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Wingerson MJ, Schmitz B, Smulligan KL, Walker GA, Magliato S, Wilson JC, Howell DR. Concussion symptom presentation and clinical recovery among pediatric athletes: comparing concussions sustained during school and summer months. Brain Inj 2024; 38:574-582. [PMID: 38511887 DOI: 10.1080/02699052.2024.2332770] [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: 05/24/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE We examined post-concussion symptom presentation, exercise, and sleep among pediatric athletes who sustained concussion during the school year vs. summer months. METHODS We evaluated athletes 6-18 years old within 21-days of concussion. They reported symptoms (Health and Behavior Inventory), with cognitive/somatic domain sub-scores calculated, and indicated if they had exercised or experienced sleep problems since injury. We grouped patients by injury season: summer months (June-August) vs. school year (September-May). RESULTS 350 patients (14.4 ± 2.4 years old; 37% female; initial visit 8.8 ± 5.3 days post-concussion) were seen for care: 24% sustained a concussion during summer months, 76% during the school year. Lower cognitive (median = 7 [IQR = 1, 15] vs. 9.5 [4, 17]; p = 0.01), but not somatic (7 [2.5, 11] vs. 8 [4, 13]; p = 0.06), HBI scores were observed for patients injured during the summer. Groups were similar in proportion exercising (16% vs 17%) and endorsing sleep problems (29% vs 31%). After adjustments, sustaining a concussion during the summer predicted total (β=-3.43; 95%CI = -6.50, -0.36; p = 0.029) and cognitive (β = -2.29; 95%CI = -4.22, -0.36; p = 0.02), but not somatic (β=-1.46; 95%CI = -2.84, -0.08; p = 0.04), symptom severity. CONCLUSION Pediatric patients with concussion may present with greater cognitive symptoms during the school year, compared to summer months.
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Affiliation(s)
- Mathew J Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
| | - Baylie Schmitz
- Doctor of Occupational Therapy Program, Northern Arizona University, Phoenix, Arizona, USA
| | - Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
| | - Gregory A Walker
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
| | - Samantha Magliato
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine Denver, Colorado, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
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Leggett B, Eliason P, Sick S, Burma JS, Wong SK, Laperrière D, Goulet C, Fremont P, Russell K, Schneider KJ, Emery CA. Youth Preseason Performance on the Sport Concussion Assessment Tool 5 Across Multiple Sports. Clin J Sport Med 2024; 34:288-296. [PMID: 38149828 DOI: 10.1097/jsm.0000000000001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/07/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To examine preseason Sport Concussion Assessment Tool 5 (SCAT5) performance of adolescent sport participants by environment (in-person/virtual), sex, age, concussion history, collision/noncollision sport participation, and self-reported medical diagnoses. DESIGN Cross-sectional. SETTING Canadian community and high-school sport settings. PARTICIPANTS Three thousand eight hundred five adolescent (2493 male, 1275 female, and 37 did not disclose; 11- to 19-year-old) sport participants. ASSESSMENT OF RISK FACTORS Sport Concussion Assessment Tool 5 administration method (in-person/virtual), sex (male/female/unreported), age (years), concussion history (0/1/2/3+), collision/noncollision sport participant, and self-reported medical diagnoses [attention deficit disorder or attention-deficit/hyperactivity disorder, headache/migraine, learning disability, and psychiatric disorder (ie, anxiety/depression/other)]. OUTCOME MEASURES Preseason SCAT5 outcomes including total number of symptoms (TNS; /22), symptom severity score (SSS; /132), Standardized Assessment of Concussion (SAC; /50), and modified Balance Error Scoring System (mBESS; /30). RESULTS Multiple multilevel linear or Poisson regression complete case analyses adjusting for clustering and robust standard errors, with β-coefficients (95% CI) back-transformed to indicate an increase/decrease in SCAT5 subdomains when relevant for clinical interpretation. Virtual (V) performance was associated with fewer symptoms reported [TNS Difference V-IP = -1.53 (95% CI, -2.22 to -0.85)], lower SSS [-2.49 (95% CI, -4.41 to -0.58)], and fewer mBESS errors (IP) [-0.52 (95% CI, -0.77 to -0.27)] compared with in-person. For every one-year increase in age, more symptoms [TNS = 0.22 (95% CI, 0.01-0.44)], higher SSS [0.52 (95% CI, 0.01-1.06)], higher SAC [0.27 (95% CI, 0.15-0.38), and poorer balance [mBESS = -0.19 (-0.28 to -0.09)] were observed. Differences between males and females were also seen across all SCAT5 outcomes. Individuals reporting any medical diagnosis or 3+ concussion history also reported more symptoms (TNS) and higher SSS than those who did not. CONCLUSIONS Administration environment, sex, age, concussion history, and medical diagnoses were associated with SCAT5 subdomains and are important considerations when interpreting the SCAT5 results.
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Affiliation(s)
- Benjamin Leggett
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Paul Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Stacy Sick
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Joel S Burma
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Sophie K Wong
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - David Laperrière
- Pavillon de l'Éducation physique et des sports, Université Laval, Québec City, QC, Canada
- Pediatrics and Child Health, University of Manitoba, Winnipeg, MN, Canada
- Department of Physical Education, Faculty of Education, Université Laval, Québec City, QC, Canada
| | - Claude Goulet
- Department of Physical Education, Faculty of Education, Université Laval, Québec City, QC, Canada
| | - Pierre Fremont
- Pavillon de l'Éducation physique et des sports, Université Laval, Québec City, QC, Canada
| | - Kelly Russell
- Pediatrics and Child Health, University of Manitoba, Winnipeg, MN, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Evidence Sport and Spine, Calgary, AB, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Finnegan E, Daly E, Ryan L. Nutritional Considerations of Irish Performance Dietitians and Nutritionists in Concussion Injury Management. Nutrients 2024; 16:497. [PMID: 38398823 PMCID: PMC10891776 DOI: 10.3390/nu16040497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Sport-related concussion incidence has increased in many team-based sports, such as rugby, Gaelic (camogie, hurling, football), and hockey. Concussion disrupts athletes' brain function, causing an "energy crisis" that requires energy and nutrient support to restore function and heal. Performance dietitians and nutritionists play a role in supporting athletes' post-injury nutritional demands. This study aimed to investigate Irish performance dietitians' and nutritionists' knowledge and implementation of nutritional strategies to manage and support athletes' recovery following concussion. In-depth, semi-structured interviews were conducted with seventeen (n = 17) Irish performance dietitians and nutritionists recruited from the Sport and Exercise Nutrition register and other sporting body networks across Ireland. Participants practised or had practised with amateur and/or professional athletes within the last ten years. All interviews and their transcripts were thematically analysed to extract relevant insights. These data provided valuable insights revealing performance dietitians and nutritionists: (1) their awareness of concussion events and (2) their use of nutritional supports for concussion management. Furthermore, the research highlighted their implementation of 'novel nutritional protocols' specifically designed to support and manage athletes' concussion recovery. There was a clear contrast between participants who had an awareness and knowledge of the importance of nutrition for brain recovery after sport-related concussion(s) and those who did not. Participants presenting with a practical understanding mentioned re-emphasising certain foods and supplements they were already recommending to athletes in the event of a concussion. Performance dietitians and nutritionists were keeping up to date with nutrition research on concussions, but limited evidence has prevented them from implementing protocols in practice. Meanwhile, participants mentioned trialling/recommending nutritional protocols, such as carbohydrate reloading, reducing omega-6 intake, and acutely supplementing creatine, omega-3 fish oils high in Docosahexaenoic acid, and probiotics to support brain healing. Performance dietitians' and nutritionists' use of nutrition protocols with athletes following concussion was linked to their knowledge and the limited scientific evidence available. Nutrition implementation, therefore, may be overlooked or implemented with uncertainty, which could negatively affect athletes' recovery following sports-related concussions.
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Affiliation(s)
| | | | - Lisa Ryan
- Department of Sport, Exercise and Nutrition, Atlantic Technological University (ATU), H91 T8NW Galway, Ireland; (E.F.); (E.D.)
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Fanning E, Daniels K, Cools A, Mullett H, Delaney R, McFadden C, Falvey E. Upper Limb Strength and Performance Deficits after Glenohumeral Joint Stabilization Surgery in Contact and Collision Athletes. Med Sci Sports Exerc 2024; 56:13-21. [PMID: 37703286 DOI: 10.1249/mss.0000000000003290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
PURPOSE The primary aim was to identify and quantify differences in interlimb asymmetry magnitudes across a battery of upper extremity strength and performance tests at 4 and 6 months after glenohumeral joint stabilization surgery shoulder stabilization in contact and collision athletes compared with an un-injured group. A secondary aim was to investigate if identified asymmetry magnitudes changed from 4 to 6 months after glenohumeral joint stabilization surgery. The third aim was to explore associations within the different performance and strength variables. METHODS Fifty-six male contact and collision sport athletes who had had undergone unilateral glenohumeral joint stabilization were tested at 4 and 6 months after surgery. An un-injured control group ( n = 39 for upper extremity performance tests, n = 47 for isokinetic dynamometry) were tested on a single occasion. Three upper extremity force platform-based performance tests and angle-specific concentric internal and external isokinetic shoulder rotational strength were assessed, and interlimb asymmetries were compared between the two groups. RESULTS At 4 months after surgery, the glenohumeral joint stabilization group demonstrated significantly higher absolute interlimb asymmetry values than the un-injured group for almost all the performance test variables. In the ballistic upper-body performance tests, the glenohumeral joint stabilization group achieved only half the body elevation reached by the un-injured (counter-movement push-up jump height ( η2 = 0.50) and press-jump jump height ( η2 = 0.39)). At 6 months after surgery, absolute interlimb asymmetries reduced for the performance test variables, but some asymmetry persisted. The glenohumeral joint stabilization group had significantly greater absolute interlimb asymmetries for five out the eight isokinetic variables. CONCLUSIONS Contact and collision athletes who may be cleared to return to sport at 4 to 6 months after glenohumeral joint stabilization surgery shoulder stabilization continue to demonstrate upper limb strength and performance deficits when compared with their un-injured limb and their un-injured counterparts.
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Champawat VS, Santoshi JA, Tiwari A, Behera P, Selvanayagam R, Verma VK. Sports-Related Musculoskeletal Injuries in Medical Students. Indian J Occup Environ Med 2024; 28:65-70. [PMID: 38783871 PMCID: PMC11111144 DOI: 10.4103/ijoem.ijoem_111_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/24/2023] [Accepted: 11/01/2023] [Indexed: 05/25/2024] Open
Abstract
Background Little attention is paid to the problem of sports-related injuries in amateur or nonathletes or recreational student athletes. We investigated the prevalence of sports-related musculoskeletal (MSK) injuries in medical students and attempted to identify the risk factors for these injuries. Methods We conducted a cross-sectional questionnaire-based observational study on medical students of a tertiary care teaching hospital in central India. A total of 500 medical students were approached; the questionnaire consisted of details, such as age, gender, height, weight, predominant sport played or the sport during which they sustained an injury, estimated time spent playing every week, if they had undergone any formal training for the sport, any preexisting MSK condition, details of the injury and the treatment taken, if any, after joining medical school, and duration from getting injured to return to studies and sports. The odds ratio (OR) and logistic regression were calculated for multiple parameters. Statistical significance was set at P ≤ 0.05. Results Seventy-four of the 402 students who responded reported sustaining a sports-related injury; 33 and 41 students reported injury while playing contact and noncontact sports, respectively. Of these, 58 students reported that they had received formal training in sports. Football, volleyball, cricket, and kabaddi were the sports during which most injuries occurred. The injury rate was 3.7 per 1000 playing or practice hours. Conclusions Almost one-fifth of the students reported sustaining a sports-related MSK injury after joining medical school. The risk factors identified for these injuries were male gender, participation in team sports, participation in noncontact sports, and lack of adequate preparation or practice.
