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Avedesian JM, Covassin T, Baez S, Nash J, Dufek JS. The Influence of Sports-Related Concussion on Cognition and Landing Biomechanics in Collegiate Athletes. Scand J Med Sci Sports 2024; 34:e14698. [PMID: 38984660 DOI: 10.1111/sms.14698] [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: 03/28/2024] [Revised: 06/06/2024] [Accepted: 06/30/2024] [Indexed: 07/11/2024]
Abstract
Injury surveillance data indicate that collegiate athletes are at greater risk for lower extremity (LE) injuries following sports-related concussion (SRC). While the association between SRC and LE injury appears to be clinically relevant up to 1-year post-SRC, little evidence has been provided to determine possible mechanistic rationales. Thus, we aimed to compare collegiate athletes with a history of SRC to matched controls on biomechanical and cognitive performance measures associated with LE injury risk. Athletes with a history of SRC (n = 20) and matched controls (n = 20) performed unanticipated bilateral land-and-cut tasks and cognitive assessments. Group-based analyses (ANOVA) and predictive modeling (C5.0 decision tree algorithm) were used to compare group differences on biomechanical and cognitive measures. Collegiate athletes with a history of SRC demonstrated approximately six degrees less peak knee flexion on both dominant (p = 0.03, d = 0.71) and nondominant (p = 0.02, d = 0.78) limbs during the land-and-cut tasks compared to controls. Verbal Memory, knee flexion, and Go/No Go total score (C5.0 decision tree algorithm) were identified as the strongest indicators of previous SRC injury history. Reduced knee flexion during sport-specific land-and-cut tasks may be a mechanism for increased LE injury risk in athletes with a history of SRC. There appears to be multiple biomechanical and cognitive predictors for identifying previous SRC in collegiate athletes, providing evidence to support a multifactorial SRC management strategy to reduce future injury risk.
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Affiliation(s)
- Jason M Avedesian
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
- Department of Athletics, Clemson University, Clemson, South Carolina, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Shelby Baez
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer Nash
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Janet S Dufek
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Shumski EJ, Schmidt JD, Lynall RC. Cognition Uniquely Influences Dual-Task Tandem Gait Performance Among Athletes With a Concussion History. Sports Health 2024; 16:542-550. [PMID: 37377161 PMCID: PMC11195850 DOI: 10.1177/19417381231183413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND After a concussion, there are unique associations between static balance and landing with cognition. Previous research has explored these unique correlations, but the factor of time, dual-task, and different motor tasks leave gaps within the literature. The purpose of this study was to determine the associations between cognition and tandem gait performance. HYPOTHESIS We hypothesized that athletes with a concussion history would display stronger associations compared with athletes without a concussion history between cognition and tandem gait. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 3. METHODS A total of 126 athletes without (56.3% female; age, 18.8 ± 1.3 years; height, 176.7 ± 12.3 cm; mass, 74.8 ± 19.0 kg) and 42 athletes with (40.5% female; age, 18.8 ± 1.3 years; height, 179.3 ± 11.9 cm; mass, 81.0 ± 25.1 kg) concussion history participated. Cognitive performance was assessed with CNS Vital Signs. Tandem gait was performed on a 3-meter walkway. Dual-task tandem gait included a concurrent cognitive task of serial subtraction, reciting months backward, or spelling words backward. RESULTS Athletes with a concussion history exhibited a larger number of significant correlations compared with athletes without a concussion history for cognition and dual-task gait time (4 significant correlations: rho-range, -0.377 to 0.358 vs 2 significant correlations: rho, -0.233 to 0.179) and dual-task cost gait time (4 correlations: rho range, -0.344 to 0.392 vs 1 correlation: rho, -0.315). The time between concussion and testing did significantly moderate any associations (P = 0.11-0.63). Athletes with a concussion history displayed better dual-task cost response rate (P = 0.01). There were no other group differences for any cognitive (P = 0.13-0.97) or tandem gait (P = 0.20-0.92) outcomes. CONCLUSION Athletes with a concussion history display unique correlations between tandem gait and cognition. These correlations are unaffected by the time since concussion. CLINICAL RELEVANCE These unique correlations may represent shared neural resources between cognition and movement that are only present for athletes with a concussion history. Time does not influence these outcomes, indicating the moderating effect of concussion on the correlations persists long-term after the initial injury.
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Affiliation(s)
- Eric J. Shumski
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Julianne D. Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Robert C. Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
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Antonellis P, Weightman MM, Fino PC, Chen S, Lester ME, Hoppes CW, Dibble LE, King LA. Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2024; 105:868-875. [PMID: 37931890 DOI: 10.1016/j.apmr.2023.10.013] [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: 07/05/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DESIGN Multi-center, cross-sectional study. SETTING Three institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). PARTICIPANTS Data were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. INTERVENTIONS Not applicable. OUTCOME MEASURES Cognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. RESULTS Individuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. CONCLUSIONS Combining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.
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Affiliation(s)
| | | | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT
| | - Siting Chen
- School of Public Health, Oregon Health & Science University, Portland, OR
| | - Mark E Lester
- Department of Physical Therapy, University of Texas Rio Grande Valley, Harlingen, TX
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR
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Kakavas G, Tsiokanos A, Potoupnis M, Tsaklis PV. Mechanical and Contractile Properties of Knee Joint Muscles after Sports-Related Concussions in Women Footballers. J Funct Morphol Kinesiol 2024; 9:65. [PMID: 38651423 PMCID: PMC11036212 DOI: 10.3390/jfmk9020065] [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: 01/09/2024] [Revised: 02/24/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024] Open
Abstract
The purpose of this study was to determine if women footballers have an increased lack of neuromuscular control of the knee joint after a concussion compared to a healthy cohort tested with tensiomyography (TMG). Forty-one female collegiate footballers were enrolled in this study from which there were 20 with a history of sports-related concussions (SRCs) and 21 control subjects. Results from the SRC group had significantly higher Tc (ms) (z = -5.478, p = 0.000) and significantly lower Dm (mm) (z = -3.835, p = 0.000) than the control group in the case of the rectus femoris muscle. The SRC group had significantly higher Tc (ms) (z = -2.348, p = 0.016) and significantly lower Dm (mm) (z = -4.776, p = 0.000) than the control group in the case of the vastus medialis muscle. The SRC group had significantly higher Tc (ms) (z = -5.400, p = 0.000) and significantly lower Dm (mm) (z = -4.971, p = 0.000) than the control group in the case of the vastus lateralis muscle. The SRC group had significantly higher Tc (ms) (z = -5.349, p = 0.000) than the control group in the case of the biceps femoris muscle response, whereas no significant difference was found in Dm (mm) (z = -0.198, p = 0.853) between the groups. The results of the current study may have implications for current practice standards regarding the evaluation and management of concussions and can add valuable information for knee prevention programs as well.
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Affiliation(s)
- Georgios Kakavas
- Fysiotek Spine and Sports Lab, 11635 Athens, Greece;
- ErgoMechLab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
| | - Athanasios Tsiokanos
- ErgoMechLab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
| | - Michael Potoupnis
- Medical School, 3rd Academic Orthopedic Clinic, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Panagiotis V. Tsaklis
- ErgoMechLab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
- Department of Molecular Medicine and Surgery, Growth and Metabolism, Karolinska Institute, 17164 Solna, Sweden
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5
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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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Dunne LAM, Cole MH, Cormack SJ, Howell DR, Johnston RD. Validity and Reliability of Methods to Assess Movement Deficiencies Following Concussion: A COSMIN Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:76. [PMID: 37578611 PMCID: PMC10425315 DOI: 10.1186/s40798-023-00625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There is an increased risk of subsequent concussion and musculoskeletal injury upon return to play following a sports-related concussion. Whilst there are numerous assessments available for clinicians for diagnosis and during return to play following concussion, many may lack the ability to detect these subclinical changes in function. Currently, there is no consensus or collated sources on the reliability, validity and feasibility of these assessments, which makes it difficult for clinicians and practitioners to select the most appropriate assessment for their needs. OBJECTIVES This systematic review aims to (1) consolidate the reliability and validity of motor function assessments across the time course of concussion management and (2) summarise their feasibility for clinicians and other end-users. METHODS A systematic search of five databases was conducted. Eligible studies were: (1) original research; (2) full-text English language; (3) peer-reviewed with level III evidence or higher; (4) assessed the validity of lower-limb motor assessments used to diagnose or determine readiness for athletes or military personnel who had sustained a concussion or; (5) assessed the test-retest reliability of lower-limb motor assessments used for concussion management amongst healthy athletes. Acceptable lower-limb motor assessments were dichotomised into instrumented and non-instrumented and then classified into static (stable around a fixed point), dynamic (movement around a fixed point), gait, and other categories. Each study was assessed using the COSMIN checklist to establish methodological and measurement quality. RESULTS A total of 1270 records were identified, with 637 duplicates removed. Titles and abstracts of 633 records were analysed, with 158 being retained for full-text review. A total of 67 records were included in this review; 37 records assessed reliability, and 35 records assessed the validity of lower-limb motor assessments. There were 42 different assessments included in the review, with 43% being non-instrumented, subjective assessments. Consistent evidence supported the use of instrumented assessments over non-instrumented, with gait-based assessments demonstrating sufficient reliability and validity compared to static or dynamic assessments. CONCLUSION These findings suggest that instrumented, gait-based assessments should be prioritised over static or dynamic balance assessments. The use of laboratory equipment (i.e. 3D motion capture, pressure sensitive walkways) on average exhibited sufficient reliability and validity, yet demonstrate poor feasibility. Further high-quality studies evaluating the reliability and validity of more readily available devices (i.e. inertial measurement units) are needed to fill the gap in current concussion management protocols. Practitioners can use this resource to understand the accuracy and precision of the assessments they have at their disposal to make informed decisions regarding the management of concussion. TRAIL REGISTRATION This systematic review was registered on PROSPERO (reg no. CRD42021256298).
