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Robertson D, Lempke LB, Lynall RC. Analyzing Dual-Task Paradigms to Improve Postconcussion Assessment and Management. J Sport Rehabil 2024; 33:356-364. [PMID: 38897580 DOI: 10.1123/jsr.2023-0292] [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: 09/06/2023] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 06/21/2024]
Abstract
CONTEXT Dual-task (simultaneous cognitive-motor activities) assessments have been adapted into reliable and valid clinical concussion measures. However, abundant motor and cognitive variations leave researchers and clinicians uncertain about which combinations elicit the intended dual-task effect. Our objective was to examine differences between commonly employed dual-task motor and cognitive combinations among healthy, college-aged individuals. DESIGN Cross-sectional laboratory study. METHODS Twenty participants (age: 21.3 [2.4] y; height: 176.0 [9.1] cm; mass: 76.0 [16.4] kg; 20% with concussion history) completed 4 motor tasks (gait, tandem gait, single-leg balance, and tandem balance) under 5 cognitive conditions (single task, subtraction, month reversal, spelling backward, and visual Stroop) in a research laboratory. The motor performance outcomes were spatiotemporal variables for gait and tandem gait and center of pressure path length (in centimeters) for single-leg and tandem balance. Cognitive outcomes were response rate (responses/second) and cognitive accuracy. We used separate repeated-measures analyses of variance for each motor and cognitive outcome with post hoc Tukey t tests. RESULTS Gait velocity, gait stride length, and tandem gait velocity demonstrated significant cognitive-motor interactions (P's < .001) such that all dual-task conditions resulted in varyingly slower or shorter movement than single task. Conversely, single-leg balance (P = .627) and tandem balance (P = .434) center of pressure path length did not significantly differ among the dual-task cognitive conditions or relative to single task. Statistically significant cognitive-motor interactions were observed only for spelling backward accuracy (P = .004) and response rates for spelling backward, month reversal, and visual Stroop (P's < .001) such that worse accuracy, but faster response rates, occurred during motor tasks. CONCLUSIONS Gait and tandem gait motor tasks accompanied with spelling backward or subtraction cognitive tasks demonstrated consistently strong dual-task effects and, therefore, may be the best suited for clinical and research use following concussion.
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Affiliation(s)
- Diana Robertson
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Landon B Lempke
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
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Shumski EJ, Schmidt JD, Lynall RC. Cognition Uniquely Influences Dual-Task Tandem Gait Performance Among Athletes With a Concussion History. Sports Health 2024; 16:542-550. [PMID: 37377161 DOI: 10.1177/19417381231183413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND After a concussion, there are unique associations between static balance and landing with cognition. Previous research has explored these unique correlations, but the factor of time, dual-task, and different motor tasks leave gaps within the literature. The purpose of this study was to determine the associations between cognition and tandem gait performance. HYPOTHESIS We hypothesized that athletes with a concussion history would display stronger associations compared with athletes without a concussion history between cognition and tandem gait. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 3. METHODS A total of 126 athletes without (56.3% female; age, 18.8 ± 1.3 years; height, 176.7 ± 12.3 cm; mass, 74.8 ± 19.0 kg) and 42 athletes with (40.5% female; age, 18.8 ± 1.3 years; height, 179.3 ± 11.9 cm; mass, 81.0 ± 25.1 kg) concussion history participated. Cognitive performance was assessed with CNS Vital Signs. Tandem gait was performed on a 3-meter walkway. Dual-task tandem gait included a concurrent cognitive task of serial subtraction, reciting months backward, or spelling words backward. RESULTS Athletes with a concussion history exhibited a larger number of significant correlations compared with athletes without a concussion history for cognition and dual-task gait time (4 significant correlations: rho-range, -0.377 to 0.358 vs 2 significant correlations: rho, -0.233 to 0.179) and dual-task cost gait time (4 correlations: rho range, -0.344 to 0.392 vs 1 correlation: rho, -0.315). The time between concussion and testing did significantly moderate any associations (P = 0.11-0.63). Athletes with a concussion history displayed better dual-task cost response rate (P = 0.01). There were no other group differences for any cognitive (P = 0.13-0.97) or tandem gait (P = 0.20-0.92) outcomes. CONCLUSION Athletes with a concussion history display unique correlations between tandem gait and cognition. These correlations are unaffected by the time since concussion. CLINICAL RELEVANCE These unique correlations may represent shared neural resources between cognition and movement that are only present for athletes with a concussion history. Time does not influence these outcomes, indicating the moderating effect of concussion on the correlations persists long-term after the initial injury.