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Affiliation(s)
| | | | - Anurag Tiwari
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, MP, India
| | - Prateek Behera
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, MP, India
| | - Rajkumar Selvanayagam
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, MP, India
| | - Virendra Kumar Verma
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, MP, India
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Hunzinger KJ, Caccese JB, Mannix R, Meehan WP, Swanik CB, Buckley TA. Contact or Collision Sport History, Repetitive Neurotrauma, and Patient-Reported Outcomes in Early to Midadulthood. J Athl Train 2023; 58:952-961. [PMID: 36913638 PMCID: PMC10784886 DOI: 10.4085/1062-6050-0017.23] [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] [Indexed: 03/15/2023]
Abstract
CONTEXT Data on the early to midlife effects of repetitive neurotrauma on patient-reported outcomes have been delimited to homogeneous samples of male athletes without comparison groups or accounting for modifying factors such as physical activity. OBJECTIVE To determine the effect of contact or collision sport participation and repetitive neurotrauma on patient-reported outcomes among early to middle-aged adults. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 113 adults (53 [46.9%] men, 60 [53.1%] women; age = 34.88 ± 11.80 years) in 4 groups: (1) physically inactive individuals with no repetitive head impact (RHI) exposure (NON); (2) noncontact sport athletes and nonathletes with no RHI exposure who were currently physically active (NCA); (3) former high-risk sport athletes with an RHI history who were physically active (HRS); and (4) former rugby players with prolonged RHI exposure who remained physically active. MAIN OUTCOME MEASURE(S) The 12-Item Short-Form Health Survey (SF-12), Apathy Evaluation Scale-self-rated version (AES-S), Satisfaction With Life Scale (SWLS), and Sport Concussion Assessment Tool-5th Edition (SCAT5) Symptom and Symptom Severity Checklist. RESULTS The NON group had worse self-rated physical function than the NCA group as assessed by the SF-12 physical component summary (P = .03) and worse self-rated apathy (AES-S) and satisfaction with life (SWLS) than the NCA (P = .03 for both) and HRS groups (P = .03 and P = .040, respectively). We observed no group differences for self-rated mental health (SF-12 mental component summary; P = .26) or symptoms (SCAT5; P = .42). Career duration was not associated with any patient-reported outcomes. CONCLUSIONS A history of contact or collision sport participation and career duration did not negatively affect patient-reported outcomes in physically active, early to middle-aged adults. However, physical inactivity status was negatively associated with patient-reported outcomes in these individuals in the absence of an RHI history.
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Affiliation(s)
- Katherine J. Hunzinger
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
| | - Jaclyn B. Caccese
- School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus
| | - Rebekah Mannix
- Divisions of Emergency Medicine, Boston Children’s Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - William P. Meehan
- Sports Medicine, Department of Orthopedics, Boston Children’s Hospital, MA
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA
- Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - C. Buz Swanik
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
| | - Thomas A. Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
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Kelly JT, Wilkes JR, Slobounov SM. An Examination of Visual Quality of Life and Functional Vision Among Collision and Non-Collision Athletes Over a Competitive Season. Arch Clin Neuropsychol 2023; 38:1115-1123. [PMID: 37097732 DOI: 10.1093/arclin/acad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Repetitive head impacts (RHIs) experienced during sports are gaining attention due to potential long-term neurological dysfunction, absent of a diagnosed concussion. One area susceptible to dysfunction is vision. The goal of this study was to evaluate changes in visual quality of life (VQOL) and functional vision scores from pre- to post-season among collision and non-collision athletes. METHODS The Visual Functioning Questionnaire-25 and Neuro-Ophthalmic Supplement (NOS), as well as functional vision testing (Mobile Universal Lexicon Evaluation System - MULES) were completed pre- and post-season by three groups: collision athletes, non-collision athletes, and minimally active controls (MACs). RESULTS There were 42 participants, with 41 (21 male, 20 female) completing both testing sessions, with a mean (standard deviation [SD]) age of 21 (2.46) years (collision group, n = 14; non-collision group, n = 13, MACs, n = 14). Baseline analyses revealed no significant differences between groups for VQOL or MULES scores. However, those with a family history of psychiatric disorder scored significantly worse on NOS. Post-season/follow-up testing revealed no significant differences between groups for VQOL scores. Non-collision athletes significantly improved on the MULES test by 2.46 ± 3.60 (SD) s (35.0 [95% confidence interval, 0.29-4.63]; p = .03). Change score results from pre- to post-season were not significant. CONCLUSION Although the groups were not significantly different from one another, non-collision athletes significantly improved MULES scores, whereas collision athletes performed the worst, suggesting exposure to RHIs may impact functional vision. Thus, further evaluation of RHIs and their impact on vision is warranted.
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Affiliation(s)
- Jon T Kelly
- Department of Kinesiology, Penn State University, University Park, PA, USA
| | - James R Wilkes
- Department of Kinesiology, Penn State University, University Park, PA, USA
| | - Semyon M Slobounov
- Department of Kinesiology, Penn State University, University Park, PA, USA
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Dandamudi R, Twombley K, Flynn JT, Kakajiwala A, Chand DH. Physician knowledge, attitudes, and practices regarding physical activity restrictions in pediatric hemodialysis patients. Hemodial Int 2023; 27:345-351. [PMID: 37211958 DOI: 10.1111/hdi.13095] [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: 02/23/2023] [Revised: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Epidemiologic studies of physical activity among pediatric hemodialysis (HD) patients are lacking. A sedentary lifestyle in End-Stage Kidney Disease is associated with a higher cardiovascular mortality risk. In those patients receiving HD, time spent on dialysis and restrictions on physical activity due to access also contribute. No consensus exists regarding physical activity restrictions based on vascular access type. The aim of this study was to describe the patterns of physical activity restrictions imposed by pediatric nephrologists on pediatric HD patients and to understand the basis for these restrictions. METHODS We conducted a cross-sectional study involving US pediatric nephrologists using an anonymized survey through Pediatric Nephrology Research Consortium. The survey consisted of 19 items, 6 questions detailed physician characteristics with the subsequent 13 addressing physical activity restrictions. FINDINGS A total of 35 responses (35% response rate) were received. The average years in practice after fellowship was 11.5 years. Significant restrictions were placed on physical activity and water exposure. None of the participants reported accesses damage or loss that was attributed to physical activity and sport participation. Physicians practice is based on their personal experience, standard practice at their HD center, and clinical practices they were taught. DISCUSSION There is no consensus among pediatric nephrologists about allowable physical activity in children receiving HD. Due to the lack of objective data, individual physician beliefs have been utilized to restrict activities in the absence of any deleterious effects to accesses. This survey clearly demonstrates the need for more prospective and detailed studies to develop guidelines regarding physical activity and dialysis access in order to optimize quality of care in these children.
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Affiliation(s)
- Raja Dandamudi
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine Twombley
- Department of Pediatrics, Division of Pediatric Nephrology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Aadil Kakajiwala
- Division of Nephrology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Deepa H Chand
- Novartis Pharmaceuticals, Bannockburn, Illinois, USA
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Illinois, University of Illinois College of Medicine-Peoria, Peoria, Illinois, USA
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Walshe A, Daly E, Ryan L. Existence ≠ adherence. Exploring barriers to best practice in sports-related concussion return to play (SRC-RTP) in Irish amateur female sport. Phys Ther Sport 2023; 63:1-8. [PMID: 37413953 DOI: 10.1016/j.ptsp.2023.06.004] [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: 05/18/2023] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES Sports-Related Concussion (SRCs) are of relevant risk and burden for female athletes. The following study aimed to explore potential barriers to return to play (RTP) best practice in coaches of amateur female athletes, and medical professionals who may treat and manage SRCs in amateur female athletes. DESIGN Qualitative, semi-structured, virtual interviews following a critical analysis framework. METHODS Twenty-five coaches, allied healthcare professionals (AHPs), and general practitioners (GPs) were recruited and interviewed using a convenience snowball sample. Data were transcribed verbatim and thematically analysed. RESULTS Three themes were identified following reflexive thematic analysis; biopsychosocial norms, stakeholder inaction, and practitioner effectiveness. The findings identify numerous factors which limit the uptake of best practice guidelines as endorsed by Irish national governing bodies (NGBs). Education, training, and implementation of these guidelines are lacking, with sub-standard or non-existent medical support and poor general injury and/or SRC attitudes providing further resistance to these measures. CONCLUSION Existence of SRC-RTP protocols does not equal adherence to such. Greater efforts are required to translate knowledge provided by the 6th Concussion Consensus statement. NGBs, league and club administrators, and educators need to better support coaches, practitioners and athletes in the implementation of these protocols in amateur female sport.
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Affiliation(s)
- Ayrton Walshe
- Department of Sports, Exercise and Nutrition, Atlantic Technological University, Galway City, Ireland
| | - Ed Daly
- Department of Sports, Exercise and Nutrition, Atlantic Technological University, Galway City, Ireland
| | - Lisa Ryan
- Department of Sports, Exercise and Nutrition, Atlantic Technological University, Galway City, Ireland.
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Kercher KA, Steinfeldt JA, Rettke DJ, Zuidema TR, Walker MJ, Martinez Kercher VM, Silveyra P, Seo DC, Macy JT, Hulvershorn LA, Kawata K. Association Between Head Impact Exposure, Psychological Needs, and Indicators of Mental Health Among U.S. High School Tackle Football Players. J Adolesc Health 2023; 72:502-509. [PMID: 36610880 PMCID: PMC10033334 DOI: 10.1016/j.jadohealth.2022.11.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Age of first exposure to tackle football and head impact kinematics have been used to examine the effect of head impacts on mental health outcomes. These measures coupled with retrospective and cross-sectional designs have contributed to conflicting results. The purpose of this study was to identify the effect of one season of head impact exposure, age of first exposure to football, and psychological need satisfaction on acute mental health outcomes in adolescent football players. METHODS This prospective single-season cohort study used sensor-installed mouthguards to collect head impact exposure along with surveys to assess age of first exposure to football, psychological satisfaction, depressive symptoms, anxiety symptoms, and thriving from football players at four high schools (n = 91). Linear regression was used to test the association of head impact exposure, age of first exposure, and psychological satisfaction with acute mental health outcomes. RESULTS A total of 9,428 impacts were recorded with a mean of 102 ± 113 impacts/player. Cumulative head impact exposure and age of first exposure were not associated with acute mental health outcomes at postseason or change scores from preseason to postseason. Greater psychological satisfaction was associated with fewer depressive symptoms (β = -0.035, SE = 0.008, p = < .001), fewer anxiety symptoms (β = -0.021, SE = 0.008, p = .010), and greater thriving scores (β = 0.278, SE = 0.040, p = < .001) at postseason. DISCUSSION This study does not support the premise that greater single-season head impact exposure or earlier age of first exposure to tackle football is associated with worse acute mental health indicators over the course of a single season in adolescent football players.
