Normative values for a video-force plate assessment of postural control in athletic children

Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review

OBJECTIVES

To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6).

DATA SOURCES

Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation.

ELIGIBILITY CRITERIA

(1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC.

DATA EXTRACTION

Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool.

RESULTS

Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children.

CONCLUSION

Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes.

PROSPERO REGISTRATION NUMBER

CRD42020154787.

Quantitative Assessment of Balance for Accurate Prediction of Return to Sport From Sport-Related Concussion

BACKGROUND

Determining when athletes are able to return to sport after sports-related concussion (SRC) can be difficult.

HYPOTHESIS

A multimodal algorithm using cognitive testing, postural stability, and clinical assessment can predict return to sports after SRC.

STUDY DESIGN

Prospective cohort.

LEVEL OF EVIDENCE

Level 2b.

METHODS

Athletes were evaluated within 2 to 3 weeks of SRC. Clinical assessment, Immediate Post Concussion and Cognitive Testing (ImPACT), and postural stability (Equilibrate) were conducted. Resulting data and machine learning techniques were used to optimize an algorithm discriminating between patients ready to return to sports versus those who are not yet recovered. A Fisher discriminant analysis with leave-one-out cross-validation assessed every combination of 2 to 5 factors to optimize the algorithm with lowest combination of type I and type II errors.

RESULTS

A total of 193 athletes returned to contact sports after SRC at a mean 84.6 days (±88.8). Twelve subjects (6.2%) sustained repeat SRC within 12 months after return to sport. The combination of (1) days since injury, (2) total symptom score, and (3) nondominant foot tandem eyes closed postural stability score created the best algorithm for discriminating those ready to return to sports after SRC with lowest type I error (13.85%) and type II error (11.25%). The model was able to discriminate between patients who were ready to successfully return to sports versus those who were not with area under the receiver operating characteristic (ROC) curve of 0.82.

CONCLUSION

The algorithm predicts successful return to sports with an acceptable sensitivity and specificity. Tandem balance with eyes closed measured with a video-force plate discriminated athletes ready to return to sports from SRC when combined in multivariate analysis with symptom score and time since injury. The combination of these factors may pose advantages over computerized neuropsychological testing when evaluating young athletes with SRC for return to contact sports.

CLINICAL RELEVANCE

When assessing young athletes sustaining an SRC in a concussion clinic, measuring postural stability in tandem stance with eyes closed combined with clinical assessment and cognitive recovery is effective to determine who is ready to successfully return to sports.

Reliability of Objective Eye-Tracking Measures Among Healthy Adolescent Athletes

OBJECTIVE

To determine the test-retest correlation of an objective eye-tracking device among uninjured youth athletes.

DESIGN

Repeated-measures study.

SETTING

Sports-medicine clinic.

PARTICIPANTS

Healthy youth athletes (mean age = 14.6 ± 2.2 years; 39% women) completed a brief, automated, and objective eye-tracking assessment.

INDEPENDENT VARIABLES

Participants completed the eye-tracking assessment at 2 different testing sessions.

MAIN OUTCOME MEASURES

During the assessment, participants watched a 220-second video clip while it moved around a computer monitor in a clockwise direction as an eye tracker recorded eye movements. We obtained 13 eye movement outcome variables and assessed correlations between the assessments made at the 2 time points using Spearman's Rho (rs).

RESULTS

Thirty-one participants completed the eye-tracking evaluation at 2 time points [median = 7 (interquartile range = 6-9) days between tests]. No significant differences in outcomes were found between the 2 testing times. Several eye movement variables demonstrated moderate to moderately high test-retest reliability. Combined eye conjugacy metric (BOX score, rs = 0.529, P = 0.008), the variance of the ratio for both eye movements in the horizontal (rs = 0.497, P = 0.013) and vertical (rs = 0.446; P = 0.029) movement planes along the top/bottom of the computer screen, and the variance of the left and right eye movement along the bottom segment of the computer screen (rs = 0.565; P = 0.004) each demonstrated moderate between-test correlations.

CONCLUSIONS

Automated and quantitative eye movement and conjugacy metrics provide relatively stable measurements among a group of healthy youth athletes. Thus, their inclusion as a visual tracking metric may be complementary to other visual examination techniques when monitoring concussion recovery across time.

Objective Eye Tracking Deficits Following Concussion for Youth Seen in a Sports Medicine Setting

Quantification of visual deficits may help to identify dysfunction following concussion. We evaluated eye-tracking measurements among adolescents within 10 days of concussion and healthy control participants. Patients who reported to 2 tertiary care sport concussion clinics within 10 days of concussion completed an objective eye tracking assessment. Seventy-nine participants completed the study, 44 with concussion (mean age = 14.1 ± 2.2 years, 39% female) and 35 controls (mean age = 14.3 ± 2.4 years, 57% female). Right eye skew along the bottom of the screen was significantly higher for the concussion group compared to controls (median = 0.022 [interquartile range = -0.263, 0.482] vs 0.377 [interquartile range = -0.574, -0.031]; P = .002), but not the left eye. Among the variables investigated, right eye skew was altered for adolescents with a concussion. Visual function is an important component in the postconcussion evaluation, and identifying deficits soon after injury may allow for earlier specialist referral and intervention.

Risk factors associated with self-reported injury history in female youth soccer players

BACKGROUND

studies that investigate risk factors for musculoskeletal injuries in female youth athletes are limited, especially related to training attributes and position status.

OBJECTIVE

to determine risk factors including training attributes and position status for a self-reported musculoskeletal injury history in female youth soccer players.

