Pre-season screening of the upper body and trunk in Australian football players: A prospective study. Phys Ther Sport 2020; 46:120-130. [PMID: 32942242 DOI: 10.1016/j.ptsp.2020.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether screening tests of upper body, trunk region, and of whole-body function could prospectively identify community AFL players who sustain in-season shoulder/head/neck injuries. Additionally, to present screening test reference values. DESIGN Prospective cohort; SETTING: Community sport; PARTICIPANTS: 142 male community AFL players (range 15-37 years). MAIN OUTCOME MEASURES (i) isometric shoulder external and internal rotation (ER/IR) strength; (ii) upper body combined elevation functional ROM; (iii/iv) whole-body functional jump ROM; (v) static thoracic spine angle; (vi) cervical joint proprioception, and (vii) trunk muscle size and function. Results were compared among players with (n = 21) and without (n = 121) an in-season shoulder, head, or neck injury. ROC analysis and odds ratios were used to determine the predictive values. RESULTS Two screening tests predicted an in-season shoulder, head, or neck injury; dominant and non-dominant isometric ER strength (AUC 0.629, 95%CI 0.51-0.74; optimal cut point 182 N and AUC 0.619, 95%CI 0.50-0.74; optimal cut point 184 N, respectively). The adjusted odds ratio for the strongest predictor: dominant ER muscle strength was 6.02 (95%CI 1.8-19.9). CONCLUSION Greater ER strength was associated with in-season shoulder/head/neck injuries in community AFL players; however, further research is required to determine the clinical significance of this finding.
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Affiliation(s)
- Laura M Schwab
- Griffith University, School of Allied Health, Brisbane, QLD, Australia.
| | - Deirdre McGhee
- University of Wollongong, School of Medicine, Wollongong, NSW, Australia
| | | | - M Dilani Mendis
- Griffith University, School of Allied Health, Brisbane, QLD, Australia
| | - Julie Hides
- Griffith University, School of Allied Health, Brisbane, QLD, Australia
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Sex-Specific Dependence of Linear and Nonlinear Postural Control Metrics on Anthropometrics During Clinical Balance Tests in Healthy Young Adults. J Sport Rehabil 2020; 29:405-412. [PMID: 30860414 DOI: 10.1123/jsr.2018-0197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/05/2019] [Accepted: 02/06/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Previous work suggests that balance behavior is a sex-dependent, complex process that can be characterized by linear and nonlinear metrics. Although a certain degree of center of pressure variability may be expected based on sexual dimorphism, there is evidence to suggest that these effects are obscured by potential interactions between sex and anthropometric factors. To date, no study has accounted for such interactive effects using both linear and nonlinear measures. OBJECTIVE This investigation sought to analyze interactive models featuring sex, height, and weight as predictors of linear and nonlinear aspects of postural control. DESIGN Cross-sectional study. SETTING Controlled laboratory. PARTICIPANTS A total of 26 males (23.80 [3.44] y, 177.87 [6.44] cm, 81.70 [10.80] kg) and 28 females (21.14 [2.03] y, 169.57 [8.80] cm, 64.48 [8.86] kg) were sampled from a healthy university population. MAIN OUTCOME MEASURES Linear (range [RNG], velocity [VEL], and SD) and nonlinear (detrended fluctuation analysis scaling exponent, multivariate multiscale sample entropy [MMSECI]) summary metrics of center of pressure time series. PROCEDURE Participants stood on a force plate for 20 seconds in 3 conditions: double (D), single (S), and tandem (T) stance. Data for each stance condition were analyzed using regression models with interaction terms for sex × height and sex × weight. In D, weight had a positive, significant main effect on VELy, MMSECId, and MMSECIv. In men, height was observed to have a positive effect on SDy (S), RNGy (S), and RNGx (T) and a negative effect on MMSECIv (T). In women, weight was observed to have a positive effect on SDy and VELx (both T). CONCLUSIONS Our findings suggest that men and women differ with respect to certain linear and nonlinear aspects of balance behavior, and that these differences may reflect sex-specific behavioral patterns in addition to effects related to sexual dimorphism.