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Affiliation(s)
- Kyle A Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jesse A Steinfeldt
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Devin J Rettke
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Taylor R Zuidema
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Miata J Walker
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Vanessa M Martinez Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Patricia Silveyra
- Department of Environmental and Occupational Health, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Dong-Chul Seo
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jonathan T Macy
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana; Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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11
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Zhang JK, Alimadadi A, ReVeal M, Del Valle AJ, Patel M, O'Malley DS, Mercier P, Mattei TA. Litigation involving sports-related spinal injuries: a comprehensive review of reported legal claims in the United States in the past 70 years. Spine J 2023; 23:72-84. [PMID: 36028214 DOI: 10.1016/j.spinee.2022.08.012] [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: 06/20/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Sports-related spinal injuries can be catastrophic in nature. Athletes competing in collision sports (eg, football) may be particularly prone to injury given the high-impact nature of these activities. Due to the oftentimes profound impact of sports-related spinal injuries on health and quality-of-life, they are also associated with a substantial risk of litigation. However, no study to date has assessed litigation risks associated with sports-related spinal injuries. A better understanding of the risk factors surrounding these legal claims may provide insights into injury prevention and other strategies to minimize litigation risks. In addition, it may allow the spine surgeon to better recognize the health, socioeconomic, and legal challenges faced by this patient population. PURPOSE To provide a comprehensive assessment of reported legal claims involving sports-related spinal injuries, including a comparative analysis of legal outcomes between collision and non-collision sports. To discuss strategies to prevent sports-related spinal injuries and minimize litigation risks. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE Athletes experiencing spinal injuries during sports. OUTCOME MEASURES Outcomes included verdict outcome (defendant vs. plaintiff), legal claims, injuries sustained, clinical symptoms, and award payouts. METHODS The legal research database Westlaw Edge (Thomson Reuters) was queried for legal claims brought in the United States from 1950 to 2021 involving sports-related spinal injuries. Verdict or settlement outcomes were collected as well as award payouts, time to case closure, case year, and case location. Demographic data, including type of sport (ie collision vs. non-collision sport) and level of play were obtained. Legal claims, spinal injuries sustained, and clinical symptoms were also extracted. Furthermore, the nature of injury, injured spinal region, and treatment pursued were collected. Descriptive statistics were reported for all cases and independent-samples t-tests and chi-square tests were used to compare differences between collision and non-collision sports. RESULTS Of the 840 cases identified on initial search, 78 met our criteria for in-depth analysis. This yielded 62% (n=48) defendant verdicts, 32% (n=25) plaintiff verdicts, and 6% (n=5) settlements, with a median inflation-adjusted award of $780,000 (range: $5,480-$21,585,000) for all cases. The most common legal claim was negligent supervision (n=38, 46%), followed by premises liability (n=23, 28%), and workers' compensation/no fault litigation (n=10, 12%). The most common injuries sustained were vertebral fractures (n=34, 44%) followed by disc herniation (n=14, 18%). Most cases resulted in catastrophic neurological injury (n=37, 49%), either paraplegia (n=6, 8%) or quadriplegia (n=31, 41%), followed by chronic/refractory pain (n=32, 43%). Non-collision sport cases had a higher percentage of premises liability claims (41% vs. 11%, p=.006) and alleged chronic/refractory pain (53% vs. 28%, p=.04). Conversely, collision sport cases had a higher proportion of workers' compensation/no fault litigation (23% vs. 4%, p=.03) and cases involving disc herniation (29% vs. 9%, respectively; p=.04). CONCLUSION Sports-related spinal injuries are associated with multiple and complex health, socioeconomic, and legal consequences, with median inflation-adjusted award payouts nearing $800,000 per case. In our cohort, the most commonly cited legal claims were negligent supervision and premises liability, emphasizing the need for prevention guidelines for safe sports practice, especially in non-professional settings. Cases involving athletes participating in non-collision sports were significantly associated with claims citing chronic/refractory pain, highlighting the importance of long-term care in severely injured athletes.
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Affiliation(s)
- Justin K Zhang
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Alborz Alimadadi
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Matthew ReVeal
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Armando J Del Valle
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Mayur Patel
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Deborah S O'Malley
- Associate Professor, Saint Louis University School of Law, St, Louis, MO, 63104 USA
| | - Philippe Mercier
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Tobias A Mattei
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA.
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12
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Walshe A, Daly E, Ryan L. Epidemiology of sport-related concussion rates in female contact/collision sport: a systematic review. BMJ Open Sport Exerc Med 2022; 8:e001346. [PMID: 36157128 PMCID: PMC9490625 DOI: 10.1136/bmjsem-2022-001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives To determine sport-related concussion (SRC) incidence rates in female contact/collision sport. Design Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Data sources Four databases (PubMed, SportsDiscus, Web of Science, CINAHL) were searched for data from 2012 to 2021. Eligibility criteria Studies reporting SRC incidence rates or the number of concussions and athletic exposures (AEs) per 1000 participating events or hours in healthy female contact and collision sport athletes of any age were included. Results The search yielded 8438 non-duplicate articles. Following screening, 19 were included in the analysis (median quality score=70%), with 8 reporting match or training incidence rates. Studies were primarily from US high school and collegiate populations; data are reported for eight sports. Rugby union reported the highest match SRC rates (8.2-16.11 per 1000 AE hours), followed by Gaelic football (5.21 per 1000 AE hours) and soccer (2.08-4.04 per 1000 AE events). Where available, match SRC rates were substantially higher than training and overall SRC rates. Conclusion Female sports such as rugby union, Gaelic football and soccer present the highest risk for SRCs within the available data. Previous research indicates a potentially greater injury burden for female athletes experiencing SRCs than their male counterparts. Thus, future research should analyse concussion knowledge and return-to-play protocols in these sports. Future research should also prioritise exploration of the gap in SRC rates within amateur sports, and data should be presented specifically in the context of athletic exposures (match vs training). Trial registration number CRD42021281569.
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Affiliation(s)
- Ayrton Walshe
- Sport, Exercise and Nutrition, Atlantic Technological University, Galway, Ireland
| | - Ed Daly
- Sport, Exercise and Nutrition, Atlantic Technological University, Galway, Ireland
| | - Lisa Ryan
- Sport, Exercise and Nutrition, Atlantic Technological University, Galway, Ireland
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13
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Sinnott AM, Eagle SR, Kochick V, Preszler J, Collins MW, Sparto PJ, Flanagan SD, Elbin RJ, Connaboy C, Kontos AP. The Role of Age, Sex, Body Mass Index, and Sport Type on the Dynamic Exertion Test in Healthy Athletes: A Cross-Sectional Study. Clin J Sport Med 2022; 32:e499-e507. [PMID: 35350035 DOI: 10.1097/jsm.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/09/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The dynamic exertion test (EXiT) was developed to help inform return to play after sport-related concussion, but some factors may threaten the internal validity of EXiT and affect clinical interpretation. OBJECTIVE To compare age, sex, BMI, and sport types across EXiT physiological [pre-EXiT and post-EXiT percentage of maximum heart rate (HR %max) and blood pressure (BP)], performance (change-of-direction task completion time and committed errors), and clinical [symptoms and rating of perceived exertion (RPE)] outcomes among healthy adolescents and adults. STUDY DESIGN Cross-sectional. METHODS Eighty-seven participants ( F = 55, 37.4%) reported symptoms and RPE during the EXiT, which consists of a 12-minute treadmill running protocol, and the dynamic circuit, ball toss, box shuffle (SHUF) and carioca (CAR), zig zag (ZZ), proagility (PA), and arrow agility (AA) tasks. Independent samples t tests were conducted for pre-EXiT and post-EXiT HR %max and BP and change-of-direction task completion time and Mann-Whitney U tests for errors, symptoms, and RPE. A series of 1-way analysis of variance (ANOVAs) and Kruskal-Wallis H tests were conducted to compare collision, contact, and noncontact sport types. RESULTS Adolescents had lower completion time across AA ( P = 0.01) and male athletes lower than female athletes on CAR, ZZ, PA, and AA ( P < 0.04). Male athletes reported greater RPE after the SHUF, CAR, and AA ( P < 0.03). HR %max , errors, and symptoms were equivocal across all subgroups ( P > 0.05). CONCLUSION Age and sex should be considered in the interpretation of performance and clinical, but not physiological, EXiT outcomes. The EXiT is a standardized exercise assessment and generalizable to healthy athletes.
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Affiliation(s)
- Aaron M Sinnott
- Neuromuscular Research Laboratory-Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shawn R Eagle
- UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Victoria Kochick
- Centers for Rehabilitation Services-Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan Preszler
- UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael W Collins
- UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick J Sparto
- Department of Physical Therapy University of Pittsburgh, Pennsylvania; and
| | - Shawn D Flanagan
- Neuromuscular Research Laboratory-Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert J Elbin
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas
| | - Christopher Connaboy
- Neuromuscular Research Laboratory-Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony P Kontos
- UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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14
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Angle-Specific Isokinetic Shoulder Rotational Strength Can be Reliably Assessed in Collision and Contact Athletes. J Sport Rehabil 2022; 31:1076-1082. [PMID: 35894882 DOI: 10.1123/jsr.2022-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
An increased understanding of rotational strength as a potential prognostic factor for injury in contact and collision athletes may be important in planning return to sport. The aim of this study was to (1) determine the test-retest reliability of clinically relevant, angle-specific rotational and peak torque measurements in a cohort of uninjured collision and contact athletes; (2) develop a normal descriptive profile of angle-specific rotational torque measurements in the same cohort; and (3) examine the effects of direction and joint angle on shoulder rotational strength interlimb asymmetries. Twenty-three collision and contact athletes were recruited for the interday reliability substudy and 47 athletes were recruited for the remaining substudies. We used intraclass correlation coefficients with 95% confidence intervals to quantify interday reliability of all variables. We used a 2-way repeated-measures analysis of variance to analyze differences in absolute interlimb asymmetries. Interday reliability for the isokinetic strength variables was good to excellent (0.78-0.90) on the dominant side and moderate to good (0.63-0.86) on the nondominant side. Maximum angle-specific torque (as well as peak torque) can be measured reliably in internally and externally rotated positions. A normal profile of clinically relevant, angle-specific shoulder rotational torque measurements for collision and contact athletes has been established which provides a reference when assessing shoulder strength in this population.
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15
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Oldham JR, Lanois CJ, Caccese JB, Crenshaw JR, Knight CA, Berkstresser B, Wang F, Howell DR, Meehan WP, Buckley TA. Association Between Collision Sport Career Duration and Gait Performance in Male Collegiate Student-Athletes. Am J Sports Med 2022; 50:2526-2533. [PMID: 35736366 DOI: 10.1177/03635465221104685] [Citation(s) in RCA: 2] [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 Investigations of estimated age of first exposure to repetitive head impacts from collision and contact sports have shown no associations with neurocognitive or neurobehavioral function at the collegiate level, but the effect of career duration may be a more comprehensive factor. Understanding whether longer career duration influences gait performance would provide insights into potential neurological impairment. PURPOSE To examine the relationship between career duration of collision sports and single/dual-task gait performance in collegiate student-athletes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS We recruited 168 male student-athletes from collision sports: football, lacrosse, ice hockey, and wrestling (mean ± SD age, 19.2 ± 1.3 years; height, 184.5 ± 7.2 cm; mass, 94.3 ± 15.9 kg; estimated age of first exposure, 8.6 ± 3.1 years; career duration, 10.6 ± 3.0 years). All participants completed a baseline single- and dual-task gait assessment before the start of their athletic season. Inertial measurement units were used to measure gait speed and stride length. During the dual task, participants were asked to perform working memory cognitive tasks while walking. The dependent variables were single/dual-task gait speed and stride length, cognitive accuracy, and dual-task cost. The relationship between career duration, analyzed as a continuous variable, and the dependent variables was analyzed using a linear regression. RESULTS There were no significant associations between career duration and single-task gait speed (1.16 ± 0.16 m/s; β = -0.004; P = .35; 95% CI = -0.012 to 0.004; η2 = 0.005) or dual-task gait speed (1.02 ± 0.17 m/s; β = -0.003; P = .57; 95% CI = -0.011 to 0.006; η2 = 0.002). There were also no significant associations between career duration and single/dual-task stride length, cognitive accuracy, or dual-task cost. CONCLUSION Career duration among collegiate collision sport athletes was not associated with single- or dual-task gait performance, suggesting that a greater exposure to repetitive head impacts is not detrimental to dynamic postural control at the college level. However, the effects of diminished gait performance over the lifetime remain to be elucidated.