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Affiliation(s)
- Laura A M Dunne
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia.
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
| | - Michael H Cole
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- Healthy Brain and Mind Research Centre, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Stuart J Cormack
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rich D Johnston
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Carnegie Applied Rugby Research Centre, School of Sport, Leeds Beckett University, Leeds, UK
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Pei Y, Kemp AM, O'Brien KH. Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta-Analysis. THE JOURNAL OF SCHOOL HEALTH 2023; 93:594-620. [PMID: 36852558 DOI: 10.1111/josh.13307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/14/2022] [Accepted: 02/05/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Examine concussion effects on academic outcomes, including student perspectives. METHODS This study included a systematic review and meta-analysis examining post-concussion school attendance, academic performance, perceptions of academic difficulty, and accommodations for students in elementary through college settings. The analysis considered pre- and post-injury factors, along with injury factors that contribute to post-concussion academic outcomes. RESULTS The systematic review showed that students with concussion miss more school days and perceive higher levels of academic difficulty, but results about academic performance varied. Meta-analysis yielded small concussion effects on school absence and academic performance and moderate effects on perceptions of academic difficulty. Female sex, older age, history of migraine, prior concussions, severe or persistent symptoms, vestibular-ocular motor, and cognitive disruptions are risk factors, but these moderators were not identified in the meta-analysis due to lack of effect sizes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY This study confirmed negative concussion effects on academic absences, performance, and perceptions of academic difficulty. Identified contributing factors will guide future practices to support students returning to learn after concussion. CONCLUSIONS Negative impacts to academics from concussion may be amplified by complicating factors. Future investigations are needed to confirm risk factors and mitigating effects of early identification and post-injury supports.
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Affiliation(s)
- Yalian Pei
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA, 30602
| | - Amy M Kemp
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA, 30602
| | - Katy H O'Brien
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA 30602; Courage Kenny Rehabilitation Institute Allina Health, 800 E 28th St, Minneapolis, MN, 55407
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Roach MH, Aderman MJ, Ross JD, Kelly TF, Malvasi SR, Posner MA, Svoboda SJ, Pasquina PF, Cameron KL. Risk of Upper Extremity Musculoskeletal Injury Within the First Year After a Concussion. Orthop J Sports Med 2023; 11:23259671231163570. [PMID: 37197033 PMCID: PMC10184236 DOI: 10.1177/23259671231163570] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/20/2023] [Indexed: 05/19/2023] Open
Abstract
Background Emerging evidence suggests that athletes and military personnel are at increased risk for lower extremity musculoskeletal injury after a concussion; however, the association between concussion and subsequent upper extremity (UE) musculoskeletal injury is unknown. Purpose To prospectively examine the association between concussion and UE musculoskeletal injury risk within the first year after returning to unrestricted activity. Study Design Cohort study; Level of evidence, 3. Methods A total of 316 cases of concussion 42% (132/316 women) were observed among 5660 Concussion Assessment, Research and Education Consortium participants at the United States Military Academy from May 2015 to June 2018. Active injury surveillance within the cohort was conducted for 12 months after unrestricted return to activity to identify any incident cases of acute UE musculoskeletal injury. Injury surveillance during the follow-up period was also conducted for nonconcussed controls who were matched by sex and competitive sport level. Univariate and multivariable Cox proportional hazards regression models were used to estimate hazard ratios between concussed cases and nonconcussed controls for time to UE musculoskeletal injury. Results During the surveillance period, 19.3% of concussed cases and 9.2% of nonconcussed controls sustained a UE injury. In the univariate model, concussed cases were 2.25 times (95% CI, 1.45-3.51) more likely to sustain a UE injury during the 12-month follow-up period when compared with the nonconcussed controls. In the multivariable model, adjusted for history of concussion, sport level, somatization, and history of UE injury, concussed cases were 1.84 times (95% CI, 1.10-3.07) more likely to sustain a UE injury during the surveillance period compared with nonconcussed controls. Sport level remained an independent risk factor for UE musculoskeletal injury; however, concussion history, somatization, and history of UE injury were not independent risk factors. Conclusion Concussed cases were more than twice as likely to sustain an acute UE musculoskeletal injury within the first 12 months after unrestricted return to activity when compared with nonconcussed controls. The higher hazard of injury remained in the concussed group after adjusting for other potential risk factors.
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Affiliation(s)
- Megan H. Roach
- Extremity Trauma & Amputation Center of Excellence, Defense Health Agency, Falls Church, Virginia, USA
- Department of Clinical Investigations, Womack Army Medical Center, Fort Bragg, North Carolina, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Megan H. Roach, PhD, ATC, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA () (Twitter: @houston_mn)
| | - Michael J. Aderman
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Jeremy D. Ross
- United States Military Academy, West Point, New York, USA
| | - Tim F. Kelly
- United States Military Academy, West Point, New York, USA
| | - Steven R. Malvasi
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Matthew A. Posner
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Steven J. Svoboda
- Medstar Orthopaedic Institute, Washington, District of Columbia, USA
| | - Paul F. Pasquina
- Walter Reed National Military Medical Center, Washington, District of Columbia, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, Maryland, USA
| | - Kenneth L. Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, Maryland, USA
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Teare-Ketter A, Ebert J, Todd H. The Implementation of a Return-to-Play Protocol with Standardized Physical Therapy Referrals in a Collegiate Football Program: PT's Role in Return-to-Play, A Clinical Commentary. Int J Sports Phys Ther 2023; 18:513-525. [PMID: 37020444 PMCID: PMC10069397 DOI: 10.26603/001c.73074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/28/2023] [Indexed: 04/03/2023] Open
Abstract
Sport-related concussions (SRCs) are multi-faceted injuries requiring coordinated care for return-to-play (RTP). Although the number of concussions in collegiate football is increasing annually, there is poor standardization among RTP protocols. Recent evidence suggests there is an increased risk of lower extremity injury, neuropsychiatric consequences, and re-injury after SRC, and risk factors for a prolonged recovery from SRC have also been identified. Evidence demonstrates a faster RTP and improved outcomes with early physical therapy intervention; however, this is not yet common practice in the treatment of acute SRC. There is little guidance available on the development and implementation of a multidisciplinary RTP rehabilitation protocol for SRC that incorporates standardized physical therapy. By describing an evidence-based RTP protocol with standardized physical therapy management, and measures taken to implement this protocol, this clinical commentary aims to identify steps in treating SRC that can be used to improve recovery. The purpose of this commentary is to: a) survey the current state of standardization of RTP protocols in collegiate football; b) highlight the development and implementation of a RTP protocol with standardized physical therapy referral and management in an NCAA Division II collegiate football program; and c) describe results of a full-season pilot study, including time to evaluation, time to RTP, rate of re-injury or lower extremity injury, and the clinical significance of protocol implementation. Level of Evidence Level V.
