Do Neurocognitive SCAT3 Baseline Test Scores Differ Between Footballers (Soccer) Living With and Without Disability? A Cross-Sectional Study

Evaluation of the SCAT 5 tool in the assessment of concussion in Para athletes: a Delphi study

OBJECTIVES

To investigate if the sport concussion assessment tool version 5 (SCAT5) could be suitable for application to Para athletes with a visual impairment, a spinal cord injury, or a limb deficiency.

METHODS

A 16-member expert panel performed a Delphi technique protocol. The first round encompassed an open-ended questionnaire, with round 2 onwards being composed of a series of closed-ended statements requiring each expert's opinion using a five-point Likert scale. A predetermined threshold of 66% was used to decide whether agreement had been reached by the panel.

RESULTS

The Delphi study resulted in a four-round process. After round 1, 92 initial statements were constructed with 91 statements obtaining the targeted level of agreement by round 4. The expert panellist completion rate of the full four-round process was 94%. In the case of athletes with a suspected concussion with either limb deficiencies or spinal cord injuries, the panel agreed that a baseline assessment would be needed on record is ideal before a modified SCAT5 assessment. With respect to visual impairments, it was conceded that some tests were either difficult, infeasible or should be omitted entirely depending on the type of visual impairment.

CONCLUSION

It is proposed that the SCAT5 could be conducted on athletes with limb deficiencies or spinal cord injuries with some minor modifications and by establishing a baseline assessment to form a comparison. However, it cannot be recommended for athletes with visual impairment in its current form. Further research is needed to determine how potential concussions could be more effectively evaluated in athletes with different impairments.

Head Impact in Blind Football During the Tokyo Paralympics: Video-Based Observational Study

ABSTRACT

Head impacts during blind football are common and have high injury rates; however, their characteristics and impact are still underreported. We compared head impact characteristics in blind football players with and without falls on all 18 official blind football match videos from the Tokyo 2020 Paralympic games. The rate of head impacts with falls was significantly higher in the preliminary phase, offense phase, and during dribbling. Significant differences in the region of the head impacted were also observed among the impact subjects/objects. The findings in this study would contribute to the development of injury prevention measures to minimize head injuries from head impact in blind football.

King-Devick Test in Wheelchair Sports: Identifying Normative Values and Effects of Exertion on Outcomes

OBJECTIVE

To establish normative baseline values on the King-Devick (KD) Test for contact wheelchair sport participants. The secondary purpose was to examine the effect of physical exertion on test score.

DESIGN

Quasiexperimental.

SETTING

Competitive disability sport venues before practices or games.

PARTICIPANTS

One-hundred 43 wheelchair rugby or wheelchair basketball (WBB) players completed the study. Participants were predominantly men (87.5%) and played WBB (84%).

INTERVENTION

30-m wheelchair sprint test to fatigue.

MAIN OUTCOME MEASURE

King-Devick Baseline Score.

RESULTS

Mean KD baseline score was 59.16 ± 15.56 seconds with significant differences ( P < 0.05) identified by sport and impairment type, but not sex. Athletes with spina bifida and cerebral palsy had significantly higher mean baseline KD times than athletes with spinal cord injury. KD scores improved by 3.5% in athletes who reported "light" to "somewhat hard" exertion (RPE = 13). In a subset of athletes who performed sprints until an RPE of 18 was reached, 8 of 12 players (66.7%) demonstrated an improvement in KD score; however, large increases by a few participants caused the noticeable change.

CONCLUSIONS

Normative values for wheelchair contact sport athletes are meaningfully slower than able-bodied sports participants. KD score improved with exertion with the greater improvement after moderate-intensity compared with vigorous-intensity exercise. These findings can be applied clinically to monitor athlete safety.