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Abstract
Over the last decade, numerous concussion evidence-based clinical practice guidelines (CPGs), consensus statements, and clinical guidance documents have been published. These documents have typically focused on the diagnosis of concussion and medical management of individuals post concussion, but provide little specific guidance for physical therapy management of concussion and its associated impairments. Further, many of these guidance documents have targeted specific populations in specific care contexts. The primary purpose of this CPG is to provide a set of evidence-based recommendations for physical therapist management of the wide spectrum of patients who have experienced a concussive event. J Orthop Sports Phys Ther 2020;50(4):CPG1-CPG73. doi:10.2519/jospt.2020.0301.
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Daniels KA, Henderson G, Strike S, Cosgrave C, Fuller C, Falvey É. The use of continuous spectral analysis for the assessment of postural stability changes after sports-related concussion. J Biomech 2019; 97:109400. [DOI: 10.1016/j.jbiomech.2019.109400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 02/02/2023]
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Abstract
Concussion is an ongoing concern for health care providers. The incidence rates continue to be high and the rate of recovery is variable due to potential risk factors. With no valid biomarkers, diagnosis and assessment of concussion remain a clinical challenge. The heterogeneity in presentation following injury provides an additional level of complexity, requiring the screening and evaluation of diverse body systems, including oculomotor, vestibular, autonomic, psychiatric, cervical, and cognitive symptoms. While a few tools, such as the Vestibular/Ocular Motor Screening and Balance Error Scoring System, have been developed specifically for concussion, the vast majority of tests are adapted from other conditions. Further complicating the process is the overlapping and interactive nature of the multiple domains of postconcussion presentation. This commentary illustrates how clinicians can conceptualize the multiple profiles that present following concussion and describes tools that are available to assist with screening and evaluation of each area. The multifaceted nature of concussion warrants broad clinical screening skills and an interdisciplinary approach to management. J Orthop Sports Phys Ther 2019;49(11):787-798. doi:10.2519/jospt.2019.8855.
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Reneker JC, Babl R, Pannell WC, Adah F, Flowers MM, Curbow-Wilcox K, Lirette S. Sensorimotor training for injury prevention in collegiate soccer players: An experimental study. Phys Ther Sport 2019; 40:184-192. [PMID: 31590121 DOI: 10.1016/j.ptsp.2019.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Deliver a sensorimotor training intervention; quantify the change in clinical measurements of sensorimotor control; and compare injury rate to a historical control. DESIGN One-arm experimental pilot; Level 3. SETTING NCAA Division II university athletic facilities. PARTICIPANTS 75 collegiate soccer players (38 males; 37 females) were enrolled, including 30 (40%) with history of concussion, and participated in eight training sessions. OUTCOMES Change in pre-to post-intervention for: static balance on the Sway app, near-point convergence, self-reported symptoms on the Post-Concussion Symptom Scale, cervical flexor neuromotor control/endurance, measured by the Cranial-Cervical Flexion Test and Joint Position Error test, and gaze stability on the Dynamic Visual Acuity Test. Injury incidence rate in 2018 was calculated using the number of traumatic injuries across the season and athlete exposure counts, as compared to a historical control. RESULTS Significant improvements were obtained in static balance, cervical flexor neuromotor control/endurance, and near-point convergence (p-values<0.01-0.03). Increases in symptom report (p = 0.02) and a decline in dynamic gaze stability (p < 0.01) were observed. There were 11.8 injuries/1000 athlete exposures in 2017 and 8.9 injuries/1000 athlete exposures in 2018 after the treatment (p = 0.18). CONCLUSION This intervention holds promise as a preventive strategy for sports-injury as a comprehensive population-based intervention.