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Affiliation(s)
- Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Corey J Lanois
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jeremy R Crenshaw
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA.,Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Christopher A Knight
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA.,Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | | | - Francis Wang
- Harvard University Health Service, Cambridge, Massachusetts, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Departments of Pediatrics and Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA.,Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
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16
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Chu Y, Knell G, Brayton RP, Burkhart SO, Jiang X, Shams S. Machine learning to predict sports-related concussion recovery using clinical data. Ann Phys Rehabil Med 2022; 65:101626. [PMID: 34986402 DOI: 10.1016/j.rehab.2021.101626] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Sport-related concussions (SRCs) are a concern for high school athletes. Understanding factors contributing to SRC recovery time may improve clinical management. However, the complexity of the many clinical measures of concussion data precludes many traditional methods. This study aimed to answer the question, what is the utility of modeling clinical concussion data using machine-learning algorithms for predicting SRC recovery time and protracted recovery? METHODS This was a retrospective case series of participants aged 8 to 18 years with a diagnosis of SRC. A 6-part measure was administered to assess pre-injury risk factors, initial injury severity, and post-concussion symptoms, including the Vestibular Ocular Motor Screening (VOMS) measure, King-Devick Test and C3 Logix Trails Test data. These measures were used to predict recovery time (days from injury to full medical clearance) and binary protracted recovery (recovery time > 21 days) according to several sex-stratified machine-learning models. The ability of the models to discriminate protracted recovery was compared to a human-driven model according to the area under the receiver operating characteristic curve (AUC). RESULTS For 293 males (mean age 14.0 years) and 362 females (mean age 13.7 years), the median (interquartile range) time to recover from an SRC was 26 (18-39) and 21 (14-31) days, respectively. Among 9 machine-learning models trained, the gradient boosting on decision-tree algorithms achieved the best performance to predict recovery time and protracted recovery in males and females. The models' performance improved when VOMS data were used in conjunction with the King-Devick Test and C3 Logix Trails Test data. For males and females, the AUC was 0.84 and 0.78 versus 0.74 and 0.73, respectively, for statistical models for predicting protracted recovery. CONCLUSIONS Machine-learning models were able to manage the complexity of the vestibular-ocular motor system data. These results demonstrate the clinical utility of machine-learning models to inform prognostic evaluation for SRC recovery time and protracted recovery.
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Affiliation(s)
- Yan Chu
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Gregory Knell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA; Children's Health and The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA; Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, TX, USA
| | - Riley P Brayton
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA; Children's Health and The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA; Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, TX, USA
| | - Scott O Burkhart
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, TX, USA
| | - Xiaoqian Jiang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Shayan Shams
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Department of Applied Data Science, San Jose State University, San Jose, CA, USA.
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17
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Van Patten R, Iverson GL, Terry DP, Levi CR, Gardner AJ. Predictors and Correlates of Perceived Cognitive Decline in Retired Professional Rugby League Players. Front Neurol 2021; 12:676762. [PMID: 34707552 PMCID: PMC8542796 DOI: 10.3389/fneur.2021.676762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Rugby league is an international full-contact sport, with frequent concussive injuries. Participation in other full-contact sports such as American football has been considered to be a risk factor for neuropsychiatric sequelae later-in-life, but little research has addressed the mental and cognitive health of retired professional rugby league players. We examined predictors and correlates of perceived (self-reported) cognitive decline in retired National Rugby League (NRL) players. Methods: Participants were 133 retired male elite level rugby league players in Australia. Participants completed clinical interviews, neuropsychological testing, and self-report measures. The Informant Questionnaire on Cognitive Decline in the Elderly, self-report (IQCODE-Self), measured perceived cognitive decline. Results: The median age of the sample was 55.0 (M = 53.1, SD = 13.9, range = 30-89) and the median years of education completed was 12.0 (M = 11.9, SD = 2.6, range = 7-18). The retired players reported a median of 15.0 total lifetime concussions (M = 28.0, SD = 36.6, range = 0-200). The mean IQCODE-Self score was 3.2 (SD = 0.5; Range = 1.3-5.0); 10/133 (7.5%) and 38/133 (28.6%) scored above conservative and liberal cutoffs for cognitive decline on the IQCODE-Self, respectively. Perceived cognitive decline was positively correlated with current depressive symptoms, negatively correlated with years of professional sport exposure and resilience, and unrelated to objective cognition and number of self-reported concussions. A multiple regression model with perceived cognitive decline regressed on age, concussion history, professional rugby league exposure, depression, resilience, objective cognitive functioning, daytime sleepiness, and pain severity showed depression as the only significant predictor. Conclusion: This is the first large study examining subjectively experienced cognitive decline in retired professional rugby league players. Similar to studies from the general population and specialty clinics, no relationship was found between objective cognitive test performance and perceived cognitive decline. Depressive symptoms emerged as the strongest predictor of perceived cognitive decline, suggesting that subjective reports of worsening cognition in retired elite rugby league players might reflect psychological distress rather than current cognitive impairment.
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Affiliation(s)
- Ryan Van Patten
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Spaulding Research Institute, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Douglas P. Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Christopher R. Levi
- Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Randwick, NSW, Australia
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia
| | - Andrew J. Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia
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18
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Holcomb JM, Fisicaro RA, Miller LE, Yu FF, Davenport EM, Xi Y, Urban JE, Wagner BC, Powers AK, Whitlow CT, Stitzel JD, Maldjian JA. Regional White Matter Diffusion Changes Associated with the Cumulative Tensile Strain and Strain Rate in Nonconcussed Youth Football Players. J Neurotrauma 2021; 38:2763-2771. [PMID: 34039024 PMCID: PMC8820832 DOI: 10.1089/neu.2020.7580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study is to assess the relationship between regional white matter diffusion imaging changes and finite element strain measures in nonconcussed youth football players. Pre- and post-season diffusion-weighted imaging was performed in 102 youth football subject-seasons, in which no concussions were diagnosed. The diffusion data were normalized to the IXI template. Percent change in fractional anisotropy (%ΔFA) images were generated. Using data from the head impact telemetry system, the cumulative maximum principal strain one times strain rate (CMPS1 × SR), a measure of the cumulative tensile brain strain and strain rate for one season, was calculated for each subject. Two linear regression analyses were performed to identify significant positive or inverse relationships between CMPS1 × SR and %ΔFA within the international consortium for brain mapping white matter mask. Age, body mass index, days between pre- and post-season imaging, previous brain injury, attention disorder diagnosis, and imaging protocol were included as covariates. False discovery rate correction was used with corrected alphas of 0.025 and voxel thresholds of zero. Controlling for all covariates, a significant, positive linear relationship between %ΔFA and CMPS1 × SR was identified in the bilateral cingulum, fornix, internal capsule, external capsule, corpus callosum, corona radiata, corticospinal tract, cerebral and middle cerebellar peduncle, superior longitudinal fasciculus, and right superior fronto-occipital fasciculus. Post hoc analyses further demonstrated significant %ΔFA differences between high-strain football subjects and noncollision control athletes, no significant %ΔFA differences between low-strain subjects and noncollision control athletes, and that CMPS1 × SR significantly explained more %ΔFA variance than number of head impacts alone.
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Affiliation(s)
- James M. Holcomb
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan A. Fisicaro
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Logan E. Miller
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Fang F. Yu
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Yin Xi
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jillian E. Urban
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ben C. Wagner
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Joel D. Stitzel
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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19
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Acute and Chronic Effects of Multiple Concussions on Midline Brain Structures. Neurology 2021; 97:e1170-e1181. [PMID: 34433678 PMCID: PMC8480483 DOI: 10.1212/wnl.0000000000012580] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To test the hypothesis that a history of concussion (HOC) causes greater disturbances in cerebral blood flow (CBF) and white matter microstructure of midline brain structures after subsequent concussions, during the acute and chronic phases of recovery. METHODS In this longitudinal MRI study, 61 athletes with uncomplicated concussion (36 with HOC) were imaged at the acute phase of injury (1-7 days after injury), the subacute phase (8-14 days), medical clearance to return to play (RTP), 1 month after RTP, and 1 year after RTP. A normative group of 167 controls (73 with HOC) were also imaged. Each session assessed CBF of the cingulate cortex, along with fractional anisotropy (FA) and mean diffusivity (MD) of the corpus callosum. Linear mixed models tested for interactions of HOC with time since injury. The Sport Concussion Assessment Tool (SCAT) was also used to evaluate effects of HOC on symptoms, cognition, and balance. RESULTS Athletes with HOC had significantly greater declines in midcingulate CBF subacutely (z = -3.29, p = 0.002) and greater declines in posterior cingulate CBF at 1 year after RTP (z = -2.42, p = 0.007). No significant effects of HOC were seen for FA, whereas athletes with HOC had higher MD of the splenium at RTP (z = 2.54, p = 0.008). These effects were seen in the absence of significant differences in SCAT domains (|z| ≤ 1.14, p ≥ 0.256) or time to RTP (z = 0.23, p = 0.818). DISCUSSION Results indicate subacute and chronic effects of HOC on cingulate CBF and callosal microstructure in the absence of differences in clinical indices. These findings provide new insights into physiologic brain recovery after concussion, with cumulative effects of repeated injury detected among young, healthy athletes.
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Affiliation(s)
- Nathan W Churchill
- From the Keenan Research Centre for Biomedical Science (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials and Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michael G Hutchison
- From the Keenan Research Centre for Biomedical Science (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials and Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Simon J Graham
- From the Keenan Research Centre for Biomedical Science (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials and Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tom A Schweizer
- From the Keenan Research Centre for Biomedical Science (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials and Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.
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20
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Eye tracking to assess concussions: an intra-rater reliability study with healthy youth and adult athletes of selected contact and collision team sports. Exp Brain Res 2021; 239:3289-3302. [PMID: 34467416 DOI: 10.1007/s00221-021-06205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
Eye movements that are dependent on cognition hold promise in assessing sports-related concussions but research on reliability of eye tracking measurements in athletic cohorts is very limited. This observational test-retest study aimed to establish whether eye tracking technology is a reliable tool for assessing sports-related concussions in youth and adult athletes partaking in contact and collision team sports. Forty-three youth (15.4 ± 2.2 years) and 27 adult (22.2 ± 2.9 years) Rugby Union and soccer players completed the study. Eye movements were recorded using SMIRED250mobile while participants completed a test battery twice, with a 1-week interval that included self-paced saccade (SPS), fixation stability, memory-guided sequence (MGS), smooth pursuit (SP), and antisaccades (AS) tasks. Intra-class correlation coefficient (ICC), measurement error (SEM) and smallest real difference (SRD) were calculated for 47 variables. Seventeen variables achieved an ICC > 0.50. In the adults, saccade count in SPS had good reliability (ICC = 0.86, SRD = 146.6 saccades). In the youth, the average blink duration in MGS had excellent reliability (ICC = 0.99, SRD = 59.4 ms); directional errors in AS tasks and gain of diagonal SP had good reliability (ICC = 0.78 and 0.77, SRD = 25.3 and 395.1%, respectively). Four metrics were found in this study to be reliable candidates for further biomarker validity research in contact and collision sport cohorts. Many variables failed to present a sufficient level of robustness for a practical diagnostic tool; possibly, because athletic cohorts have higher homogeneity, along with latent adverse effects of undetected concussions and repetitive head impacts. Since reliability of a measure can influence type II error, effect sizes, and confidence intervals, it is strongly advocated to conduct dedicated reliability evaluations prior to any validity studies.