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Affiliation(s)
| | | | - Hunter Todd
- Physical Therapy and Rehabilitation Atrium Health Floyd
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10
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Neumann KD, Seshadri V, Thompson XD, Broshek DK, Druzgal J, Massey JC, Newman B, Reyes J, Simpson SR, McCauley KS, Patrie J, Stone JR, Kundu BK, Resch JE. Microglial activation persists beyond clinical recovery following sport concussion in collegiate athletes. Front Neurol 2023; 14:1127708. [PMID: 37034078 PMCID: PMC10080132 DOI: 10.3389/fneur.2023.1127708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction In concussion, clinical and physiological recovery are increasingly recognized as diverging definitions. This study investigated whether central microglial activation persisted in participants with concussion after receiving an unrestricted return-to-play (uRTP) designation using [18F]DPA-714 PET, an in vivo marker of microglia activation. Methods Eight (5 M, 3 F) current athletes with concussion (Group 1) and 10 (5 M, 5 F) healthy collegiate students (Group 2) were enrolled. Group 1 completed a pre-injury (Visit1) screen, follow-up Visit2 within 24 h of a concussion diagnosis, and Visit3 at the time of uRTP. Healthy participants only completed assessments at Visit2 and Visit3. At Visit2, all participants completed a multidimensional battery of tests followed by a blood draw to determine genotype and study inclusion. At Visit3, participants completed a clinical battery of tests, brain MRI, and brain PET; no imaging tests were performed outside of Visit3. Results For Group 1, significant differences were observed between Visits 1 and 2 (p < 0.05) in ImPACT, SCAT5 and SOT performance, but not between Visit1 and Visit3 for standard clinical measures (all p > 0.05), reflecting clinical recovery. Despite achieving clinical recovery, PET imaging at Visit3 revealed consistently higher [18F]DPA-714 tracer distribution volume (VT) of Group 1 compared to Group 2 in 10 brain regions (p < 0.001) analyzed from 164 regions of the whole brain, most notably within the limbic system, dorsal striatum, and medial temporal lobe. No notable differences were observed between clinical measures and VT between Group 1 and Group 2 at Visit3. Discussion Our study is the first to demonstrate persisting microglial activation in active collegiate athletes who were diagnosed with a sport concussion and cleared for uRTP based on a clinical recovery.
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Affiliation(s)
- Kiel D Neumann
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, United States
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Vikram Seshadri
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Xavier D Thompson
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | - Jason Druzgal
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - James C Massey
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Benjamin Newman
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Jose Reyes
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Spenser R Simpson
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Katelyenn S McCauley
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - James Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - James R Stone
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Bijoy K Kundu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
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More Physical Activity Is Correlated With Reduction in Kinesiophobia for Adolescents With Persistent Symptoms After Concussion. J Sport Rehabil 2023; 32:196-202. [PMID: 36220143 DOI: 10.1123/jsr.2022-0193] [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: 05/17/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT The relationship between physical activity (PA) and fear of pain with movement (ie, kinesiophobia) during concussion recovery is unknown. Kinesiophobia may limit PA, while PA after concussion may reduce kinesiophobia. Our purpose was to examine the correlation between PA and self-reported kinesiophobia during concussion recovery for adolescents with and without persistent symptoms. DESIGN Prospective cohort study of children ages 10-18 years within 14 days of concussion. METHODS Participants rated kinesiophobia using the Tampa Scale of Kinesiophobia (TSK) at initial (≤14 d postconcussion) and return to play (RTP) assessments, and wore activity monitors between assessments. Our primary outcome was TSK score change from initial to RTP assessments. We grouped participants based on whether they experienced persistent symptoms (symptoms ≥28 days) or not (symptoms <28 days) and calculated correlation coefficients (Pearson r for normally distributed and Spearman rho for nonnormally distributed variables) between PA variables and TSK change scores. RESULTS Among the 41 participants enrolled, 44% developed persistent symptoms (n = 18; age = 14.5 [2.0] y; 50% female; symptom duration = 57.3 [6.2] d; RTP = 66.8 [6.4] d) and 56% did not (n = 23; age = 14.9 [1.8] y; 48% female; symptom duration = 15.2 [1.5] d; RTP = 21.7 [1.9] d). For the persistent symptoms group, greater TSK change scores (mean = -2.5 [5.7] point change) were significantly and moderately correlated with higher daily step count (r = -.60, P = .008) and exercise frequency (r = -.63, P = .005), but were not correlated with exercise duration (ρ = -.12, P = .65). Among the no persistent symptoms group, TSK change scores (mean = -6.0 [5.0] point change) were not correlated with step count (r = -.18, P = .41) or exercise duration (ρ = .10, P = .67), and the correlation with frequency was low and not significant (r = -.34, P = .12). CONCLUSIONS Regular PA during concussion recovery, regardless of duration or intensity, may help reduce kinesiophobia for those experiencing persistent symptoms.
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Art K, Ridenour C, Durbin S, Bauer M, Hassen-Miller A. The Effectiveness of Physical Therapy Interventions for Athletes Post-Concussion: A Systematic Review. Int J Sports Phys Ther 2023; 18:26-38. [PMID: 36793559 PMCID: PMC9897009 DOI: 10.26603/001c.68071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/30/2022] [Indexed: 02/04/2023] Open
Abstract
Background Sports-related concussions are the most common cause of head injury in adolescents and young adults. Typical treatment methods for this injury include cognitive and physical rest. Evidence suggests that physical activity and physical therapy interventions can be beneficial to decrease post-concussion symptoms. Purpose The aim of this systematic review was to investigate the effectiveness of physical therapy interventions for adolescent and young adult athletes post-concussion. Study Design Systematic Review. Methods The following databases were utilized for the search: PubMed, CINAHL, Proquest, MEDLINE, SPORTDiscus, and SCOPUS. The search strategy focused on athletes, concussions, and physical therapy interventions. Data extraction from each article included: Authors, subjects, gender, mean age, age range, specific sport, acute or chronic concussion, first or recurrent concussion, treatments for intervention and control group, and outcomes measured. Results Eight studies met the inclusion criteria. Six of the eight articles scored seven or higher on the PEDro Scale. Physical therapy intervention(s), such as an aerobic intervention or a multimodal approach, show improvements in time to recovery and reduction of post-concussion symptoms in patients who have had a concussion. Physical activity and physical therapy as early as a couple days following injury, is beneficial at decreasing post-concussion symptoms, allows for earlier return to play, and/or shorter days to recovery, and is considered safe for treating post-concussion symptoms. Conclusion This systematic review demonstrates that physical therapy interventions including aerobic exercise and multimodal approaches have been found to be beneficial in treating adolescent and young adult athletes post-concussion. Utilizing aerobic or multimodal interventions for this population allows for a quicker symptom recovery and return to sport than traditional treatment of physical and cognitive rest. Future research should investigate the superior intervention for adolescents and young adults with post-concussion syndrome and determine if a single treatment or a multimodal approach is more beneficial.
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Fino PC, Dibble LE, Wilde EA, Fino NF, Johnson P, Cortez MM, Hansen CR, van der Veen SM, Skop KM, Werner JK, Tate DF, Levin HS, Pugh MJV, Walker WC. Sensory Phenotypes for Balance Dysfunction After Mild Traumatic Brain Injury. Neurology 2022; 99:e521-e535. [PMID: 35577572 PMCID: PMC9421603 DOI: 10.1212/wnl.0000000000200602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent team-based models of care use symptom subtypes to guide treatments of individuals with chronic effects of mild traumatic brain injury (mTBI). However, these subtypes, or phenotypes, may be too broad, particularly for balance (e.g., vestibular subtype). To gain insight into mTBI-related imbalance, we (1) explored whether a dominant sensory phenotype (e.g., vestibular impaired) exists in the chronic mTBI population, (2) determined the clinical characteristics, symptomatic clusters, functional measures, and injury mechanisms that associate with sensory phenotypes for balance control in this population, and (3) compared the presentations of sensory phenotypes between individuals with and without previous mTBI. METHODS A secondary analysis was conducted on the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium. Sensory ratios were calculated from the sensory organization test, and individuals were categorized into 1 of the 8 possible sensory phenotypes. Demographic, clinical, and injury characteristics were compared across phenotypes. Symptoms, cognition, and physical function were compared across phenotypes, groups, and their interaction. RESULTS Data from 758 Service Members and Veterans with mTBI and 172 individuals with no lifetime history of mTBI were included. Abnormal visual, vestibular, and proprioception ratios were observed in 29%, 36%, and 38% of people with mTBI, respectively, with 32% exhibiting more than 1 abnormal sensory ratio. Within the mTBI group, global outcomes (p < 0.001), self-reported symptom severity (p < 0.027), and nearly all physical and cognitive functioning tests (p < 0.027) differed across sensory phenotypes. Individuals with mTBI generally reported worse symptoms than their non-mTBI counterparts within the same phenotype (p = 0.026), but participants with mTBI in the vestibular-deficient phenotype reported lower symptom burdens than their non-mTBI counterparts (e.g., mean [SD] Dizziness Handicap Inventory = 4.9 [8.1] for mTBI vs 12.8 [12.4] for non-mTBI, group × phenotype interaction p < 0.001). Physical and cognitive functioning did not differ between the groups after accounting for phenotype. DISCUSSION Individuals with mTBI exhibit a variety of chronic balance deficits involving heterogeneous sensory integration problems. While imbalance when relying on vestibular information is common, it is inaccurate to label all mTBI-related balance dysfunction under the vestibular umbrella. Future work should consider specific classification of balance deficits, including specific sensory phenotypes for balance control.