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Affiliation(s)
| | - Ryan Babl
- University of Mississippi Medical Center Jackson, MS, USA
| | - W Cody Pannell
- University of Mississippi Medical Center Jackson, MS, USA
| | - Felix Adah
- University of Mississippi Medical Center Jackson, MS, USA
| | | | | | - Seth Lirette
- University of Mississippi Medical Center Jackson, MS, USA
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History of concussion and risk of subsequent injury in athletes and service members: A systematic review and meta-analysis. Musculoskelet Sci Pract 2019; 42:173-185. [PMID: 31014921 DOI: 10.1016/j.msksp.2019.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/28/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
Risk of secondary injury after a primary concussion in sports and military contexts is an emerging area of interest in research. The purpose of this review was to provide an evidence synthesis describing risk of injury in athletic and military populations with and without a history of concussion. Electronic database searches were completed through September 7, 2018 in PubMed, EMBASE, CINAHL and SCOPUS. Peer-reviewed observational studies of any design with participants who were athletes or service members; measured the outcome of any type of injury; and compared injury between those with and without a history of concussion were included. Risk of bias was assessed using the Q-Coh II. Twenty-seven articles were included. Seventeen meta-analyses were completed for risk of any injury, risk of concussion, and risk of extremity injury using odds, hazard, and rate ratios. The results indicate significantly increased odds of all injuries (OR = 2.55; 95%CI 1.85,3.52); concussion (OR = 3.73; 95%CI 2.41,5.78); and lower extremity injuries (OR = 1.60; 95%CI 1.32,1.94) in those with a history of concussion compared to those without. Additional analyses reveal this increased risk is apparent when looking at time to event data and rate of injury based on number of exposures. While the reasons for the increased incidence of secondary injury associated with a concussion are not yet understood, there are potentially behavioral attributes and motor control deficits that contribute. It is suggested that research is needed to determine if active therapeutic treatment for disturbances in sensorimotor and neuromotor control after concussion could attenuate the increased risk for injury.
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Schneider KJ. Concussion - Part I: The need for a multifaceted assessment. Musculoskelet Sci Pract 2019; 42:140-150. [PMID: 31133539 DOI: 10.1016/j.msksp.2019.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Concussion is among the most commonly occurring sport and recreation injuries in today's society. An understanding of the heterogenous nature of concussion will assist in directing a multifaceted and comprehensive interdisciplinary assessment following injury. PURPOSE The purpose of this masterclass article is to summarize the current state of the evidence in the area of concussion, describe typical symptom presentations and assessment techniques that may assist in directing appropriate management following concussion. IMPLICATIONS A comprehensive assessment including a thoughtful differential diagnosis will assist the clinician to direct care appropriately and efficiently in individuals who have suffered a concussion.
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Affiliation(s)
- Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, KNB3300D 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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Bussey M, McLean M, Pinfold J, Anderson N, Kiely R, Romanchuk J, Salmon D. History of concussion is associated with higher head acceleration and reduced cervical muscle activity during simulated rugby tackle: An exploratory study. Phys Ther Sport 2019; 37:105-112. [DOI: 10.1016/j.ptsp.2019.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE Evaluate postconcussive symptom reporting and recovery. SETTING Public high school. PARTICIPANTS Unmatched controls (n = 760); students who sustained a sports-related concussion (n = 77); matched controls (gender, grade, sport) (n = 77). DESIGN Prospective longitudinal cohort study. OUTCOME MEASURE Immediate Postconcussion Assessment and Cognitive Testing. RESULTS At baseline, athletes who went on to sustain concussions were more likely than unmatched controls to be younger (P = .02), male (P = .001), and participate in different sports (P < .0001) such as football (concussed = 52%, unmatched controls = 20%). Differences were also noted regarding a previous history of concussion (P = .045; concussed athletes = 26%; unmatched control athletes = 16%) and lifetime number of concussions (P = .05). At baseline, those whose sustained concussions during the study period were more likely than matched controls to report numbness (P = .01) and concentration problems (P = .01) and more likely than unmatched controls to report dizziness (P = .02), sensitivity to light (P = .01), sensitivity to noise (P = .002), and numbness (P = .02). However, when data were reanalyzed and those with a previous history of concussion were removed, differences between those who sustained concussions during the study period and matched controls were no longer significant; when compared to unmatched controls, sensitivity to light (P = .01) and vision problems (P = .04) remained significant. Among those who sustained concussions, median time to recovery was 6 days (95% confidence interval: 4-9), and 71 out of 77 (92%) recovered by the fourth postinjury evaluation (median: 20 days postinjury). CONCLUSIONS Course and time frame of recovery were variable. Data also suggest that a previous history of concussion may be contributing to baseline symptom reporting and highlight the potential enduring impact of history of concussion on sensorimotor function. However, further research as to whether preinjury measures of sensorimotor function may increase understanding regarding concussion risk is warranted.