METHODS

we conducted a cross-sectional study of young female soccer players (mean age: 13.6 ± 2.3 years). we asked about their history of musculoskeletal injuries using an electronic questionnaire. the proportion of young female soccer players with and without a history of soccer-related musculoskeletal injuries were compared based on physical characteristics, training attributes, position status (single vs. multiple), lower extremity strength, and joint laxity. a binary logistic regression analysis was used to generate, and adjusted odds ratios adjusted for potential co-variates (aor). a 95% confidence interval (95%ci) that did not cross one or p < 0.05 were considered statistically significant.

RESULTS

a total of 160 young female soccer players (mean age: 13.6 ± 2.3 years) participated in the study. an independent association was found between prior musculoskeletal injuries and older ages (aor: 1.60, 95%ci: 1.17, 2.20, p = 0.004), higher weight (aor: 1.10, 95%ci: 1.01, 1.20, p = 0.026), and greater bmi (aor: 1.43, 95%ci: 1.07, 1.90, p = 0.014).

CONCLUSIONS

musculoskeletal injuries were associated with age, weight, and bmi in female youth players. the current study indicates that maintaining proper body composition may be beneficial to reduce musculoskeletal injuries among female youth soccer players.

Using concurrent gait and cognitive assessments to identify impairments after concussion: a narrative review

Understanding how a concussion affects an individual is oftentimes difficult for clinicians due to the varying symptom profiles reported by the patient and the multifaceted and heterogeneous nature of the injury. Accordingly, the interpretation of postconcussion performance can be challenging, because many different testing paradigms have been reported as potentially useful in the literature. Among the types of tests clinicians use to understand how concussion affects an individual, both gait and neurocognitive evaluations have demonstrated utility. Our purpose is to describe how combined gait and cognitive (i.e., dual task), as well as single-task gait and computerized neurocognitive examinations can assist clinical decision-making.

Range of motion and ankle injury history association with sex in pediatric and adolescent athletes

BACKGROUND

Ankle sprain is one of the most common musculoskeletal injuries among young athletes, and there remains a gap in the literature regarding susceptibility to such injuries among physically active youth.

OBJECTIVE

The primary purpose of this study was to determine the associations between sex, a history of ankle sprain, and ankle range of motion (ROM) in pediatric and adolescent athletes.

METHODS

Athletes under the age of 18 years old who presented to a sports injury prevention center underwent ankle ROM measurements including plantarflexion (PF), inversion (IV), and eversion (EV). A two-way analysis of covariance (ANCOVA) was performed to examine effect of sex and a history of ankle sprain on ROMs. Also, a binary logistic regression was performed to investigate variables that are associated with a history of ankle injury.

RESULTS

Among 452 pediatric and adolescent athletes [268 females (13.6 ± 2.3 years old) and 184 males (13.3 ± 2.5 years old)], 128 reported a history of previous ankle sprain. Females demonstrated significantly increased ROMs (PF and IV bilaterally, and right EV) compared to males while there was no effect of a history of ankle sprain on ROMs. Female sex was independently associated with a history of ankle sprain.

CONCLUSION

There was a strong effect of female sex on ROMs rather than a history of ankle injury history. Additionally, pediatric and adolescent females have greater odds of a history of ankle sprain when compared to their male counterparts.

Physical activity outside of organised sports is associated with functional performance

AIM

The purpose of this study was to determine whether high levels of strenuous physical activity outside of organised sports are associated with better functional test performance.

METHODS

Youth athletes (n = 445, mean = 14.2 ± 2.5 years) reported their frequency of strenuous physical activity outside of organised sports. The functional performance tests: vertical jump height, pro agility test time, estimated maximal oxygen uptake (VO₂ max), front plank time and postural stability were measured and compared between groups.

RESULTS

Athletes in the five or more times a week group demonstrated faster pro agility times (5.37 ± 0.43 seconds) than the never group (5.59 ± 0.56 seconds; p = 0.002) and the 1-4 times a week group (5.52 ± 0.47 seconds; p = 0.005). The five or more times a week group demonstrated higher mean vertical jump height (42.9 ± 13.3 vs. 40.3 ± 10.8 cm; p = 0.009) and higher estimated VO₂ max (48.1 vs. 45.6 mL/kg/minute; p = 0.001) than the 1-4 times a week group.

CONCLUSION

Youth athletes who engaged in strenuous physical activity outside of organised sports five or more times a week performed best on functional performance tests.

Evaluation of postural stability in youth athletes: the relationship between two rating systems

OBJECTIVES

The Balance Error Scoring System (BESS) has been documented as a useful way to evaluate postural control following sport-related concussions sustained by youth athletes. However, limitations have been reported with its use due to the reliance on visual observation as the primary measurement outcome. The primary purpose of this study was to examine the correlation between the modified BESS (mBESS) as rated by a clinician and a simultaneous analysis performed by an integrated video-force plate system. The secondary purpose was to assess if a history of prior concussion affected postural control.

METHODS

A group of healthy youth athletes (n = 398; mean age 13.7 ± 2.4 years) completed the mBESS while simultaneously undergoing an integrated video-force plate evaluation to measure postural stability. Spearman rank-order correlations were used to determine the strength of correlation between the 2 rating systems. In addition, performance on the mBESS between those with and without a history of concussion was compared using univariate ANCOVAs.

RESULTS

A moderately high correlation was found during single-leg stance (ρ = -0.64, p < .001), while a weak correlation was found during tandem stance (ρ = -0.30, p < .001). No postural control differences were found between groups with and without a concussion history.

CONCLUSION

The video-force plate rating system correlates well with the clinician rating during the single-leg stance of the mBESS, but not during double-leg or tandem stances. A history of concussion did not affect mBESS scores.