Comparing dynamic visual acuity between athletes who are deaf or hard-of-hearing and athletes who are hearing

This study examined the difference in the dynamic visual acuity test (DVAT) between collegiate athletes who are deaf or hard-of-hearing (D/HoH) (n = 38) and university club-level athletes who are hearing (n = 38). Dynamic visual acuity was assessed using the Bertec Vision Advantage (Bertec® Corporation, Columbus, Ohio, USA). No statistically significant differences between athletes who are D/HoH and who are hearing were found in DVAT for leftward (χ2 = 0.71, p = 0.40) or rightward (χ2 = 0.04, p = 0.84) head yaw rotation around an earth vertical axis. Dynamic visual acuity was similar for athletes regardless of hearing status. Baseline DVAT data may be of use for post-injury management of athletes who are D/HoH.

Concussion through my eyes: a qualitative study exploring concussion experiences and perceptions of male English blind footballers

OBJECTIVES

Athletes with impairments play sports with a risk of sustaining head injuries and concussions. However, the scientific knowledge needed to improve care is lacking. This qualitative study explores English blind 5-a-side footballers' perceptions of concussion, concussion risks and prevention to improve para concussion care.

METHODS

Nine semi-structured interviews were conducted with male English blind footballers (six current and three retired). Data were analysed by thematic analysis using a six-stage approach.

RESULTS

Blind footballers were not sure about the number of concussions they had sustained. They lacked an understanding of what to experience when concussed, and they perceived the diagnosis and experience of a concussion to be different for a person without vision. Perceived concussion severity and previous concussion experiences were key concepts affecting their concussion reporting behaviours. Participants mentioned spatial orientation and sleep are important to function in daily life and were affected by concussions. However, these factors are not adequately included in current assessment tools or clinical guidance for sports-related concussions.

CONCLUSION

Blind footballers suggested the quality and accuracy of reported concussions were impacted by lack of concussion experience, knowledge and concomitant impairment. A better understanding of concussion symptoms and injury mechanisms will improve concussion reporting for athletes with visual impairments. These athlete insights should guide future studies and para sports governing body initiatives to improve concussion reporting, diagnosis and management in para athletes.

Is the King-Devick Test a Reliable Tool in Wheelchair Athletes? A Preliminary Prospective Study in Wheelchair Basketball

OBJECTIVE

(1) To determine the reliability of the King-Devick (KD) test among wheelchair basketball athletes across a season and (2) to compare the KD test time changes among those with and without a clinically suspected concussion.

DESIGN

Prospective, observational study.

SETTING

Division 3 college athletics department.

PARTICIPANTS

Twenty-nine intercollegiate wheelchair basketball athletes.

INTERVENTIONS

Athletes were prospectively monitored for concussions throughout the 2018 to 2019 season. King-Devick testing was completed preseason, midseason, postseason, and after clinically suspected concussions.

MAIN OUTCOME MEASURES

Two-way random effects intraclass correlation coefficient (ICC) was calculated. Friedman's test and pairwise comparison with Bonferroni correction were used to compare for change over time. Mean KD times and changes were compared between athletes with and without suspected concussion.

RESULTS

The KD test demonstrated good test-retest reliability (ICC = 0.826). Among participants without a concussion, there was a significant decrease in the mean KD test time from preseason to midseason (-3.3 seconds; P = 0.0167) and preseason to postseason (-3.3 seconds; P = 0.0167). No change was seen from mid-to-post season. Six athletes had 7 suspected concussions. Each demonstrated an increase in the KD test time, with a mean increase from 44.3 ± 9.5 seconds to 53.7 ± 12.8 seconds. King-Devick test times returned to or below baseline by postseason.

CONCLUSIONS

The KD test shows good reliability among wheelchair basketball athletes without a concussion. A learning effect is demonstrated initially but plateaus on subsequent testing. Unlike athletes without a concussion, players with a clinically suspected concussion showed an increase in the KD test time.

