Concussion Epidemiology in Athletes Who Are Deaf or Hard-of-Hearing Compared With Athletes Who Are Hearing

Sport-Related Concussion in Para Athletes: A Scoping Review of Concussion Incidence, Assessment, and Management

ABSTRACT

Although research on sport-related concussion has grown substantially in the last decade, research on concussion in para sports remains limited. The aim of this scoping review is to synthesize and describe the current literature on the incidence, assessment, and management of sport-related concussion in para athletes. The literature search was conducted in CINAHL, Google Scholar, MEDLINE, SPORTDiscus, and Web of Science databases and identified 22 studies that addressed one of our research questions. A majority of studies addressed concussion in elite athletes; youth and collegiate para athletes were largely underrepresented. Fewer studies addressed concussion assessment and management, in part due to limitations in accessibility of current assessment tools for athletes with varying disabilities. Moving forward, there is a need to capture a larger range of incidence data, create modified assessment tools with para-specific normative data, and develop risk prevention strategies for para athletes.

Sports-Related Health Problems in Para-Sports: A Systematic Review With Quality Assessment

CONTEXT

Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports.

OBJECTIVE

To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention.

DATA SOURCES

A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist.

STUDY SELECTION

The search yielded 3006 articles, of which 64 met all inclusion criteria.

STUDY DESIGN

Systematic review with quality assessment.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence.

RESULTS

A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days).

CONCLUSION

This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse.

Effect of Hearing Status on Concussion Knowledge and Attitudes of Collegiate Athletes

CONTEXT

Collegiate athletes who are deaf or hard-of-hearing (D/HoH) are diagnosed with concussions at a similar rate as athletes who are hearing; however, little evidence exists on knowledge and attitudes of athletes who are D/HoH toward concussions. This study aimed to examine differences in knowledge of and attitudes toward concussions between athletes who are D/HoH and athletes who are hearing.

DESIGN

Cross-sectional research design.

METHODS

Of the 310 athletes who are D/HoH and 430 athletes who are hearing that were invited to participate, 90 athletes who are D/HoH, and 72 athletes who are hearing completed the survey. The Rosenbaum Concussion Knowledge and Attitudes Survey was used to quantify knowledge of and attitude toward concussions. The Rosenbaum Concussion Knowledge and Attitudes Survey consists of the concussion knowledge index (CKI) and the concussion attitudes index (CAI) subscales. Linear regressions were run to test the association of hearing status with CKI and CAI scores. Pearson correlations were performed to determine relationships between CKI and CAI for athletes who are D/HoH and athletes who are hearing. Alpha level was set a priori at P ≤ .05.

RESULTS

Athletes who are hearing demonstrated a higher CKI component score (19.58 [2.19]) compared to athletes who are D/HoH (16.14 [3.31]; P < .001). There were no statistical differences in CAI between hearing groups (hearing: 57.18 [8.73], D/HoH: 55.97 [9.92]; P = .41). There was a moderate positive correlation between CKI and CAI (r = .58) for athletes who are D/HoH, while a weak positive correlation (r = .30) for athletes who are hearing was observed.

CONCLUSIONS

Athletes who are D/HoH have poorer knowledge of concussions but similar attitudes toward concussion as that of athletes who are hearing. Current concussion educational interventions are in written or spoken form which may not be inclusive to athletes who are D/HoH. Health care professionals should consider an athlete's preferred communication mode to improve the efficiency and effectiveness of education.

Hearing Status and Static Postural Control of Collegiate Athletes

CONTEXT

Because of the close proximity of the cochlea, vestibular apparatus, and shared neurovascular structures, the static postural control of athletes who are deaf or hard of hearing (D/HoH) may be different from that of athletes who are hearing. Limited research is available to quantify differences between these athletes.

OBJECTIVE

To determine the effect of hearing status and stance condition on the static postural control of athletes.

DESIGN

Cross-sectional study.

SETTING

Athletic training facilities.

PATIENTS OR OTHER PARTICIPANTS

Fifty-five collegiate varsity athletes who were D/HoH (age = 20.62 ± 1.80 years, height = 1.73 ± 0.08 m, mass = 80.34 ± 18.92 kg) and 100 university club athletes who were hearing (age = 20.11 ± 1.59 years, height = 1.76 ± 0.09 m, mass = 77.66 ± 14.37 kg).

MAIN OUTCOME MEASURE(S)

Participants completed the Modified Clinical Test of Sensory Interaction and Balance on a triaxial force plate. Anteroposterior and mediolateral (ML) center-of-pressure (CoP) velocity, anteroposterior and ML CoP amplitude root mean square, and 95% ellipse sway area were calculated.

RESULTS

Athletes who were D/HoH had a larger CoP velocity, larger ML root mean square, and larger sway area than those who were hearing (P values < .01). A significant main effect of stance condition was observed for all postural control variables (P values < .01).

CONCLUSIONS

During the Modified Clinical Test of Sensory Interaction and Balance, athletes who were D/HoH demonstrated a larger sway area compared with athletes who were hearing. Therefore, individualized baseline assessments of static postural control may be warranted for athletes who are D/HoH as opposed to comparisons with existing normative data.

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.