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21
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Hunzinger KJ, Caccese JB, Costantini KM, Swanik CB, Buckley TA. Age of First Exposure to Collision Sports Does Not Affect Patient Reported Outcomes in Women and Men Community Rugby Players. Med Sci Sports Exerc 2021; 53:1895-1902. [PMID: 33731652 DOI: 10.1249/mss.0000000000002657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine the relationship between age of first exposure (AFE) to repetitive head impacts through contact/collision sports and patient-reported outcomes in community rugby players. METHODS We recruited community rugby players older than 18 yr with at least 1 yr of contact rugby participation to complete an online survey. Participants completed the Brief Symptom Inventory-18 (BSI-18), Short-Form Health Survey 12 (SF-12), and Satisfaction with Life Scale (SWLS) via Qualtrics. We used generalized linear models to examine the association between AFE (continuous) and patient-reported outcomes by sex, while controlling for cumulative years contact/collision sport history, age, and concussion history (yes/no). In addition, we used Mann-Whitney U tests to compare patient-reported outcomes between AFE <12 and AFE ≥12. RESULTS A total of 1037 rugby players (31.6 ± 11.3 yr (range, 18-74 yr), 59.1% men) participated in this study. Whether analyzed continuously or dichotomously at age 12 yr, younger AFE was not associated with worse patient-reported outcomes for either men or women. Positive concussion history was a significant predictor of worse BSI-18 subscores, SF-12 subscores, and SWLS in women and worse BSI-18 subscores in men. Cumulative contact/collision sport history was a significant predictor of better BSI-18 Depression and SF-12 (Mental Component Summary) subscores in men only. In men and women, older age was a significant predictor of better BSI-18 Depression, Anxiety, and GSI subscores; better SWLS (in men only); and better SF-12 Mental Component Summary, but worse SF-12 (Physical Component Summary). CONCLUSIONS Younger AFE to contact/collision sport is not associated with worse patient-reported outcomes in early adult rugby players. Concussion history was predictive of worse patient-reported outcomes.
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Affiliation(s)
| | - Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH
| | - Katelyn M Costantini
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
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22
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Concussion Risk and Resilience: Relationships with Pre-Injury Salience Network Connectivity. J Neurotrauma 2021; 38:3097-3106. [PMID: 34314246 DOI: 10.1089/neu.2021.0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Concussion is a major health concern, making it critical to identify factors that influence risk and resilience. The salience network (SN) likely plays a key role in concussion risk, given its roles in orienting attention, functional adaptability, and interoceptive awareness. The SN's functions are thought to be mediated through causal control of other networks, including the default mode network (DMN) and executive control network (ECN). It was therefore hypothesized that the SN of at-risk individuals would have altered functional and structural connectivity with the DMN and ECN. For this prospective study, 167 university athletes had baseline clinical assessments and magnetic resonance imaging scans and were monitored for the rest of their varsity career, with any concussions recorded. Athletes concussed in the same season as imaging (CSS; n = 17) and those concussed in later seasons (CLS; n = 15) were matched to controls that were not concussed after imaging. Functional connectivity and white matter fractional anisotropy (FA) were compared between concussed and control groups. Prior to injury, CSS athletes had significantly elevated total symptom severity scores, elevated SN-DMN functional connectivity and reduced FA of connecting white matter tracts, whereas CLS athletes showed no significant clinical or imaging effects. These findings provide new insights into the neurobiology of concussion risk and resilience, as indices of SN-DMN network connectivity are associated with short-term but not long-term concussion risk.
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Affiliation(s)
- Nathan W Churchill
- Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael G Hutchison
- Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Kinesiology and Physical Education, University of Toronto, Toronto. Ontario, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto. Ontario, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Tom A Schweizer
- Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Neurosurgery, University of Toronto, Toronto. Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, Toronto. Ontario, Canada
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23
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Chizuk HM, Haider MN, Solomito M, Kostyun R, Willer BS, Leddy JJ, Wang D. Concussion reporting behaviors in student athletes across sexes and levels of contact. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211015093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context Sport-related concussions (SRC) are common in student athletes. However, current literature suggests that many athletes do not accurately report their symptoms. The under-reporting of concussion symptoms can result in an increased risk of further injury and an underestimation of concussion prevalence. Objective This study aims to identify perspectives on concussion reporting behaviors in student athletes across levels of contact and by sex. Design Cross-sectional study. Setting Elementary and high school, college. Patients or other participants: 1126 female (52%) and male (48%) athletes, mean age 16.6 years. Main outcome measure(s): Standardized questionnaire on concussion reporting during a series of hypothetical scenarios. Results Student athletes participating in sports with higher levels of contact had more education about concussions, yet professed they were less likely to report a concussion. The most common reasons athletes chose not to report were ‘not wanting to miss the game’ and ‘not wanting to let the coach down.’ Minimal differences were found between sexes, with females being just as unlikely, or sometimes more unlikely, to report a concussion than males. Lastly, females playing contact and non-contact sports appear to be more concerned about not wanting to let their coach down than males. Conclusions Although perspective on concussion reporting behavior varied across sports of different levels of contact, we did not find any conclusive evidence of differences in willingness to report a concussion between sexes when compared within the same level of contact.
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Affiliation(s)
- Haley M Chizuk
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, USA
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, USA
| | - Mohammad N Haider
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, USA
| | - Matthew Solomito
- The Bone and Joint Institute, Hartford Health Care, Hartford, USA
| | - Regina Kostyun
- The Bone and Joint Institute, Hartford Health Care, Hartford, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, USA
| | - John J Leddy
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, USA
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, USA
| | - David Wang
- Department of Orthopedics, UConn Health Farmington, Farmington, USA
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24
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Howell DR, Kirkwood MW, Laker S, Wilson JC. Collision and Contact Sport Participation and Quality of Life Among Adolescent Athletes. J Athl Train 2021; 55:1174-1180. [PMID: 33112960 DOI: 10.4085/1062-6050-0536.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Researchers investigating collision and contact sport participation during high school have found mixed results. Understanding the association between current contact and collision sport participation and quality-of-life outcomes can enhance our knowledge about the risks and benefits of sport participation. OBJECTIVE To examine quality-of-life outcomes among high school athletes who reported participation in collision and contact sports in the year preceding assessment compared with no- or limited-contact sport athletes. DESIGN Cross-sectional study. SETTING Preparticipation physical examination. PATIENTS OR OTHER PARTICIPANTS High school athletes 13 to 18 years of age. MAIN OUTCOME MEASURE(S) We obtained sport participation and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 outcomes, which assess self-reported, quality-of-life domains in the preceding 7 days (ie, state assessment). Our grouping variable was collision and contact versus no- or limited-contact sport participation during the year preceding assessment. We used multivariable linear regression models to identify the associations between PROMIS scores and collision and contact sport participation and adjusted for sex; age; history of bone, muscle, ligament, or tendon injury; history of acute fracture or dislocation; and history of concussion. RESULTS A total of 143 (51%) athletes reported collision and contact sport participation (24% female, mean age = 15.1 ± 1.7 years) and 138 (49%) reported no- or limited-contact sport participation (66% female, mean age = 15.4 ± 1.2 years). A higher proportion of collision and contact sport athletes reported a history of time loss for bone, muscle, ligament, and tendon injuries (51% versus 29%, P < .001) and for acute fracture or dislocation (46% versus 26%, P < .001) than did no- or limited-contact athletes. After adjusting for covariates, we found that collision and contact sport participation was significantly associated with lower state anxiety (β = -1.072, 95% confidence interval = -1.834, -0.310, P = .006) and depressive (β = -0.807, 95% confidence interval = -1.484, -0.130, P = .020) symptom scores. CONCLUSIONS Collision and contact sport athletes reported fewer anxiety and depressive symptoms in the week preceding evaluation than did no- or limited-contact sport athletes, but they had more extensive orthopaedic injury histories. Potential benefits and risks are associated with collision and contact sport participation. These data reinforce the need to examine the assumption that youth collision and contact sports are associated with negative quality of life.
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Affiliation(s)
- David R Howell
- Departments of Orthopedics, Sports Medicine Center, and Rehabilitation Medicine, Children's Hospital Colorado, Aurora.,Department of Orthopaedics, University of Colorado School of Medicine, Aurora
| | - Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora
| | - Scott Laker
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora
| | - Julie C Wilson
- Departments of Orthopedics, Sports Medicine Center, and Rehabilitation Medicine, Children's Hospital Colorado, Aurora.,Department of Orthopaedics, University of Colorado School of Medicine, Aurora.,Pediatrics, University of Colorado School of Medicine, Aurora
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25
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Fanning E, Daniels K, Cools A, Miles JJ, Falvey É. Biomechanical upper-extremity performance tests and isokinetic shoulder strength in collision and contact athletes. J Sports Sci 2021; 39:1873-1881. [PMID: 33874850 DOI: 10.1080/02640414.2021.1904694] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was threefold (1) to assess the reliability of three upper-extremity performance tests: a countermovement push up, press jump and drop box land, performed on a set of dual-force plates (2) to examine whether there was an association between isokinetic dynamometry and the performance tests in a non-injured cohort of collision/contact athletes and (3) to establish a normal descriptive profile of the vertical ground reaction forces from the performance tests, in a cohort of contact/collision athletes. The study was split into two sub-sections; the inter-day reliability of three upper-extremity performance tests (n = 21) and a descriptive, correlation study investigating the relationship between isokinetic dynamometry and performance tests metrics (n = 39). We used intraclass correlation coefficients (absolute agreement, 2-way mixed-effects model) with 95% confidence intervals to quantify inter-day reliability of all variables. We used Pearson correlation coefficients to investigate associations between isokinetic strength and vertical ground reaction force asymmetry variables. Inter-day reliability was moderate-to-excellent for the upper-extremity performance tests (ICC 0.67-0.97). There was no statistically significant correlation between external and internal rotational peak torque and the variables of CPMU, PJ and BDL (r range = .02-.24).These upper-extremity tests are reliable for use with male contact/collision athletes.
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Affiliation(s)
- Edel Fanning
- Sports Medicine, Sports Surgery Clinic, Dublin, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Katherine Daniels
- Sports Medicine, Sports Surgery Clinic, Dublin, Ireland.,Queen's School of Engineering, University of Bristol, University Walk, Bristol, UK
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Josh J Miles
- Department for Health, University of Bath, Bath, UK
| | - Éanna Falvey
- Sports Medicine, Sports Surgery Clinic, Dublin, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
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26
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Disturbances in Brain Physiology Due to Season Play: A Multi-Sport Study of Male and Female University Athletes. Front Physiol 2021; 12:653603. [PMID: 33868020 PMCID: PMC8044759 DOI: 10.3389/fphys.2021.653603] [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: 01/15/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
High-performance university athletes experience frequent exertion, resulting in disrupted biological homeostasis, but it is unclear to what extent brain physiology is affected. We examined whether athletes without overtraining symptoms show signs of increased neurophysiological stress over the course of a single athletic season, and whether the effects are modified by demographic factors of age, sex and concussion history, and sport-related factors of contact exposure and season length. Fifty-three university-level athletes were recruited from multiple sports at a single institution and followed longitudinally from beginning of season (BOS) to end of season (EOS) and 1 month afterwards, with a subset followed up at the subsequent beginning of season. MRI was used to comprehensively assess white matter (WM) diffusivity, cerebral blood flow (CBF), and brain activity, while overtraining symptoms were assessed with Hooper’s Index (HI). Although athletes did not report increased HI scores, they showed significantly increased white matter diffusivity and decreased CBF at EOS and 1 month afterwards, with recovery at follow-up. Global brain activity was not significantly altered though, highlighting the ability of the brain to adapt to exercise-related stressors. Male athletes had greater white matter diffusivity at EOS, but female athletes had greater declines in CBF at 1 month afterwards. Post-season changes in MRI measures were not related to change in HI score, age, concussion history, contact exposure, or length of athletic season. Hence, the brain shows substantial but reversible neurophysiological changes due to season play in the absence of overtraining symptoms, with effects that are sex-dependent but otherwise insensitive to demographic variations. These findings provide new insights into the effects of training and competitive play on brain health.