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Affiliation(s)
- Peter C Fino
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA.
| | - Leland E Dibble
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Elisabeth A Wilde
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Nora F Fino
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA.
| | - Paula Johnson
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Melissa M Cortez
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Colby R Hansen
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Susanne M van der Veen
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Karen M Skop
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - J Kent Werner
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - David F Tate
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Harvey S Levin
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - Mary Jo V Pugh
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
| | - William C Walker
- From the Departments of Health & Kinesiology (P.C.F.), and Physical Therapy and Athletic Training (L.E.D.), University of Utah; George E. Wahlen VA Salt Lake City Healthcare System (E.A.W., D.F.T.); Department of Neurology (E.A.W., P.J., M.M.C., D.F.T.), University of Utah, Salt Lake City; H. Ben Taub Department of Physical Medicine and Rehabilitation (E.A.W., H.S.L.), Baylor College of Medicine, Houston, TX; Division of Epidemiology (N.F.F.), Department of Internal Medicine, and Department of Physical Medicine and Rehabilitation (C.R.H.), University of Utah, Salt Lake City; Department of Physical Therapy (S.M.v.d.V.), Virginia Commonwealth University, Richmond; Department of Physical Medicine & Rehabilitation Services (K.M.S.), James A. Haley Veterans' Hospital; Department of Physical Therapy (K.M.S.), Morsani College of Medicine, University of South Florida, Tampa, FL; Center for Neuroscience and Regenerative Medicine (CNRM) (J.K.W.), and Department of Neurology (J.K.W.), Uniformed Services University, Bethesda, MD; Department of Medicine (M.J.V.P.), University of Utah School of Medicine, Salt Lake City; Information Decision-Enhancement and Analytic Sciences Center (M.J.V.P.), VA Salt Lake City, UT; Department of Physical Medicine and Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; and Hunter Holmes McGuire Veterans Affairs Medical Center (W.C.W.), Richmond, VA
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McCann R, Schussler E, Martinez J, Ramirez V. The Effect of Concussion History on Lower Extremity Injury Risk in College Athletes: A Systematic Review and Meta-Analysis. Int J Sports Phys Ther 2022; 17:753-765. [PMID: 35949388 PMCID: PMC9340842 DOI: 10.26603/001c.36810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Collegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury. Objective To conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes. Methods A literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, ["concussion" OR "brain injury" OR "mild traumatic brain injury" OR "mTBI"] AND ["lower extremity injury" OR "musculoskeletal injury"]. Articles were included if they were published between January 2000 and July 2021 and examined collegiate athletes' risk of sustaining a lower extremity musculoskeletal injury following a concussion. Methodological quality of included studies was performed with a modified Downs and Black Checklist. The primary outcome of interest was the risk of sustaining a lower extremity musculoskeletal injury following a concussion. A random effects meta-analysis was conducted in which a summative relative risk (RR) for sustaining a lower extremity injury in athletes with and without a history of concussion was calculated. Results Seven studies met the eligibility criteria to be included in the systematic review. There were 348 athletes in the concussion group and 482 control athletes in the included studies. Most of the studies were of good or excellent quality. Five of the seven studies were able to be included in the meta-analysis. College athletes who suffered a concussion possessed a 58% greater risk of sustaining a lower extremity musculoskeletal injury than those who did not have a history of a concussion (RR = 1.58[1.30, 1.93]). Conclusions Lower extremity injury risk is potentially increased in college athletes following a concussion compared to those without a history of a concussion. Further research is needed to investigate the mechanism behind this increased risk. Clinical assessments throughout the concussion return-to-play protocol may need to be improved in order to detect lingering impairments caused by concussions. Level of Evidence 1.
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Affiliation(s)
- Ryan McCann
- Rehabilitation Sciences, Old Dominion University
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Howell DR, Seehusen CN, Carry PM, Walker GA, Reinking SE, Wilson JC. An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk: A Randomized Clinical Trial. Am J Sports Med 2022; 50:1120-1129. [PMID: 35060759 DOI: 10.1177/03635465211069372] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Existing data suggest that after concussion, athletes experience an increased risk of subsequent injury. Exploring methods that may reduce injury risk after successful postconcussion return to play may lead to new treatment approaches. PURPOSE To examine the efficacy of a neuromuscular training (NMT) intervention on acute sports-related time-loss injury over the subsequent year relative to standard of care. STUDY DESIGN Randomized clinical trial; Level of evidence, 1. METHODS A total of 27 youth athletes were assessed initially postconcussion (median, 7 days postconcussion; interquartile range [IQR], 5-10) and after return-to-play clearance (median, 40 days postconcussion; IQR, 15-52). After return-to-play clearance, they were randomly assigned to NMT intervention (n = 11; mean ± SD age, 14.7 ± 1.7 years; 36% female) or standard of care (n = 16; mean ± SD age, 15.3 ± 1.8 years; 44% female). The intervention (duration, 8 weeks; frequency, 2 times per week) included guided strength exercises with landing stabilization focus. Standard of care received no recommendations. For the subsequent year, athletes prospectively completed a monthly log of sports-related injuries and organized sports competitions. RESULTS During the first year after postconcussion return-to-play clearance, sports-related time-loss injuries were more common among standard of care relative to NMT intervention (75% [95% CI, 48%-93%] vs 36% [95% CI, 11%-69%]). After adjusting for age and sex, the hazard of subsequent injury in the standard-of-care group was 3.56 times (95% CI, 1.11-11.49; P = .0334) that of the NMT intervention group. Sports participation was similar between NMT intervention and standard of care during the year-long monitoring period (hours of organized sports per month; median, 12 [IQR, 2.6-32.1] vs 15.6 [IQR, 3.5-105.9]; P = .55). The age- and sex-adjusted incidence of injuries was 10.2 per 1000 competitive exposures (95% CI, 3.7-28.4) in the standard-of-care group as opposed to 3.4 per 1000 (95% CI, 0.9-13.4) in the NMT intervention group. After adjusting for age and sex, incidence of injuries was higher for standard of care vs NMT intervention (rate ratio, 2.96 [95% CI, 0.89-9.85]; P = .076). CONCLUSION Although preliminary, our findings suggest that an NMT intervention initiated after return-to-play clearance may significantly reduce sports-related time-loss injuries over the subsequent year. REGISTRATION NCT03917290 (ClinicalTrials.gov identifier).
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Corrine N Seehusen
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Patrick M Carry
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Gregory A Walker
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah E Reinking
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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16
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Sideline Assessment of Concussion. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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17
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Smulligan KL, Wilson JC, Howell DR. INCREASED RISK OF MUSCULOSKELETAL INJURIES AFTER CONCUSSION. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Romeas T, Greffou S, Allard R, Forget R, McKerral M, Faubert J, Gagnon I. Dynamic Visual Stimulations Produced in a Controlled Virtual Reality Environment Reveals Long-Lasting Postural Deficits in Children With Mild Traumatic Brain Injury. Front Neurol 2021; 12:596615. [PMID: 34899549 PMCID: PMC8654728 DOI: 10.3389/fneur.2021.596615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
Motor control deficits outlasting self-reported symptoms are often reported following mild traumatic brain injury (mTBI). The exact duration and nature of these deficits remains unknown. The current study aimed to compare postural responses to static or dynamic virtual visual inputs and during standard clinical tests of balance in 38 children between 9 and 18 years-of-age, at 2 weeks, 3 and 12 months post-concussion. Body sway amplitude (BSA) and postural instability (vRMS) were measured in a 3D virtual reality (VR) tunnel (i.e., optic flow) moving in the antero-posterior direction in different conditions. Measures derived from standard clinical balance evaluations (BOT-2, Timed tasks) and post-concussion symptoms (PCSS-R) were also assessed. Results were compared to those of 38 healthy non-injured children following a similar testing schedule and matched according to age, gender, and premorbid level of physical activity. Results highlighted greater postural response with BSA and vRMS measures at 3 months post-mTBI, but not at 12 months when compared to controls, whereas no differences were observed in post-concussion symptoms between mTBI and controls at 3 and 12 months. These deficits were specifically identified using measures of postural response in reaction to 3D dynamic visual inputs in the VR paradigm, while items from the BOT-2 and the 3 timed tasks did not reveal deficits at any of the test sessions. PCSS-R scores correlated between sessions and with the most challenging condition of the BOT-2 and as well as with the timed tasks, but not with BSA and vRMS. Scores obtained in the most challenging conditions of clinical balance tests also correlated weakly with BSA and vRMS measures in the dynamic conditions. These preliminary findings suggest that using 3D dynamic visual inputs such as optic flow in a controlled VR environment could help detect subtle postural impairments and inspire the development of clinical tools to guide rehabilitation and return to play recommendations.