Neurodevelopmental Disorders and Risk of Concussion: Findings from the National Collegiate Athletic Association Department of Defense Grand Alliance Concussion Assessment, Research, and Education (NCAA-DOD CARE) Consortium (2014-2017)

Evidence suggests neurodevelopmental disorders (NDs) may be associated with an increased incidence of concussion, but no studies have cross-sectionally and longitudinally assessed the associations of NDs and sex with concussion in collegiate athletes. We sought to assess the odds and relative risk (RR) of concussion in athletes self-reporting a diagnosis of attention deficit/hyperactivity disorder (ADHD), learning disability (LD), and ADHD+LD. Data from the Concussion Assessment, Research and Education (CARE) Consortium (2014-2017) were used to evaluate the likelihood of concussion for male and female athletes with ADHD, LD, and ADHD+LD, relative to controls. Odds ratios (ORs) of concussion history prior to enrollment and relative risk ratios for incurring a concussion following enrollment, with and without concussion history were calculated for all groups. Athletes with self-reported diagnosis of ADHD, LD, and ADHD+LD were more likely to report a single concussion (OR range = 1.528 to 1.828) and multiple concussions (OR range = 1.849 to 2.365) prior to enrollment in the CARE Consortium, irrespective of sex compared with control athletes. While enrolled in CARE, male athletes with ADHD, LD, and ADHD+LD had greater risk of incurring a concussion (RR range = 1.369 to 2.243) than controls, irrespective of concussion history. Male athletes with ADHD+LD with concussion history (RR = 2.221) and without concussion history (RR = 1.835) had greater risk of incurring a concussion than controls. These results suggest NDs may be associated with increased odds of single and multiple concussions, irrespective of sex. However, when we accounted for concussion history, it appears only male athletes with ADHD+LD had greater risk than respective controls. There were no significant differences between females and males with ADHD, LD, or ADHD+LD for either odds of concussion history or risk for incurring concussion.

Adaptive Cycling: Injuries and Health Concerns

Para-cycling has high rates of acute injuries. The underlying medical conditions of para-athletes predispose these cyclists to injury patterns and sequelae different from those of their able-bodied counterparts. Such injuries include an increased incidence of upper-extremity and soft tissue injuries, along with predisposition for respiratory, skin, genitourinary, and heat-related illnesses. There are no validated sideline assessment tools or return-to-play protocols for sports-related concussion in wheelchair user para-athletes or those with balance deficits. Para-cyclists may be at increased risk for relative energy deficiency in sport due to competitive pressure to maintain certain weights and increased incidence of low bone mineral density.

Para sport translation of the IOC consensus on recording and reporting of data for injury and illness in sport

In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.

Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group

Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.

Exploring Baseline Concussion-Assessment Performance in Adapted Wheelchair Sport Athletes

CONTEXT

With growing awareness of and advocacy for including individuals with disabilities in sport, implementation of concussion-assessment and -management strategies is warranted. Limited research is available on concussion assessment in adapted wheelchair sport athletes.

OBJECTIVE

To examine baseline symptom reporting, computerized neurocognitive testing, and a modified balance scoring system in adapted athletes. A secondary objective was to provide preliminary normative data for this population.

DESIGN

Cross-sectional study.

SETTING

University athletic training room and computer laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty-one athletes (age = 22.1 ± 3.0 years) from 1 institution's collegiate adapted athletics program.

MAIN OUTCOME MEASURE(S)

Athletes completed baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the Wheelchair Error Scoring System (WESS) before the start of their respective seasons. Symptom reporting variables consisted of total symptoms, symptom severity scores, and baseline symptom factors (eg, vestibular-somatic, sleep arousal, cognitive-sensory, and affective). We analyzed ImPACT composite scores of verbal memory, visual memory, visual motor processing speed, and reaction time and impulse control to determine neurocognitive function. Balance performance was quantified using the WESS condition and overall errors.

RESULTS

Compared with normative reference values, 17 (81%) of adapted athletes reported greater symptoms and 20 (95%) performed at or below average on at least 1 neurocognitive composite score. Mean errors on the WESS were 3.14 ± 2.9, with 81% committing ≥1 error. Sex differences were not present for symptoms, neurocognitive testing, or balance measures.

CONCLUSIONS

Our findings provide context for baseline performance in adapted athletes and help to further develop the WESS as an assessment of balance in these athletes.