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Affiliation(s)
- Nathan W Churchill
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael G Hutchison
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, ON, Canada.,The Institute of Biomaterials & Biomedical Engineering (IBBME) at the University of Toronto, Toronto, ON, Canada
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27
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Knell G, Caze T, Burkhart SO. Evaluation of the vestibular and ocular motor screening (VOMS) as a prognostic tool for protracted recovery following paediatric sports-related concussion. BMJ Open Sport Exerc Med 2021; 7:e000970. [PMID: 33868706 PMCID: PMC7996664 DOI: 10.1136/bmjsem-2020-000970] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To understand the relationship between initial vestibular and ocular motor screening (VOMS) and recovery time, and the utility of VOMS to screen for protracted recovery in youth/adolescent patients with sport-related concussion (SRC). Methods Participants (8–18 years) who were diagnosed with an SRC within 7 days of the injury were administered the VOMS test by certified medical personnel. Recovery time (days) and protracted recovery (>30 days) were the primary outcomes. Multivariable regression models were used to evaluate the association between VOMS symptom provocation and (1) recovery time (days) and (2) protracted recovery. Measures of VOMS validity, predictive ability and receiver operator curves were used to assess VOMS as a prognostic tool to accurately classify a normal/protracted recovery. Results After adjustment, any symptom provocation across all VOMS domains was associated (p<0.05) with greater recovery time, except the convergence test (p=0.08) in females. All VOMS test thresholds (≥1 to ≥10) in males and (≥1 to ≥5) in females were associated (p<0.05) with recovery time. However, the VOMS test performed poorly among males (receiver operating characteristic (ROC) area=0.66) and failed among females (ROC area=0.56) as a prognostic tool to identify those that will have a normal/protracted recovery. Conclusion In this sample, overall, the VOMS test was associated with recovery time (days); however, the VOMS was not a valid stand-alone prognostic tool to identify a delayed recovery, but may be useful in combination with other concussion symptomology assessments. Future studies should confirm these findings in larger samples while taking into consideration other comorbid factors that may influence recovery time.
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Affiliation(s)
- Gregory Knell
- Center for Pedatric Population Health, Children's Health System of Texas and University of Texas Health Science Center at Houston, Dallas, TX, USA.,Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Dallas, TX, USA.,Andrews Institute for Orthopaedics and Sports Medicine, Children's Health System of Texas, Plano, TX, USA
| | - Todd Caze
- Andrews Institute for Orthopaedics and Sports Medicine, Children's Health System of Texas, Plano, TX, USA.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Scott O Burkhart
- Andrews Institute for Orthopaedics and Sports Medicine, Children's Health System of Texas, Plano, TX, USA
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28
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Prien A, Feddermann-Demont N, Verhagen E, Twisk J, Junge A. Neurocognitive performance and mental health of retired female football players compared to non-contact sport athletes. BMJ Open Sport Exerc Med 2020; 6:e000952. [PMID: 33312682 PMCID: PMC7716672 DOI: 10.1136/bmjsem-2020-000952] [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] [Accepted: 11/15/2020] [Indexed: 11/25/2022] Open
Abstract
Background Adverse long-term effects of playing football due to repetitive head impact exposure on neurocognition and mental health are controversial. To date, no studies have evaluated such effects in women. Aims To (1) compare neurocognitive performance, cognitive symptoms and mental health in retired elite female football players (FB) with retired elite female non-contact sport athletes (CON), and to (2) assess whether findings are related to history of concussion and/or heading exposure in FB. Methods Neurocognitive performance, mental health and cognitive symptoms were assessed using computerised tests (CNS-vital signs), paper pen tests (Category fluency, Trail-Making Test, Digit Span, Paced Auditory Serial Addition Test), questionnaires (Hospital Anxiety and Depression Scale, SF-36v2 Health Survey) and a symptom checklist. Heading exposure and concussion history were self-reported in an online survey and in a clinical interview, respectively. Linear regression was used to analyse the effect of football, concussion and heading exposure on outcomes adjusted for confounders. Results FB (n=66) performed similar to CON (n=45) on neurocognitive tests, except for significantly lower scores on verbal memory (mean difference (MD)=−7.038, 95% CI −12.98 to –0.08, p=0.038) and verbal fluency tests (MD=−7.534, 95% CI –13.75 to –0.46, p=0.016). Among FB weaker verbal fluency performance was significantly associated with ≥2 concussions (MD=−10.36, 95% CI –18.48 to –2.83, p=0.017), and weaker verbal memory performance with frequent heading (MD=−9.166, 95% CI –17.59 to –0.123, p=0.041). The depression score differed significantly between study populations, and was significantly associated with frequent heading but not with history of concussion in FB. Conclusion Further studies should investigate the clinical relevance of our findings and whether the observed associations point to a causal link between repetitive head impacts and verbal memory/fluency or mental health.
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Affiliation(s)
- Annika Prien
- Fakultät Humanwissenschaften, MSH Medical School Hamburg, Hamburg, Germany.,Amsterdam Collaboration on Health & Safety in Sports, Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Nina Feddermann-Demont
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Swiss Concussion Center (SCC), Schulthess Klinik, Zurich, Switzerland
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands.,Department of Human Biology, Division of Exercise Science and Sports Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Jos Twisk
- Epidemiology and Biostatistics, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Astrid Junge
- Fakultät Humanwissenschaften, MSH Medical School Hamburg, Hamburg, Germany.,Swiss Concussion Center (SCC), Schulthess Klinik, Zurich, Switzerland
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Abstract
BACKGROUND Female participation in sport has grown substantially over the last 4 decades. OBJECTIVES We investigated the association between sports participation and (1) later-life health outcomes and (2) later-life quality-of-life (QoL) measures among female college alumni. METHODS We conducted a cross-sectional study of female alumni between the ages of 40 and 70 years. Participants completed a questionnaire that included QoL measures assessing general health, negative consequences of alcohol use, mental health, and other self-reported health outcomes. We divided alumni into athletes and nonathletes. Between-group comparisons of health outcomes were adjusted for age; QoL measures were adjusted for age, exercise habits, cigarette smoking, alcohol use, and comorbidities. RESULTS Questionnaires were sent to 47 836 alumni, 3702 (8%) responded. Forty-four percent of female respondents participated in collegiate sports. After adjusting for age, female respondents who participated in collegiate sports were more likely to exercise >3×/week (61.8% vs 50.2%; P ≤ 0.001), view themselves in good/great health (91% vs 85%; P < 0.001), and less likely to have ever smoked (13.6% vs 25.3%; P ≤ 0.001) or used recreational drugs (7.5% vs 9.5%; P = 0.018). A smaller proportion of female athletes reported hypertension (5.5% vs 13.5%; P ≤ 0.001), high cholesterol (9.9% vs 17.0%; P < 0.001), and obesity (3.1% vs 6.8%; P = 0.001) compared with nonathletes. Participation in sports was, however, associated with decreased mobility (R = 0.1826; P = 0.002) and increased anxiety (R = 0.039; P = 0.016) QoL scores. CONCLUSIONS Sports participation for female collegiate athletes was associated with mostly positive health outcomes, but also with lower mobility and increased anxiety QoL scores.
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Abstract
PURPOSE OF REVIEW The goal of the present paper is to provide a comprehensive overview of mental health concerns in young athletes, with a focus on common disorders, as well as population-specific risk factors. RECENT FINDINGS Athletes experience similar mental health concerns as non-athlete peers, such as anxiety, depression and suicidal ideation, ADHD, eating disorders, and substance abuse. However, they also experience unique stressors that put them at risk for the development or exacerbation of mental health disorders. Student athletes have to balance academics with rigorous training regimens while focusing on optimal performance and managing high expectations. Physical injuries, overtraining, concussion, sleep disorders, and social identity are some of the factors that also impact the mental health of student athletes. Existing literature highlights the need to develop proactive mental health and wellness education for young athletes, and to develop services that recognize the unique needs of this population.
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Affiliation(s)
- Melissa S Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Tami Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jason Lewis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Julia A Case
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Christina L Master
- Pediatric and Adolescent Sports Medicine, Division of Pediatric Orthopedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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31
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Turner M, Maddocks D, Hassan M, Anderson A, McCrory P. Consent, capacity and compliance in concussion management: cave ergo medicus (let the doctor beware). Br J Sports Med 2020; 55:bjsports-2020-102108. [PMID: 32788296 DOI: 10.1136/bjsports-2020-102108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 11/03/2022]
Abstract
While the acute effects of concussion and mild traumatic brain injury (TBI) are well understood, the certainty in the medical literature regarding the long-term outcomes of sports-related concussion is limited. Long-term deficits that may result from single, repeated concussions, and possibly subconcussive impacts, include cognitive dysfunction, depression and executive dysfunction. Perhaps most troublingly, repetitive head impacts have been linked to neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), although the precise risk of long-term consequences remains unknown. CTE represents a distinct tauopathy with an unknown incidence in athletic populations; however, a cause and effect relationship has not yet been demonstrated between CTE and concussions or between CTE and exposure to contact sports, as no prospective longitudinal studies have been performed to address that question. Studies of high-school sports exposure and long-term outcomes have not demonstrated consistent findings.Medical advice regarding return to play and the risk of acute and/or long-term consequences is therefore problematic. It is important that the individual's right to make their own choices regarding their health is respected. Team, coach, parental, peer or financial pressures should not influence this decision. The choice to return to play after a concussion or mild TBI injury is the athlete's decision once they have (1) recovered from their injury and have the legal capacity to make an informed decision; (2) been medically assessed and (3) been informed of any possible long-term risks in a language that they can understand.Given the current lack of certainty in relation to long-term outcomes from concussion, is it possible to provide a framework to inform players of current evidence, as part of a consent process, even if the information upon which the decision to return to sport is based remains uncertain and evolving?
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Affiliation(s)
- Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
| | - David Maddocks
- Centre for Health Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Paul McCrory
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Baseline vs. cross-sectional MRI of concussion: distinct brain patterns in white matter and cerebral blood flow. Sci Rep 2020; 10:1643. [PMID: 32015365 PMCID: PMC6997378 DOI: 10.1038/s41598-020-58073-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
Neuroimaging has been used to describe the pathophysiology of sport-related concussion during early injury, with effects that may persist beyond medical clearance to return-to-play (RTP). However, studies are typically cross-sectional, comparing groups of concussed and uninjured athletes. It is important to determine whether these findings are consistent with longitudinal change at the individual level, relative to their own pre-injury baseline. A cohort of N = 123 university-level athletes were scanned with magnetic resonance imaging (MRI). Of this group, N = 12 acquired a concussion and were re-scanned at early symptomatic injury and at RTP. A sub-group of N = 44 uninjured athletes were also re-imaged, providing a normative reference group. Among concussed athletes, abnormalities were identified for white matter fractional anisotropy and mean diffusivity, along with grey matter cerebral blood flow, using both cross-sectional (CS) and longitudinal (LNG) approaches. The spatial patterns of abnormality for CS and LNG were distinct, with median fractional overlap below 0.10 and significant differences in the percentage of abnormal voxels. However, the analysis methods did not differ in the amount of change from symptomatic injury to RTP and in the direction of observed abnormalities. These results highlight the impact of using pre-injury baseline data when evaluating concussion-related brain abnormalities at the individual level.