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Affiliation(s)
- Eric J Shumski
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
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3
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Martini DN, Mancini M, Antonellis P, McDonnell P, Vitorio R, Stuart S, King LA. Prefrontal Cortex Activity During Gait in People With Persistent Symptoms After Concussion. Neurorehabil Neural Repair 2024:15459683241240423. [PMID: 38506532 DOI: 10.1177/15459683241240423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Concussions result in transient symptoms stemming from a cortical metabolic energy crisis. Though this metabolic energy crisis typically resolves in a month, symptoms can persist for years. The symptomatic period is associated with gait dysfunction, the cortical underpinnings of which are poorly understood. Quantifying prefrontal cortex (PFC) activity during gait may provide insight into post-concussion gait dysfunction. The purpose of this study was to explore the effects of persisting concussion symptoms on PFC activity during gait. We hypothesized that adults with persisting concussion symptoms would have greater PFC activity during gait than controls. Within the concussed group, we hypothesized that worse symptoms would relate to increased PFC activity during gait, and that increased PFC activity would relate to worse gait characteristics. METHODS The Neurobehavior Symptom Inventory (NSI) characterized concussion symptoms. Functional near-infrared spectroscopy quantified PFC activity (relative concentration changes of oxygenated hemoglobin [HbO2]) in 14 people with a concussion and 25 controls. Gait was assessed using six inertial sensors in the concussion group. RESULTS Average NSI total score was 26.4 (13.2). HbO2 was significantly higher (P = .007) for the concussed group (0.058 [0.108]) compared to the control group (-0.016 [0.057]). Within the concussion group, HbO2 correlated with NSI total symptom score (ρ = .62; P = .02), sagittal range of motion (r = .79; P = .001), and stride time variability (r = -.54; P = .046). CONCLUSION These data suggest PFC activity relates to symptom severity and some gait characteristics in people with persistent concussion symptoms. Identifying the neurophysiological underpinnings to gait deficits post-concussion expands our knowledge of motor behavior deficits in people with persistent concussion symptoms.
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Affiliation(s)
- Douglas N Martini
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Paul McDonnell
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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4
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Barnes A, Smulligan K, Wingerson MJ, Little C, Lugade V, Wilson JC, Howell DR. A Multifaceted Approach to Interpreting Reaction Time Deficits After Adolescent Concussion. J Athl Train 2024; 59:145-152. [PMID: 36701688 PMCID: PMC10895397 DOI: 10.4085/1062-6050-0566.22] [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: 01/27/2023]
Abstract
CONTEXT Reaction time (RT) is a critical element of return to participation (RTP), and impairments have been linked to subsequent injury after a concussion. Current RT assessments have limitations in clinical feasibility and in the identification of subtle deficits after concussion symptom resolution. OBJECTIVES To examine the utility of RT measurements (clinical drop stick, simple stimulus-response, single-task Stroop, and dual-task Stroop) to differentiate between adolescents with concussion and uninjured control individuals at initial assessment and RTP. DESIGN Prospective cohort study. SETTING A pediatric sports medicine center associated with a regional tertiary care hospital. PATIENTS OR OTHER PARTICIPANTS Twenty-seven adolescents with a concussion (mean age = 14.8 ± 2.1 years; 52% female; tested 7.0 ± 3.3 days postconcussion) and 21 uninjured control individuals (mean age = 15.5 ± 1.6 years; 48% female). MAIN OUTCOME MEASURE(S) Participants