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Affiliation(s)
- Thomas Romeas
- Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada.,Institut National du Sport du Québec, Montréal, QC, Canada
| | - Selma Greffou
- Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada
| | - Remy Allard
- Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada
| | - Robert Forget
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal - IURDPM, Montréal, QC, Canada
| | - Michelle McKerral
- Department of Psychology, Université de Montréal and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal - IURDPM, Montréal, QC, Canada
| | - Jocelyn Faubert
- Faubert Laboratory, École d'Optométrie, Université de Montréal, Montréal, QC, Canada
| | - Isabelle Gagnon
- Montreal Children's Hospital, McGill University Health Center, McGill University, Montréal, QC, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
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19
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Formosa A, Dobronyi I, Topolovec-Vranic J. The educational needs of Canadian homeless shelter workers related to traumatic brain injury. Work 2021; 70:1165-1175. [PMID: 34864707 DOI: 10.3233/wor-205111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) has a higher prevalence in the homeless population. Caregivers to individuals who have TBIs may require better education surrounding screening, diagnosis and management of this disease to tailor interventions to their clients' needs. OBJECTIVE To assess the insight and educational needs of homeless care providers in recognizing and dealing with clients who had experienced a TBI. METHODS A survey assessing the point of views of homeless care providers across Canada regarding their level of confidence in identifying and managing symptoms of TBI. RESULTS Eight-eight completed surveys were included. Overall, frontline workers expressed a moderate level of confidence in identifying and managing TBI, stating that educational initiatives in this context would be of high value to themselves and their clients. CONCLUSIONS Frontline workers to homeless clients rate their educational needs on the identification and management of TBI to be high such that educational initiatives for shelter workers across Canada may be beneficial to increase their knowledge in identifying and managing the TBI-related symptoms. Improved education would not only benefit frontline workers but may also have a positive effect on health outcomes for their clients.
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Affiliation(s)
- Amanda Formosa
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | | | - Jane Topolovec-Vranic
- Interprofessional Practice Based Research, Unity Health Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
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20
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Kaminski TW, Chrisman SPD, Glutting J, Wahlquist V, Eagle S, Putukian M, Tierney R, Broglio SP, McAllister TW, McCrea MA, Pasquina PF, Kontos AP, Investigators CARES. Mechanisms of injury for concussions in collegiate soccer: an NCAA/DoD CARE consortium study. SCI MED FOOTBALL 2021; 6:325-330. [DOI: 10.1080/24733938.2021.1991586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Thomas W. Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Sara P. D. Chrisman
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
| | - Joseph Glutting
- School of Education, University of Delaware, Ne’wark, DE, USA
| | - Victoria Wahlquist
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Shawn Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Margot Putukian
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Ryan Tierney
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Steven P. Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W. McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul F. Pasquina
- Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, USA
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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21
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Avedesian JM, Covassin T, Baez S, Nash J, Nagelhout E, Dufek JS. Relationship Between Cognitive Performance and Lower Extremity Biomechanics: Implications for Sports-Related Concussion. Orthop J Sports Med 2021; 9:23259671211032246. [PMID: 34458386 PMCID: PMC8388230 DOI: 10.1177/23259671211032246] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 01/14/2023] Open
Abstract
Background Collegiate athletes with prior sports-related concussion (SRC) are at increased risk for lower extremity (LE) injuries; however, the biomechanical and cognitive mechanisms underlying the SRC-LE injury relationship are not well understood. Purpose To examine the association between cognitive performance and LE land-and-cut biomechanics among collegiate athletes with and without a history of SRC and to determine the association among multiple cognitive testing batteries in the same athlete cohort. Study Design Controlled laboratory study. Methods A cohort of 20 collegiate athletes with prior SRC (9 men, 11 women; mean ± standard deviation [SD] age, 20.5 ± 1.3 years; mean ± SD time since last SRC, 461 ± 263 days) and 20 matched controls (9 men, 11 women; mean ± SD age, 19.8 ± 1.3 years) completed land-and-cut tasks using the dominant and nondominant limbs. LE biomechanical variables and a functional visuomotor reaction time (FVMRT) were collected during each trial. Athletes also completed the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) and Senaptec Sensory Station assessments. Results In the SRC cohort, Pearson correlation coefficients indicated slower FVMRT was moderately correlated with decreased dominant limb (r = -0.512) and nondominant limb (r = -0.500) knee flexion, while increased dominant limb knee abduction moment was moderately correlated with decreased ImPACT Visual Memory score (r = -0.539) and slower ImPACT Reaction Time (r = 0.515). Most computerized cognitive measures were not associated with FVMRT in either cohort (P > .05). Conclusion Decreased reaction time and working memory performance were moderately correlated with decreased sagittal plane knee motion and increased frontal plane knee loading in collegiate athletes with a history of SRC. The present findings suggest a potential unique relationship between cognitive performance and LE neuromuscular control in athletes with a history of SRC injury. Last, we determined that computerized measures of cognitive performance often utilized for SRC management are dissimilar to sport-specific cognitive processes. Clinical Relevance Understanding the relationship between cognitive performance and LE biomechanics in athletes with prior SRC may inform future clinical management strategies. Future research should prospectively assess cognitive and biomechanical measures, along with LE injury incidence, to identify mechanisms underlying the SRC-LE injury relationship.
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Affiliation(s)
- Jason M Avedesian
- Emory Sports Performance and Research Center, Flowery Branch, Georgia, USA.,Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, Nevada, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Shelby Baez
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jennifer Nash
- Department of Physical Therapy, University of Nevada-Las Vegas, Las Vegas, Nevada, USA
| | - Ed Nagelhout
- Department of English, University of Nevada-Las Vegas, Las Vegas, Nevada, USA
| | - Janet S Dufek
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
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22
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Avedesian JM, Singh H, Diekfuss JA, Myer GD, Grooms DR. Loss of Motor Stability After Sports-Related Concussion: Opportunities for Motor Learning Strategies to Reduce Musculoskeletal Injury Risk. Sports Med 2021; 51:2299-2309. [PMID: 34339041 DOI: 10.1007/s40279-021-01527-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
Current best practices to direct recovery after sports-related concussion (SRC) typically require asymptomatic presentation at both rest and during a graduated exercise progression, and cognitive performance resolution. However, this standard of care results in a significantly elevated risk for musculoskeletal (MSK) injury after return-to-sport (RTS). The elevated risk is likely secondary to, in part, residual neurophysiological and dual-task motor stability deficits that remain despite RTS. These deficits present as a loss of autonomous control of gait and posture and an increased need for cognition for motor stability. Thus, the incorporation of strategies that can enhance motor stability and restore autonomous control of gait and posture during SRC recovery and RTS progression may facilitate a reduction of the elevated risk of secondary MSK injury. We provide a theoretical framework for the application of motor learning principles to restore autonomous gait and postural stability after SRC via incorporation, or targeted manipulation, of external focus, enhanced expectations, autonomy support, practice schedule variability, and dual-task strategies during rehabilitation and RTS training.
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Affiliation(s)
- Jason M Avedesian
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA.
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA.
| | - Harjiv Singh
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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23
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Reinking S, Seehusen CN, Walker GA, Wilson JC, Howell DR. Transitory kinesiophobia after sport-related concussion and its correlation with reaction time. J Sci Med Sport 2021; 25:20-24. [PMID: 34404602 DOI: 10.1016/j.jsams.2021.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine kinesiophobia (i.e. fear of movement) among adolescent athletes with concussion compared to controls, and correlations of kinesiophobia with symptoms and reaction time. DESIGN Prospective cohort study. METHODS We evaluated 49 adolescent athletes twice. The concussion group was assessed within 14 days of injury and at return-to-play clearance. The control group was tested initially and approximately 28 days later. Participants completed Tampa Scale of Kinesiophobia, Post-Concussion Symptom Inventory, and clinical reaction time assessments. RESULTS We included 32 concussion participants (15 ± 2 years; 50% female) and 17 controls (16 ± 1 years; 47% female). Acutely (<14 days post-injury), the concussion group reported greater Tampa Scale of Kinesiophobia scores (38.5 ± 5.4 vs. 29.4 ± 6.7; p < 0.001; Cohen's d = 1.54), and a greater proportion of "high" (≥37) scores than controls (69% vs. 6%; p < 0.001). At return-to-play, there were no significant between-group differences (33.3 ± 6.5 vs. 30.8 ± 7.4; p = 0.23; Cohen's d = 0.36); 28% of the concussion group reported "high" Tampa Scale of Kinesiophobia scores. At return-to-play, kinesiophobia was significantly/moderately correlated with clinical reaction time for the concussion group (r = 0.50; p = 0.01). CONCLUSIONS Adolescents recovering from concussion commonly reported high kinesiophobia initially postconcussion, while 28% continued to report high kinesiophobia at return-to-play clearance. Additionally, a correlation between Tampa Scale of Kinesiophobia scores and clinical reaction time was observed for the concussion group. This finding would benefit from further study to determine potential perception-behavior relationships following concussion.