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Affiliation(s)
- Nathan W Churchill
- Neuroscience Research Program, St. Michael's Hospital, Toronto ON, M5B 1M8, Canada. .,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.
| | - Michael G Hutchison
- Neuroscience Research Program, St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto ON, M5S 2C9, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto ON, M5G 1L7, Canada.,Sunnybrook Research Institute, Sunnybrook Hospital, Toronto ON, M4N 3M5, Canada
| | - Tom A Schweizer
- Neuroscience Research Program, St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto ON, M5B 1M8, Canada.,Faculty of Medicine (Neurosurgery), University of Toronto, Toronto ON, M5T 1P5, Canada
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Cunningham J, Broglio SP, O'Grady M, Wilson F. History of Sport-Related Concussion and Long-Term Clinical Cognitive Health Outcomes in Retired Athletes: A Systematic Review. J Athl Train 2020; 55:132-158. [PMID: 31935139 DOI: 10.4085/1062-6050-297-18] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sport-related concussions (SRCs) are known to have short-term effects on cognitive processes, which can result in diverse clinical presentations. The long-term effects of SRC and repeated exposure to head impacts that do not result in SRC on specific cognitive health outcomes remain unclear. OBJECTIVES To synthesize and appraise the evidence base regarding cognitive health in living retired athletes with a history of head-impact exposure or SRC. DATA SOURCES A systematic search of the EMBASE, PsycINFO, MEDLINE/PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted from inception to April 2018 using common key words and medical subject headings related to 3 components: (1) the participant (eg, retired athlete), (2) the primary outcome measure (eg, cognitive test used), and (3) the secondary outcome measure (eg, history of sport concussion). STUDY SELECTION Cross-sectional studies of living retired male or female athletes in which at least 1 cognitive test was used as an outcome measure were included. Two reviewers independently screened studies. DATA EXTRACTION Data extraction was performed using Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodologic quality was assessed independently by 2 reviewers using the Downs and Black tool. DATA SYNTHESIS The search yielded 46 cross-sectional observational studies that were included in a qualitative synthesis. Most included studies (80%, n = 37) were published in the 5 years before our review. A large proportion of these studies (n = 20) included retired American National Football League players. The other research investigated professional, university, high school, and amateur retired athletes participating in sports such as American and Australian football, boxing, field and ice hockey, rugby, and soccer. The total sample consisted of 13 975 participants: 7387 collision-sport athletes, 662 contact-sport athletes, 3346 noncontact-sport athletes, and 2580 participants classified as controls. Compared with control participants or normative data, retired athletes displayed worse performance in 17 of 31 studies (55%) of memory, 6 of 11 studies (55%) of executive function, and 4 of 6 studies (67%) of psychomotor function and increased subjective concerns about cognitive function in 11 of 14 studies (79%). The authors of 13 of 46 investigations (28%) reported a frequency-response relationship, with poorer cognitive outcomes in athletes who had greater levels of exposure to head impacts or concussions. However, these results must be interpreted in light of the lack of methodologic rigor and moderate quality assessment of the included studies. CONCLUSIONS Evidence of poorer cognitive health among retired athletes with a history of concussion and head-impact exposure is evolving. Our results suggest that a history of SRC may more greatly affect the cognitive domains of memory, executive function, and psychomotor function. Retired athletes appeared to have increased self-reported cognitive difficulties, but the paucity of high-quality, prospective studies limited the conclusions that could be drawn regarding a cause-and-effect relationship between concussion and long-term health outcomes. Future researchers should consider a range of cognitive health outcomes, as well as premorbid ability, in diverse samples of athletes with or without a history of concussion or head-impact exposure to delineate the long-term effects of sport participation on cognitive functioning.
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Affiliation(s)
- Joice Cunningham
- Trinity Centre for Health Sciences, St James Hospital, Trinity College Dublin, Ireland
| | | | - Megan O'Grady
- Trinity Centre for Health Sciences, St James Hospital, Trinity College Dublin, Ireland
| | - Fiona Wilson
- Trinity Centre for Health Sciences, St James Hospital, Trinity College Dublin, Ireland
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Mapping brain recovery after concussion: From acute injury to 1 year after medical clearance. Neurology 2019; 93:e1980-e1992. [PMID: 31619480 DOI: 10.1212/wnl.0000000000008523] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/27/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To test the hypothesis that concussion-related brain alterations seen at symptomatic injury and medical clearance to return to play (RTP) will have dissipated by 1 year after RTP. METHODS For this observational study, 24 athletes with concussion were scanned longitudinally within 1 week after injury, at RTP, and 1 year after RTP. A large control cohort of 122 athletes were also scanned before the season. Each imaging session assessed global functional connectivity (Gconn) and cerebral blood flow (CBF), along with white matter fractional anisotropy (FA) and mean diffusivity (MD). The main effects of concussion on MRI parameters were evaluated at each postinjury time point. In addition, covariation was assessed between MRI parameters and clinical measures of acute symptom severity and time to RTP. RESULTS Different aspects of brain physiology showed different patterns of recovery over time. Both Gconn and FA displayed no significant effects at 1 year after RTP, whereas CBF and MD exhibited persistent long-term effects. The effects of concussion on MRI parameters were also dependent on acute symptom severity and time to RTP for all postinjury time points. CONCLUSION This study provides the first longitudinal evaluation of concussion focused on time of RTP and 1 year after medical clearance, using multiple different MRI measures to assess brain structure and function. These findings significantly enhance our understanding of the natural course of brain recovery after a concussion.
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Affiliation(s)
- Nathan W Churchill
- From the Keenan Research Centre of the Li Ka Shing Knowledge Institute (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials & Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michael G Hutchison
- From the Keenan Research Centre of the Li Ka Shing Knowledge Institute (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials & Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Simon J Graham
- From the Keenan Research Centre of the Li Ka Shing Knowledge Institute (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials & Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tom A Schweizer
- From the Keenan Research Centre of the Li Ka Shing Knowledge Institute (N.W.C., M.G.H., T.A.S.) and Neuroscience Research Program (N.W.C., T.A.S.), St. Michael's Hospital; Faculty of Kinesiology and Physical Education (M.G.H.), Department of Medical Biophysics (S.J.G.), Faculty of Medicine (Neurosurgery) (T.A.S.), and Institute of Biomaterials & Biomedical Engineering (T.A.S.), University of Toronto; and Physical Sciences Platform (S.J.G.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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35
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Bohr AD, Boardman JD, McQueen MB. Association of Adolescent Sport Participation With Cognition and Depressive Symptoms in Early Adulthood. Orthop J Sports Med 2019; 7:2325967119868658. [PMID: 31598525 PMCID: PMC6764154 DOI: 10.1177/2325967119868658] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Recent studies have associated sport-related concussion with depression and
impaired cognitive ability later in life in former professional football
players. However, population studies with two 1950s-era cohorts did not find
an association between high school football participation and impaired
cognition or depressive symptoms in late adulthood. Purpose/Hypothesis: This study assessed whether actual/intended participation in contact sports
during adolescence had an adverse effect on participants’ cognition or
depressive symptoms in early adulthood. We hypothesized that there would not
be an association. Study Design: Cohort study; Level of evidence, 2. Methods: This study used a subsample (n = 10,951) from the National Longitudinal Study
of Adolescent to Adult Health (Add Health), a nationally (United States)
representative prospective cohort study following participants through 4
waves of data collection from 1994 through 2008. Participants were
categorized as actual/intended participation in no sports, noncontact sports
only, and contact sports. We constructed 6 multivariate and logistic
regression models predicting word recall, number recall, modified Center for
Epidemiologic Studies Depression Scale, depression diagnosis, suicide
ideation, and suicide attempts at wave IV as a function of sport
participation during wave I. Sport participation was treated as a factor
with the referent category noncontact sports. This analysis was repeated on
a males-only sample (n = 5008). In the males-only analysis, participants
were classified as actual/intended participation in no sports, noncontact
sports, contact sports other than American football, and American football.
The referent category remained noncontact sports. Results: Intention to participate in contact sports was not significantly associated
with any of the outcomes in the full-sample analysis. Intention to
participate in football was significantly associated with a reduced odds of
depression diagnosis in adulthood (odds ratio, 0.70; P =
.02) when compared with noncontact sports participation in the males-only
sample. Football was not significantly associated with impaired cognitive
ability, increased depressive symptoms, or increased suicide ideation. Conclusion: Actual/intended participation in contact sports during adolescence did not
adversely affect Add Health participants’ cognition or depressive symptoms
in young adulthood.
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Affiliation(s)
- Adam D Bohr
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jason D Boardman
- Department of Sociology and Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Matthew B McQueen
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
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36
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Newman SD, Grantz JG, Brooks K, Gutierrez A, Kawata K. Association between History of Concussion and Substance Use Is Mediated by Mood Disorders. J Neurotrauma 2019; 37:146-151. [PMID: 31359826 DOI: 10.1089/neu.2019.6550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Understanding the impact of concussion history on mental health-mood disorders and substance use-is an essential step in characterizing the psychological and behavioral consequences of concussion and in developing effective treatments. The objective of this study was to examine the association between the history of concussion and substance abuse by investigating both its direct and indirect association via mood disorder. A secondary objective was to determine whether gender moderates the association. A comprehensive survey was administered to 4849 college-age adults that assessed history of concussion; depression, anxiety, and panic disorders using the Patient Health Questionnaire (PHQ); and substance use using the Alcohol Use Disorders Identification Test (AUDIT) (alcohol) and Cannabis Use Disorders Identification Test-Revised (CUDIT) (cannabis). Regression models were used to examine the association between concussion history and substance use. Mood disorders were entered into the model as mediators and gender as a moderator variable. Those with a history of concussion had higher panic, AUDIT, and CUDIT scores than those with no history of concussion, and AUDIT and CUDIT scores showed an interaction between concussion history and gender. The regression models revealed significant direct and indirect (via depression and panic disorder) effects of concussion history on alcohol and cannabis use, which was moderated by gender. Concussion can have long-term psychological consequences and appears to affect both mood and substance use. The results presented demonstrate that the relationship between concussion and substance use is complex with mood disorder mediating the effect.
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Affiliation(s)
- Sharlene D Newman
- Department of Psychological and Brain Sciences, School of Public Health, Indiana University, Bloomington, Indiana.,Program in Neuroscience, College of Arts and Sciences, School of Public Health, Indiana University, Bloomington, Indiana
| | - Jesse G Grantz
- Department of Psychological and Brain Sciences, School of Public Health, Indiana University, Bloomington, Indiana
| | - Kelsie Brooks
- Department of Psychological and Brain Sciences, School of Public Health, Indiana University, Bloomington, Indiana
| | - Arianna Gutierrez
- Department of Psychological and Brain Sciences, School of Public Health, Indiana University, Bloomington, Indiana
| | - Keisuke Kawata
- Program in Neuroscience, College of Arts and Sciences, School of Public Health, Indiana University, Bloomington, Indiana.,Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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37
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Evaluating Cerebrovascular Reactivity during the Early Symptomatic Phase of Sport Concussion. J Neurotrauma 2019; 36:1518-1525. [DOI: 10.1089/neu.2018.6024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Nathan W. Churchill
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Ontario, Canada
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael G. Hutchison
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Simon J. Graham
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | - Tom A. Schweizer
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Ontario, Canada
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, Ontario, Canada
- The Institute of Biomaterials & Biomedical Engineering (IBBME) at the University of Toronto, Toronto, Ontario, Canada
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Abstract
Background Elite athletes can experience a diverse range of symptoms following post-concussive injury. The impact of sport-related concussion on specific mental health outcomes is unclear in this population. Objective The aim was to appraise the evidence base regarding the association between sport-related concussion and mental health outcomes in athletes competing at elite and professional levels. Methods A systematic search of PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane, and Cinahl databases was conducted. Results A total of 27 studies met inclusion criteria for review. Most of the included studies (67%, n = 18) were published in 2014 or later. Study methodology and reporting varied markedly. The extant research has been conducted predominantly in North America (USA, n = 23 studies; Canada, n = 3), often in male only (44.4%, n = 12) and college (70.4%, n = 19) samples. Depression is the most commonly studied mental health outcome (70.4%, n = 19 studies). Cross-sectional retrospective studies and studies including a control comparison tend to support an association between concussion exposure and depression symptoms, although several studies report that these symptoms resolved in the medium term (i.e. 1 month) post-concussion. Evidence for anxiety is mixed. There are insufficient studies to draw conclusions for other mental health domains. Conclusion Consistent with current recommendations to assess mood disturbance in post-concussive examinations, current evidence suggests a link between sports-related concussion and depression symptoms in elite athletes. Causation cannot be determined at this stage of enquiry because of the lack of well-designed, prospective studies. More research is required that considers a range of mental health outcomes in diverse samples of elite athletes/sports. Electronic supplementary material The online version of this article (10.1007/s40279-017-0810-3) contains supplementary material, which is available to authorized users.