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Vestibulo-ocular dysfunction in adolescent rugby union players with and without a history of concussion. Musculoskelet Sci Pract 2019; 39:144-149. [PMID: 30599447 DOI: 10.1016/j.msksp.2018.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Sport-related concussions are common in adolescent contact sports. Vestibulo-ocular dysfunction has been reported in athletes post-concussion. There is a lack of research on vestibulo-ocular function in sporting adolescents, and the influence of previous concussions on the vestibular system in this population. The aim of this study was to investigate vestibulo-ocular function in a cohort of adolescent rugby players with and without a history of concussion during pre-season assessment. DESIGN Cross-sectional cohort. METHODS 213 male adolescent (13-18 years old) rugby players were recruited from six schools in Queensland, Australia. Vestibulo-ocular assessments were conducted during the preseason and included clinical assessment of oculomotor function and the vestibulo-ocular reflex (VOR) using the clinical and video-Head Impulse Test (HIT). Players were allocated into two groups: no history of concussion in the last 12 months (n = 165); and concussion in the last 12 months (n = 48). RESULTS There were no between group differences in vestibulo-ocular function for players with and without a history of concussion (p = 0.65). However, vestibulo-ocular dysfunction was reported in 69 (32.7%) of the players tested, who had either abnormal oculomotor control or VOR function. CONCLUSIONS The high prevalence of vestibulo-ocular dysfunction in adolescent rugby players suggests that positive clinical findings post-concussion need to be interpreted carefully in the absence of baseline or pre-concussion assessments.
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Abstract
Research into sports-related concussion (SRC) or brain injury has vastly expanded our knowledge of the connection between brain activity and behavioral outcomes. Historical examination of concussion reveals components of structural changes in the brain resulting from injury. A constellation of clinical symptoms is typically present following concussion for several days and weeks. However, the intersection of structural changes and clinical examination still remains elusive to medical professionals. With emerging technologies and modalities such as quantitative electroencephalography (EEG), functional magnetic resonance imaging (fMRI), virtual reality (VR), and the study of movement, we can better understand the brain–behavior relationship on clinical findings post-injury. Our advancement in SRC study using athletics provides a unique window into the advances in our ability to study this public health crisis. SRC also allows us to understand how athletics and exercise influence brain health. The evolution of SRC diagnosis, treatment, and management informs our current abilities in the study of the brain.
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HIDES JULIEA, FRANETTOVICH SMITH MELINDAM, MENDIS MDILANI, TRELEAVEN JULIA, ROTSTEIN ANDREWH, SEXTON CHRISTOPHERT, LOW CHOY NANCY, MCCRORY PAUL. Self-reported Concussion History and Sensorimotor Tests Predict Head/Neck Injuries. Med Sci Sports Exerc 2017; 49:2385-2393. [DOI: 10.1249/mss.0000000000001372] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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