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Affiliation(s)
- Sarah Reinking
- Department of Physical Therapy, Children's Hospital Colorado, USA; Sports Medicine Center, Children's Hospital Colorado, USA
| | | | - Gregory A Walker
- Sports Medicine Center, Children's Hospital Colorado, USA; Department of Orthopedics, University of Colorado School of Medicine, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, USA; Department of Orthopedics, University of Colorado School of Medicine, USA; Department of Pediatrics, University of Colorado School of Medicine, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, USA; Department of Orthopedics, University of Colorado School of Medicine, USA.
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24
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Lubega SK, Makubuya T, Muwonge H, Lambert M. A descriptive prospective study of sports medicine practices for athletes in Uganda. Afr Health Sci 2021; 21:826-834. [PMID: 34795741 PMCID: PMC8568218 DOI: 10.4314/ahs.v21i2.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many international sporting organizations have recommended practices to reduce the risk of injury. These practices include screening for injury, having appropriate emergency medical care, and protocols for managing injury before return-to-play. The extent of the uptake of these practices in a developing country such as Uganda, is unknown. METHODOLOGY Using a descriptive case study approach, this investigation focused on a sample of injured athletes (n = 75) in Uganda from four main sports associations (football, athletics, basketball and rugby). The data were collected through observations and interviews after the injury. Using a best medical practice framework the phases of emergency, intermediate, rehabilitative, and return-to-sports participation were described. RESULT Nine conditions/types of injury were included. The results revealed a lack of specific pre-season screening or return-to-play readiness for all the injured athletes. Further, there was a lack of application of best practice principles for most of the injury types. For athletes who received medical care, the results show inconsistencies and inadequacies from the acute stage of the injury to return-to-sports participation. CONCLUSION This study identified barriers such as up-to-date knowledge among the sports resource providers; the gaps for appropriate and adequate specific facilities for managing injured athletes, and policies to mandate care of injured athletes. These barriers detract from applying best medical practices.
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Affiliation(s)
- Samuel K Lubega
- Exercise Science, Division of Exercise Science and Sports Medicine (ESSM). Department of Human Biology, University of Cape Town, Cape Town, South Africa, 7700
| | - Timothy Makubuya
- Center for Sports Research in Uganda, Department of Educator Preparation and Leadership, College of Education, University of Missouri- St. Louis, 364 Marillac Hall, 1 University Blvd, St. Louis, MO 63121, USA
| | - Haruna Muwonge
- Department of Physiology, College of Health Sciences, Makerere University P.O. Box 37580, Kampala (Uganda)
| | - Mike Lambert
- Exercise Science, Division of Exercise Science and Sports Medicine (ESSM). Department of Human Biology, University of Cape Town, Cape Town, South Africa, 7700
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25
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Wilson JC, Carry PM, Daoud AK, Strunk S, Sweeney EA, Howell DR, Comstock RD. Single season re-injury risk after concussion and lower extremity injury among male, collision sport, high school athletes. J Sci Med Sport 2021; 24:1105-1109. [PMID: 34074605 DOI: 10.1016/j.jsams.2021.04.015] [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: 11/03/2020] [Revised: 02/04/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Research suggests that a recent concussion increases subsequent lower extremity injury risk; however, data in high school athletes is limited. This study evaluates the association between concussion and subsequent injury risk among male, collision sport, high school athletes over a single season. DESIGN Retrospective cohort study. METHODS Data were obtained from 2005/06-2014/15 in the High School Reporting Information Online database. A two stage, multi-method matching process was used to identify athletes who suffered multiple injuries over a single athletic season. Demographics and injury characteristics were compared with Chi square and Student's t-tests. Multiple Cox Proportional Hazards regression analysis was used to test whether index injury type was associated with hazard of subsequent injury following return to play from index injury. RESULTS Overall 1364 HS athletes sustained 2 injuries over a single athletic season (subsequent injury within 45 days of the index injury). Index injuries included 686 (50.2%) lower extremity injuries, 417 (30.6%) upper extremity injuries, and 261 (19.1%) concussions. Hazard of subsequent concussion was increased in the index concussion group relative to the index lower extremity injury group [hazard ratio (HR): 1.60, 95% CI: 1.15-2.23, p = 0.0052]. Hazard of a subsequent lower extremity injury was not significantly different for the index lower extremity injury group relative to the index concussion group [HR: 1.27, 95% CI: 0.98-1.65, p = 0.0728]. CONCLUSIONS History of recent concussion or recent lower extremity injury are both risk factors for subsequent lower extremity injury in male, collision sport, high school athletes.
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Affiliation(s)
- Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, United States of America; University of Colorado School of Medicine, United States of America.
| | - Patrick M Carry
- Musculoskeletal Research Center, Children's Hospital Colorado, United States of America
| | | | | | - Emily A Sweeney
- Sports Medicine Center, Children's Hospital Colorado, United States of America; University of Colorado School of Medicine, United States of America
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, United States of America; University of Colorado School of Medicine, United States of America
| | - R Dawn Comstock
- Colorado School of Public Health, University of Colorado Anschutz, United States of America
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26
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Biese KM, Kliethermes SA, Watson AM, McGuine TA, Lang PJ, Bell DR, Alison Brooks M. Musculoskeletal Injuries and Their Association With Previous Concussion History: A Prospective Study of High School Volleyball and Soccer Players. Am J Sports Med 2021; 49:1634-1641. [PMID: 33719583 DOI: 10.1177/0363546521997116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sports-related concussions may have a neurobiological recovery period that exceeds the period of clinical recovery, and one consequence of an extended neurobiological recovery may be the risk of subsequent musculoskeletal injuries. Most literature citing an increased risk of musculoskeletal injury after a sports-related concussion has been reported in populations other than adolescent athletes. PURPOSE/HYPOTHESIS The purpose was to prospectively determine if incidence rates of musculoskeletal injury differ between adolescent athletes with and without a previous sports-related concussion, while controlling for sex, sport, and age. A secondary aim was to determine if this relationship differs between male and female athletes of the same sport. Our hypotheses were that acute-noncontact injury rates would be higher in athletes with a previous sports-related concussion when compared with athletes without a previous sports-related concussion, and that this relationship would exist only in female athletes and not male athletes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS High school soccer and volleyball players were recruited in 2 prospective cohort studies that observed 4837 athletes during their sporting season (females, 80%; soccer, 57%; mean [SD] age, 15.6 [1.1] years). At preseason, all participants self-reported demographics and previous sports-related concussion within the past 12 months. During the sport season, team athletic trainers electronically recorded athlete exposures and injury data, including injury characteristics. Injury rates per 1000 athlete exposures and injury rate ratios (IRRs) with 95% confidence intervals were calculated. All injury rates and IRRs were adjusted for sex, age, and sport. RESULTS The rate of acute-noncontact lower extremity injury was 87% greater (IRR, 1.87; 95% CI, 1.29-2.74) in participants with a previous sports-related concussion versus those without one. The acute-noncontact lower extremity injury rates (IRRs) for females and males with a previous sports-related concussion were 1.76 (95% CI, 1.19-2.59) and 2.83 (95% CI, 0.85-9.50), respectively. No difference was detected in acute-contact (IRR, 0.98; 95% CI, 0.56-1.73) or overuse (IRR, 1.09; 95% CI, 0.51-2.37) lower extremity injury rates by previous sports-related concussion. CONCLUSION Female adolescent athletes who reported a sports-related concussion within the past 12 months were more likely to sustain an acute-noncontact lower extremity injury during their high school sports season when compared with female athletes without a previous sport-related concussion.
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Affiliation(s)
- Kevin M Biese
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrew M Watson
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Timothy A McGuine
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Pamela J Lang
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - David R Bell
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - M Alison Brooks
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Bliss RA, Long A, Anderson C, Niederee A, Arellanes H, Quinlin K. Gaze stabilization function does not predict injury incidence among collegiate athletes. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rebecca A. Bliss
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Addie Long
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Chloe Anderson
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Allison Niederee
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Hannah Arellanes
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Kelly Quinlin
- Athletic Department Northwest Missouri State University Maryville MO USA
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Biese KM, Stamm JM, Wichman DM, Hetzel SJ, Post EG, Bell DR. Association of lower extremity injuries and injury mechanism with previous concussion history in adolescent athletes. Phys Ther Sport 2021; 48:76-82. [PMID: 33387901 DOI: 10.1016/j.ptsp.2020.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Determine the association between concussion and subsequent contact, non-contact, and overuse lower extremity (LE) injuries in a cohort of adolescent athletes. Secondarily, to identify this association between males and females. STUDY DESIGN Cross-sectional. SETTING Summer athletic events with participants ages 12-18. MAIN OUTCOME Anonymous survey included sport-related injuries (injury month/year) and participants classified injuries as a contact, non-contact, overuse injury, or concussion. Multivariable logistic regression analyses were used to examine associations between a concussion event and a subsequent LE injury while controlling for age and any previous LE injury. RESULTS A concussion was reported in 219 athletes (Female = 96, 44%) and were matched with 219 non-concussed athletes (438 total participants). Concussion was not association with a specific injury mechanism but was significant for any subsequent LE injury (OR = 1.58 95%CI = [1.03-2.41]; p < 0.05). Concussed females were more likely to report any subsequent LE injury compared to non-concussed female athletes (2.49[1.31, 4.74]; p < 0.01). This relationship was not observed between concussed and non-concussed males (1.11[0.62-1.99]; p > 0.5). CONCLUSION A history of concussion was associated with any subsequent LE injury, but not associated with a specific mechanism of injury. The association with concussion and a subsequent LE injury was different between males and females.