Influence of Musculoskeletal System Dysfunction Degree on Psychophysiological Indicators of Paralympic Athletes

The purpose of the work was to identify the influence of functional class and degree of damage to extremities on psychophysiological indicators of Paralympians. The study involved 33 elite athletes with musculoskeletal system disorders of the 6 (n = 15) and 10 (n = 18) functional classes in table tennis, aged 21–25 years old. Parameters characteristic for determining the psychophysiological state and typological characteristics of the nervous system were analyzed with the help of computer programs for psychophysiological testing. We determined the latent time of simple and complex reactions in different testing modes. Dispersion analysis was also used. We applied single-factor multidimensional dispersion analysis: one-way analysis of variance and General Linear Model, Multivariate. The indicators of psychophysiological testing were applied as dependent variables. The values of the functional class of athletes were used as the independent variable. To study the influence of damage degree of the upper or lower extremities on psychophysiological indicators, the extremities damage degree was applied as an independent variable. The time in the Paralympic 6 functional class to reach the minimum signal exposure in feedback mode was significantly longer compared with the 10 Paralympic functional class (p < 0.05). Comparing psychophysiological indicators when Paralympians are divided into groups more differentiated than functional classes (that is, according to the nature of the disease or the degree of limb lesions), significant differences were found in all psychophysiological indicators between the athletes of different groups. The greatest impact on psychophysiological indicators was a lesion of the lower extremities. The training of Paralympians in table tennis should consider the reaction rate indicators. In addition, when improving the functional classification of Paralympians in table tennis, a more differentiated approach should be taken when considering their capabilities, including psychophysiological indicators. During training and functional classification of Paralympic athletes in table tennis, it is important to consider their functional class as well as the degree of damage to upper and lower extremities and the level of psychophysiological functioning.

Особенности психофизиологических функций элитных атлетов – паралимпийцев (на примере фехтования и настольного тенниса)

Цель работы – выявить особенности психофизиологических показателей у атлетов-паралимпийцев по сравнению с атлетами – олимпийцами и влияние особенностей поражения верхних и нижних конечностей на психофизиологические показатели. Материал и методы. В исследовании приняли участие 15 элитных фехтовальщиков, выступающих в олимпийском спорте, 15 элитных фехтовальщиков – паралимпийцев; 33 элитных спортсмена с нарушениями опорно-двигательного аппарата шестого (15 человек) и десятого (18 человек) функциональных классов в настольном теннисе, возраст 21-25 лет. Параметры, характерные для определения психофизиологического состояния определялись с помощью компьютерных программ для психофизиологического тестирования. Также был использован дисперсионый анализ. Определено влияние функционального класса спортсменов на скорость реакции в различных режимах испытаний. Результаты. Были выявлены достоверные различия между фехтовальщиками-олимпийцами и фехтовальщиками - паралимпийцами по показателю «Минимальное время экспозиции сигнала в тесте с обратной связью» (p<0,05) и по времени сложной реакции при выборе 1 объекта из 3-х.; у фехтовальщиков-олимпийцев эти показатели достоверно выше по сравнению с паралимпийцами. Показано, что принадлежность к определенному функциональному классу атлетов – паралимпийцев в настольном теннисе влияет на показатель стабильност скорости реакции и на показатель времени выхода на минимальную экспозицию сигнала в тесте на скорость реакции выбора с обратной связью. Скорость реагирования на визуальный сигнал, количество ошибок при прохождении теста на скорость реакции, подвижность нервных процессов у атлетов – паралимпийцев в настольном теннисе достоверно зависит от степени поражения верхних и нижних конечностей. Наихудшие результаты по психофизиологическим показателям были выявлены у атлетов с нарушениями работы обеих нижних конечностей. Меньшее влияние на психофизиологические функции оказывает одностороннее поражение конечностей и врожденное недоразвитие конечностей. Выводы. При подготовке паралимпийцев – фехтовальщиков и проведении соревнований необходимо учитывать не только физические, но и психофизиологические особенности фехтовальщиков – паралимпийцев. При подготовке и функциональной классификации атлетов – паралимпийцев в настольном теннисе важно учитывать не только их принадлежность к определенному функциональному классу, но и степень нарушений работы верхних и нижних конечностей и уровень психофизиологических функций.