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39
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Systematic review of mental health measures associated with concussive and subconcussive head trauma in former athletes. Int J Psychophysiol 2018; 132:55-61. [DOI: 10.1016/j.ijpsycho.2017.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 09/11/2017] [Accepted: 11/08/2017] [Indexed: 11/18/2022]
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40
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Mainwaring L, Ferdinand Pennock KM, Mylabathula S, Alavie BZ. Subconcussive head impacts in sport: A systematic review of the evidence. Int J Psychophysiol 2018; 132:39-54. [DOI: 10.1016/j.ijpsycho.2018.01.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 12/18/2022]
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41
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Cunningham J, Broglio S, Wilson F. Influence of playing rugby on long-term brain health following retirement: a systematic review and narrative synthesis. BMJ Open Sport Exerc Med 2018; 4:e000356. [PMID: 29719729 PMCID: PMC5926651 DOI: 10.1136/bmjsem-2018-000356] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives The aim of this review was to systematically investigate long-term brain health in retired rugby players. Methods Six databases were systematically searched from inception to January 2018 using Medical Subject Headings and keywords. Two reviewers independently screened studies for inclusion. Cross-sectional studies of living retired male or female rugby players in which at least one cognitive test was used as an outcome measure were included. Data extraction was performed using Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality was assessed independently by two reviewers using the Downs and Black methodological quality tool. Results This review yielded six studies with an overall methodological quality of 'moderate'. A total of 672 male retired rugby players (mean ages of 38-52 years) were included in this review. Three studies investigated neuropsychological functioning in retired rugby players in comparison with controls, with no significant evidence of decreased performance in the majority of tests when compared with controls. Five out of the six studies explored self-reported measures of cognition. Three studies compared retired rugby players to controls, one of which found significantly increased subjective cognitive complaints among retired rugby players. The other two studies found that persistent postconcussion symptoms were associated with a higher number of self-reported concussions. Two studies reported decreased fine motor control in retired rugby players in comparison with controls. Neurometabolites and electrophysiological changes were explored by two studies, with minimal and non-significant findings. Conclusions Overall findings are mixed. Methodological biases reduce the overall study quality and limited the conclusions that can be drawn. Findings of decreased fine motor control in retired athletes may be influenced by lack of controlling for evidence of upper limb musculoskeletal injuries. While some studies show evidence of reduced cognitive function among former athletes, the results are not significantly lower than population norms. Cognitive findings from this review are inconsistent within and across study cohorts and are biased towards positive findings when self-report methods were selected. Current evidence suggests that large gaps remain in the understanding of the cause-and-effect relationships between playing rugby and long-term brain health in retired players.
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Affiliation(s)
- Joice Cunningham
- Department of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Centre for Learning and Development, Trinity Centre, St. James's Hospital, Dublin, Ireland
| | - Steven Broglio
- Departments of Neurology and Physical Medicine and Rehabilitation, University of Michigan in the School of Kinesiology, Ann Arbor, Michigan, USA.,Neuro Trauma Research Laboratory, Ann Arbor, Michigan, USA
| | - Fiona Wilson
- Department of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Centre for Learning and Development, Trinity Centre, St. James's Hospital, Dublin, Ireland
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Abstract
My objectives are to review: 1) a brief history of sport-related concussion (SRC) and chronic traumatic encephalopathy (CTE), 2) the evolution of CTE in American professional football, 3) the data regarding SRC/CTE as they relate to depression and suicide, 4) the data on the neurocognitive effects of subconcussion/repetitive head trauma (with emphases on heading the ball in soccer and early exposure to football), 5) the evidence related to SRC and neurodegenerative diseases, 6) the published studies of CTE, 7) the NINDS neuropathological criteria for CTE, 8) public beliefs about SRC/CTE, and 9) the scientific questions regarding CTE.
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Affiliation(s)
- Gary Solomon
- a Department of Neurological Surgery, Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
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Churchill NW, Hutchison MG, Di Battista AP, Graham SJ, Schweizer TA. Structural, Functional, and Metabolic Brain Markers Differentiate Collision versus Contact and Non-Contact Athletes. Front Neurol 2017; 8:390. [PMID: 28878729 PMCID: PMC5572295 DOI: 10.3389/fneur.2017.00390] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/21/2017] [Indexed: 01/11/2023] Open
Abstract
There is growing concern about how participation in contact sports affects the brain. Retrospective evidence suggests that contact sports are associated with long-term negative health outcomes. However, much of the research to date has focused on former athletes with significant health problems. Less is known about the health of current athletes in contact and collision sports who have not reported significant medical issues. In this cross-sectional study, advanced magnetic resonance imaging (MRI) was used to evaluate multiple aspects of brain physiology in three groups of athletes participating in non-contact sports (N = 20), contact sports (N = 22), and collision sports (N = 23). Diffusion tensor imaging was used to assess white matter microstructure based on measures of fractional anisotropy (FA) and mean diffusivity (MD); resting-state functional MRI was used to evaluate global functional connectivity; single-voxel spectroscopy was used to compare ratios of neural metabolites, including N-acetyl aspartate (NAA), creatine (Cr), choline, and myo-inositol. Multivariate analysis revealed structural, functional, and metabolic measures that reliably differentiated between sport groups. The collision group had significantly elevated FA and reduced MD in white matter, compared to both contact and non-contact groups. In contrast, the collision group showed significant reductions in functional connectivity and the NAA/Cr metabolite ratio, relative to only the non-contact group, while the contact group overlapped with both non-contact and collision groups. For brain regions associated with contact sport participation, athletes with a history of concussion also showed greater alterations in FA and functional connectivity, indicating a potential cumulative effect of both contact exposure and concussion history on brain physiology. These findings indicate persistent differences in brain physiology for athletes participating in contact and collision sports, which should be considered in future studies of concussion and subconcussive impacts.
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Affiliation(s)
- Nathan W. Churchill
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
| | - Michael G. Hutchison
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | | | - Simon J. Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tom A. Schweizer
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, ON, Canada
- The Institute of Biomaterials & Biomedical Engineering (IBBME) at the University of Toronto, Toronto, ON, Canada
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Manley G, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, Castellani RJ, Turner M, Jordan BD, Randolph C, Dvořák J, Hayden KA, Tator CH, McCrory P, Iverson GL. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med 2017; 51:969-977. [PMID: 28455362 PMCID: PMC5466926 DOI: 10.1136/bjsports-2017-097791] [Citation(s) in RCA: 380] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/14/2022]
Abstract
Objective Systematic review of possible long-term effects of sports-related concussion in retired athletes. Data sources Ten electronic databases. Study selection Original research; incidence, risk factors or causation related to long-term mental health or neurological problems; individuals who have suffered a concussion; retired athletes as the subjects and possible long-term sequelae defined as >10 years after the injury. Data extraction Study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, neuroimaging findings and neuropathology results. Risk of bias and level of evidence were evaluated by two authors. Results Following review of 3819 studies, 47 met inclusion criteria. Some former athletes have depression and cognitive deficits later in life, and there is an association between these deficits and multiple prior concussions. Former athletes are not at increased risk for death by suicide (two studies). Former high school American football players do not appear to be at increased risk for later life neurodegenerative diseases (two studies). Some retired professional American football players may be at increased risk for diminishment in cognitive functioning or mild cognitive impairment (several studies), and neurodegenerative diseases (one study). Neuroimaging studies show modest evidence of macrostructural, microstructural, functional and neurochemical changes in some athletes. Conclusion Multiple concussions appear to be a risk factor for cognitive impairment and mental health problems in some individuals. More research is needed to better understand the prevalence of chronic traumatic encephalopathy and other neurological conditions and diseases, and the extent to which they are related to concussions and/or repetitive neurotrauma sustained in sports.
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Affiliation(s)
- Geoff Manley
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, USA
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle; Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, Australia
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology; Alberta Children's Hospital Research Institute for Child & Maternal Health, Cumming School of Medicine; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina, Chapel Hill, USA
| | - Julian Bailes
- Department of Neurosurgery, NorthShore University Health System, Co-Director, NorthShore Neurological Institute; University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Robert C Cantu
- Department of Neurosurgery, Emerson Hospital, Concord, MA, and Center for the Study of Traumatic Encephalopathy, Boston University Medical Center, Boston, USA
| | - Rudolph J Castellani
- Center for Neuropathology, Western Michigan University, and Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - Michael Turner
- The International Concussion and Head Injury Research Foundation, Marylebone, UK
| | | | | | - Jiří Dvořák
- Department of Nerology, University of Zurich, Schulthess Clinic, Swiss Concussion Center, Zurich, Switzerland
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Charles H Tator
- Canadian Concussion Centre, Toronto Western Hospital, University of Toronto, Krembil Neuroscience Centre, Toronto, Canada
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre - Austin Campus, Heidelberg, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston, USA
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LYNALL ROBERTC, CLARK MICHAELD, GRAND ERINE, STUCKER JACLYNC, LITTLETON ASHLEYC, AGUILAR ALAINJ, PETSCHAUER MEREDITHA, TEEL ELIZABETHF, MIHALIK JASONP. Head Impact Biomechanics in Women’s College Soccer. Med Sci Sports Exerc 2016; 48:1772-8. [DOI: 10.1249/mss.0000000000000951] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Di Battista AP, Rhind SG, Richards D, Churchill N, Baker AJ, Hutchison MG. Altered Blood Biomarker Profiles in Athletes with a History of Repetitive Head Impacts. PLoS One 2016; 11:e0159929. [PMID: 27458972 PMCID: PMC4961456 DOI: 10.1371/journal.pone.0159929] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/11/2016] [Indexed: 01/07/2023] Open
Abstract
The long-term health effects of concussion and sub-concussive impacts in sport are unknown. Growing evidence suggests both inflammation and neurodegeneration are pivotal to secondary injury processes and the etiology of neurodegenerative diseases. In the present study we characterized circulating brain injury and inflammatory mediators in healthy male and female athletes according to concussion history and collision sport participation. Eighty-seven university level athletes (male, n = 60; female, n = 27) were recruited before the start of the competitive season. Athletes were healthy at the time of the study (no medications, illness, concussion or musculoskeletal injuries). Dependent variables included 29 inflammatory and 10 neurological injury analytes assessed in the peripheral blood by immunoassay. Biomarkers were statistically evaluated using partial least squares multivariate analysis to identify possible relationships to self-reported previous concussion history, number of previous concussions and collision sport participation in male and female athletes. Multiple concussions were associated with increases in peripheral MCP-1 in females, and MCP-4 in males. Collision sport participation was associated with increases in tau levels in males. These results are consistent with previous experimental and clinical findings that suggest ongoing inflammatory and cerebral injury processes after repetitive mild head trauma. However, further validation is needed to correlate systemic biomarkers to repetitive brain impacts, as opposed to the extracranial effects common to an athletic population such as exercise and muscle damage.
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Affiliation(s)
- Alex P. Di Battista
- Institute of Medical Science, University of Toronto, Toronto ON, Canada
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Shawn G. Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto ON, Canada
| | - Doug Richards
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto ON, Canada
| | - Nathan Churchill
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
| | - Andrew J. Baker
- Institute of Medical Science, University of Toronto, Toronto ON, Canada
- Departments of Critical Care, Anesthesia and Surgery, St. Michael’s Hospital, University of Toronto, Toronto ON, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | - Michael G. Hutchison
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- * E-mail:
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47
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Henry LC, Tremblay S, De Beaumont L. Long-Term Effects of Sports Concussions: Bridging the Neurocognitive Repercussions of the Injury with the Newest Neuroimaging Data. Neuroscientist 2016; 23:567-578. [PMID: 27188455 DOI: 10.1177/1073858416651034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Little is known of the long-term effects of sports-related concussion. Within the scientific literature, conclusions vary substantially where some work suggests there are no long-term consequences at all and other studies show rampant neurodegeneration thought to be caused by sometimes even a single concussive blow to the head. There is growing evidence that supports multiple long-term outcomes, showing both subclinical and clinically relevant changes in the brains of athletes, young and old alike. This article reviews the pathohistology of cerebral concussions and examines the extant literature with a focus on electrophysiological and neuroimaging findings. Neurobehavioral and neurocognitive changes are also reviewed, particularly as they are related to chronic traumatic encephalopathy. Lacunae within the literature are explored, and future research directions are proposed.
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Affiliation(s)
- Luke C Henry
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sebastien Tremblay
- 2 Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Louis De Beaumont
- 3 Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,4 Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
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