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Affiliation(s)
- Kevin M Biese
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Julie M Stamm
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel M Wichman
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott J Hetzel
- Department of Biostatistics and Medical Information, University of Wisconsin-Madison, Madison, WI, USA
| | - Eric G Post
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA
| | - David R Bell
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
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Howell DR, Oldham J, Lanois C, Koerte I, Lin AP, Berkstresser B, Wang F, Meehan WP. Dual-Task Gait Recovery after Concussion among Female and Male Collegiate Athletes. Med Sci Sports Exerc 2020; 52:1015-1021. [PMID: 31985574 DOI: 10.1249/mss.0000000000002225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Few studies have investigated recovery between sexes using objective outcome measures. Our purpose was to examine the independent association between biological sex and recovery of postconcussion gait among collegiate athletes. METHODS We evaluated participants with a diagnosed concussion <7 d postinjury, and approximately 1.5 months and 3.5 months postinjury. Participants completed a single/dual-task gait evaluation and symptom inventory. During dual-task trials, they completed a mental task (backward subtraction, spelling, or month recitation). The primary outcome measure was height-adjusted gait velocity recovery, defined as achieving normal gait velocity using established values: >0.56 and >0.50 gait velocity (m·s)/height (m) under single and dual-task conditions, respectively. We used a multivariable Cox proportional hazard model to identify associations between sex and dual-task recovery, controlling for age, concussion history, symptom severity, and loss of consciousness at the time of injury. RESULTS Ninety-four individuals participated in the study: 47 (50%) were female athletes (mean age = 20.1, SD = 1.3 yr) and 47 (50%) were male athletes (mean age = 20.3, SD = 1.3 yr). Sex was not independently associated with height-adjusted single-task gait velocity recovery after controlling for potential confounders (hazard ratio = 1.62, 95% confidence interval = 0.87-3.01). However, male sex was independently associated with longer dual-task gait recovery time after controlling for potential confounders (hazard ratio = 2.43, 95% confidence interval = 1.11-5.35). CONCLUSION Male athletes required a longer duration of time after concussion to achieve dual-task gait recovery than female athletes. Thus, functional dual-task abilities after concussion may be affected differentially by sex and should be accounted for within individualized concussion management strategies.
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Affiliation(s)
| | | | | | | | - Alexander P Lin
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Francis Wang
- Harvard University Health Service, Cambridge, MA
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Büttner F, Howell D, Severini G, Doherty C, Blake C, Ryan J, Delahunt E. Using functional movement tests to investigate the presence of sensorimotor impairment in amateur athletes following sport-related concussion: A prospective, longitudinal study. Phys Ther Sport 2020; 47:105-113. [PMID: 33242699 DOI: 10.1016/j.ptsp.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To longitudinally investigate the presence of sensorimotor impairments in amateur athletes following sport-related concussion using two functional movement tests. DESIGN Prospective, longitudinal study. SETTING Human movement analysis laboratory. PARTICIPANTS Athletes who presented to a hospital emergency department and were diagnosed with sport-related concussion, and sex-, age-, and activity-matched non-concussed, control athletes. Concussed participants were assessed within one-week following sport-related concussion, upon clearance to return-to-sporting activity (RTA), and two weeks after RTA. Control participants were assessed at an initial time-point and approximately two and four weeks following their initial study assessment. MAIN OUTCOMES MEASURES At each laboratory assessment, participants completed two functional movement tests: the Star Excursion Balance Test to evaluate anterior reach distance (normalised for leg length) and fractal dimension (centre of pressure path complexity), and the Multiple Hop Test to evaluate corrective postural strategies and time-to-stabilisation. RESULTS Fifty concussed athletes and 50 control athletes completed the study. There were no significant differences at any study assessment between the concussion and control group on the Star Excursion Balance Test anterior reach distance or fractal dimension (centre of pressure path complexity). During the Multiple Hop Test, the concussion group used a significantly greater number of corrective postural strategies than the control group one-week following sport-related concussion and upon clearance to RTA, but not two weeks following RTA. CONCLUSION Recently concussed athletes made a greater number of corrective postural strategies than control participants during the Multiple Hop Test upon clearance to RTA but not two weeks after RTA. The Multiple Hop Test may offer a clinically useful tool for practitioners to examine the recovery of subtle sensorimotor impairments and related RTA readiness.
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Affiliation(s)
- Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - David Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.
| | - Giacomo Severini
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland; Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland; UCD Centre for Biomedical Engineering, University College Dublin, Dublin, Ireland.
| | - Cailbhe Doherty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - John Ryan
- Emergency Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Eamonn Delahunt
- Institute for Sport & Health, University College Dublin, Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
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McGuine TA, Post E, Biese K, Kliethermes S, Bell D, Watson A, Brooks A, Lang P. The Incidence and Risk Factors for Injuries in Girls Volleyball: A Prospective Study of 2072 Players. J Athl Train 2020; 58:446976. [PMID: 33150377 PMCID: PMC10072088 DOI: 10.4085/182-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Girls high school volleyball is very popular across the United States. There is limited prospective data regarding the incidence and risk factors of time loss (TL) and non-time loss (NTL) injuries sustained in this population. OBJECTIVES To estimate the incidence and describe the characteristics of injuries (TL and NTL) sustained in a girls' high school volleyball season. DESIGN Descriptive epidemiology study. SETTING Convenience sample of 78 high school interscholastic volleyball programs. PATIENTS OR OTHER PARTICIPANTS High school volleyball players participating during the 2018 interscholastic season. MAIN OUTCOME MEASURES TL and NTL injury rates, proportions, rate ratios, and with 95%CI. RESULTS A total of 2,072 girls enrolled in the study with 468 subjects (22.5%) sustaining 549 injuries (NTL=28.4%, TL=71.6%) for an overall injury rate of 5.31 [4.89, 5.79] per 1000 AEs. The competition injury rate was greater than the practice injury rate for all injuries (IRR: 1.19, [1.00, 1.41]) and TL injuries (IRR: 1.31, [1.07, 1.60]). Players with a previous musculoskeletal injury had a higher rate of TL than NTL injuries (IRR; 1.36 [1.12, 1.65]). Ankle injuries accounted for the greatest proportion of TL injuries (n=110, 28%), while the greatest proportion of NTL injuries occurred in the hand/fingers (n=34, 22%). Moreover, ligament sprains accounted for 40% of TL injuries (n=156), whereas muscle/tendon strains (n=79, 51%) accounted for over half of all NTL injuries. CONCLUSIONS While the majority of injuries sustained by adolescent girls' volleyball athletes were TL in nature, nearly a third of all injuries were NTL injuries. Injury characteristics differed widely between TL and NTL injuries. Understanding the most common types and characteristics of injury among high school volleyball players is critical for the development of effective injury prevention programs.
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Dual-Task Gait Stability after Concussion and Subsequent Injury: An Exploratory Investigation. SENSORS 2020; 20:s20216297. [PMID: 33167407 PMCID: PMC7663806 DOI: 10.3390/s20216297] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022]
Abstract
Persistent gait alterations can occur after concussion and may underlie future musculoskeletal injury risk. We compared dual-task gait stability measures among adolescents who did/did not sustain a subsequent injury post-concussion, and uninjured controls. Forty-seven athletes completed a dual-task gait evaluation. One year later, they reported sport-related injuries and sport participation volumes. There were three groups: concussion participants who sustained a sport-related injury (n = 8; age =15.4 ± 3.5 years; 63% female), concussion participants who did not sustain a sport-related injury (n = 24; 14.0 ± 2.6 years; 46% female), and controls (n = 15; 14.2 ± 1.9 years; 53% female). Using cross-recurrence quantification, we quantified dual-task gait stability using diagonal line length, trapping time, percent determinism, and laminarity. The three groups reported similar levels of sports participation (11.8 ± 5.8 vs. 8.6 ± 4.4 vs. 10.9 ± 4.3 hours/week; p = 0.37). The concussion/subsequent injury group walked slower (0.76 ± 0.14 vs. 0.65 ± 0.13 m/s; p = 0.008) and demonstrated higher diagonal line length (0.67 ± 0.08 vs. 0.58 ± 0.05; p = 0.02) and trapping time (5.3 ± 1.5 vs. 3.8 ± 0.6; p = 0.006) than uninjured controls. Dual-task diagonal line length (hazard ratio =1.95, 95% CI = 1.05–3.60), trapping time (hazard ratio = 1.66, 95% CI = 1.09–2.52), and walking speed (hazard ratio = 0.01, 95% CI = 0.00–0.51) were associated with subsequent injury. Dual-task gait stability measures can identify altered movement that persists despite clinical concussion recovery and is associated with future injury risk.
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Morris A, Cassidy B, Pelo R, Fino NF, Presson AP, Cushman DM, Monson NE, Dibble LE, Fino PC. Reactive Postural Responses After Mild Traumatic Brain Injury and Their Association With Musculoskeletal Injury Risk in Collegiate Athletes: A Study Protocol. Front Sports Act Living 2020; 2:574848. [PMID: 33345138 PMCID: PMC7739642 DOI: 10.3389/fspor.2020.574848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Deficits in neuromuscular control are widely reported after mild traumatic brain injury (mTBI). These deficits are speculated to contribute to the increased rate of musculoskeletal injuries after mTBI. However, a concrete mechanistic connection between post-mTBI deficits and musculoskeletal injuries has yet to be established. While impairments in some domains of balance control have been linked to musculoskeletal injuries, reactive balance control has received little attention in the mTBI literature, despite the inherent demand of balance recovery in athletics. Our central hypothesis is that the high rate of musculoskeletal injuries after mTBI is in part due to impaired reactive balance control necessary for balance recovery. The purpose of this study is to (1) characterize reactive postural responses to recover balance in athletes with recent mTBI compared to healthy control subjects, (2) determine the extent to which reactive postural responses remain impaired in athletes with recent mTBI who have been cleared to return to play, and (3) determine the relationship between reactive postural responses and acute lower extremity musculoskeletal injuries in a general sample of healthy collegiate athletes. Methods: This two-phase study will take place at the University of Utah in coordination with the University of Utah Athletics Department. Phase 1 will evaluate student-athletes who have sustained mTBI and teammate-matched controls who meet all the inclusion criteria. The participants will be assessed at multiple time points along the return-to-play progress of the athlete with mTBI. The primary outcome will be measures of reactive postural response derived from wearable sensors during the Push and Release (P&R) test. In phase 2, student-athletes will undergo a baseline assessment of postural responses. Acute lower extremity musculoskeletal injuries for each participant will be prospectively tracked for 1 year from the date of first team activity. The primary outcomes will be the measures of reactive postural responses and the time from first team activity to lower extremity injury. Discussion: Results from this study will further our understanding of changes in balance control, across all domains, after mTBI and identify the extent to which postural responses can be used to assess injury risk in collegiate athletes.
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Affiliation(s)
- Amanda Morris
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Benjamin Cassidy
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Ryan Pelo
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Nora F Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Daniel M Cushman
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Nicholas E Monson
- Department of Orthopaedic Surgery Operations, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
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van Ierssel J, Osmond M, Hamid J, Sampson M, Zemek R. What is the risk of recurrent concussion in children and adolescents aged 5-18 years? A systematic review and meta-analysis. Br J Sports Med 2020; 55:663-669. [PMID: 33077482 DOI: 10.1136/bjsports-2020-102967] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We aimed to examine the risk of concussion in children with a previous history of concussion. DESIGN Systematic review and meta-analysis. The primary outcome was number of children with and without a previous lifetime history of concussion who sustained a diagnosed concussion within each study period. Risk of bias was assessed using the Newcastle-Ottawa Scale. A random effects model was used to estimate a pooled risk ratio (RR) with corresponding 95% CIs; results were summarised in forest plots. DATA SOURCES Four electronic databases (MEDLINE, Embase, CINAHL, SPORTDiscus) and selected reference lists were searched (PROSPERO registration No CRD42019135462). ELIGIBILITY CRITERIA Original English language peer-reviewed publications that compared concussion risk in children aged 5-18 years with and without a previous concussion history in which risk estimates were reported or able to be calculated. RESULTS Of 732 identified studies, 7 studies representing 23 411 children (risk of bias range, 7-9; maximum possible score=9) were included for meta-analysis. Pooled risk of sustaining a concussion was more than three times greater in children with a previous concussion compared with those with no previous concussion (RR=3.64; 95% CI: 2.68 to 4.96; p<0.0001; I 2=90.55%). Unreported sex-stratified data precluded direct comparison of concussion risk in male versus female athletes. CONCLUSION Previously concussed children have four times the risk of sustaining a concussion compared with those with no previous concussion history. This should be a consideration for clinicians in return to sport decision-making. Future studies examining subsequent recurrent concussion in youth sports must consider sex differences.
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Affiliation(s)
| | - Martin Osmond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Emergency Department, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jemila Hamid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Emergency Department, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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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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Stuart S, Parrington L, Martini D, Peterka R, Chesnutt J, King L. The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area. Front Sports Act Living 2020; 2:5. [PMID: 33345000 PMCID: PMC7739790 DOI: 10.3389/fspor.2020.00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/08/2020] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI), or concussion, occurs following a direct or indirect force to the head that causes a change in brain function. Many neurological signs and symptoms of mTBI can be subtle and transient, and some can persist beyond the usual recovery timeframe, such as balance, cognitive or sensory disturbance that may pre-dispose to further injury in the future. There is currently no accepted definition or diagnostic criteria for mTBI and therefore no single assessment has been developed or accepted as being able to identify those with an mTBI. Eye-movement assessment may be useful, as specific eye-movements and their metrics can be attributed to specific brain regions or functions, and eye-movement involves a multitude of brain regions. Recently, research has focused on quantitative eye-movement assessments using eye-tracking technology for diagnosis and monitoring symptoms of an mTBI. However, the approaches taken to objectively measure eye-movements varies with respect to instrumentation, protocols and recognition of factors that may influence results, such as cognitive function or basic visual function. This review aimed to examine previous work that has measured eye-movements within those with mTBI to inform the development of robust or standardized testing protocols. Medline/PubMed, CINAHL, PsychInfo and Scopus databases were searched. Twenty-two articles met inclusion/exclusion criteria and were reviewed, which examined saccades, smooth pursuits, fixations and nystagmus in mTBI compared to controls. Current methodologies for data collection, analysis and interpretation from eye-tracking technology in individuals following an mTBI are discussed. In brief, a wide range of eye-movement instruments and outcome measures were reported, but validity and reliability of devices and metrics were insufficiently reported across studies. Interpretation of outcomes was complicated by poor study reporting of demographics, mTBI-related features (e.g., time since injury), and few studies considered the influence that cognitive or visual functions may have on eye-movements. The reviewed evidence suggests that eye-movements are impaired in mTBI, but future research is required to accurately and robustly establish findings. Standardization and reporting of eye-movement instruments, data collection procedures, processing algorithms and analysis methods are required. Recommendations also include comprehensive reporting of demographics, mTBI-related features, and confounding variables.
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Affiliation(s)
- Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Douglas Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Robert Peterka
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - James Chesnutt
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
- Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, United States
| | - Laurie King
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
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Effect of a Concussion on Anterior Cruciate Ligament Injury Risk in a General Population. Sports Med 2020; 50:1203-1210. [PMID: 31970718 DOI: 10.1007/s40279-020-01262-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent studies indicate concussion increases risk of musculoskeletal injury in specific groups of patients. The purpose of this study was to determine the odds of anterior cruciate ligament (ACL) injury after concussion in a population-based cohort. METHODS International Classification of Diseases, 9th and 10th Revision (ICD-9, ICD-10) codes relevant to the diagnosis and treatment of a concussion and ACL tear were utilized to search the Rochester Epidemiology Project (REP) between 2000 and 2017. A total of 1653 unique patients with acute, isolated ACL tears were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion within 3 years prior to the ACL injury. Cases were matched by age, sex, and REP availability date to patients without an ACL tear (1:3 match), resulting in 4959 controls. The medical records of the matched control patients were reviewed to determine history of concussion. RESULTS 39 patients with a concussion suffered an ACL injury up to 3 years after the concussion. The rate of prior concussion was higher in ACL-injured cases (2.4%) compared to matched controls with no ACL injury (1.5%). This corresponds to an odds ratio of 1.6 (95% CI 1.1-2.4; p = 0.015). CONCLUSIONS Although activity level could not be assessed, there are increased odds of ACL injury after concussion in a general population. Based on the evidence of increased odds of musculoskeletal injury after concussion, standard clinical assessments should consider concussion symptom resolution as well as assessment of neuromuscular factors associated with risk of injuries.
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38
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Falla D, Jull G. Introduction to the special issue on concussion. Musculoskelet Sci Pract 2019; 42:138-139. [PMID: 31155451 DOI: 10.1016/j.msksp.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom; Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom; NIHR Surgical Reconstruction & Microbiology Research Centre, Queen Elizabeth Medical Centre, Birmingham, B15 2TH, United Kingdom.
| | - Gwendolen Jull
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia
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