completed the Post-Concussion Symptoms Inventory (PCSI) and a battery of RT tests: clinical drop stick, simple stimulus-response, single-task Stroop, and dual-task Stroop. RESULTS The concussion group demonstrated slower clinical drop stick (β = 58.8; 95% CI = 29.2, 88.3; P < .001) and dual-task Stroop (β = 464.2; 95% CI = 318.4, 610.0; P < .001) RT measures at the initial assessment than the uninjured control group. At 1-month follow up, the concussion group displayed slower clinical drop stick (238.9 ± 25.9 versus 188.1 ± 21.7 milliseconds; P < .001; d = 2.10), single-task Stroop (1527.8 ± 204.5 versus 1319.8 ± 133.5 milliseconds; P = .001; d = 1.20), and dual-task Stroop (1549.9 ± 264.7 versus 1341.5 ± 114.7 milliseconds; P = .002; d = 1.04) RT than the control group, respectively, while symptom severity was similar between groups (7.4 ± 11.2 versus 5.3 ± 6.5; P = .44; d = 0.24). Classification accuracy and area under the curve (AUC) values were highest for the clinical drop stick (85.1% accuracy, AUC = 0.86, P < .001) and dual-task Stroop (87.2% accuracy, AUC = 0.92, P < .002) RT variables at initial evaluation. CONCLUSIONS Adolescents recovering from concussion may have initial RT deficits that persist despite symptom recovery. The clinical drop stick and dual-task Stroop RT measures demonstrated high clinical utility given high classification accuracy, sensitivity, and specificity to detect postconcussion RT deficits and may be considered for initial and RTP assessment.
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Affiliation(s)
- Alice Barnes
- Sports Medicine Center, Children's Hospital Colorado, Aurora
| | - Katherine Smulligan
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
| | - Mathew J Wingerson
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
| | - Casey Little
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
| | - Vipul Lugade
- Division of Physical Therapy, Binghamton University, NY
- Control One LLC, Atlanta, GA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
- Departments of Pediatrics, University of Colorado School of Medicine, Aurora
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
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Chou TY, Huang YL, Leung W, Brown CN, Kaminski TW, Norcross MF. Does prior concussion lead to biomechanical alterations associated with lateral ankle sprain and anterior cruciate ligament injury? A systematic review and meta-analysis. Br J Sports Med 2023; 57:1509-1515. [PMID: 37648411 DOI: 10.1136/bjsports-2023-106980] [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: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To determine whether individuals with a prior concussion exhibit biomechanical alterations in balance, gait and jump-landing tasks with and without cognitive demands that are associated with risk of lateral ankle sprain (LAS) and anterior cruciate ligament (ACL) injury. DESIGN Systematic review and meta-analysis. DATA SOURCES Five electronic databases (Web of Science, Scopus, PubMed, SPORTDiscus and CiNAHL) were searched in April 2023. ELIGIBILITY CRITERIA Included studies involved (1) concussed participants, (2) outcome measures of spatiotemporal, kinematic or kinetic data and (3) a comparison or the data necessary to compare biomechanical variables between individuals with and without concussion history or before and after a concussion. RESULTS Twenty-seven studies were included involving 1544 participants (concussion group (n=757); non-concussion group (n=787)). Individuals with a recent concussion history (within 2 months) had decreased postural stability (g=0.34, 95% CI 0.20 to 0.49, p<0.001) and slower locomotion-related performance (g=0.26, 95% CI 0.11 to 0.41, p<0.001), both of which are associated with LAS injury risk. Furthermore, alterations in frontal plane kinetics (g=0.41, 95% CI 0.03 to 0.79, p=0.033) and sagittal plane kinematics (g=0.30, 95% CI 0.11 to 0.50, p=0.002) were observed in individuals approximately 2 years following concussion, both of which are associated with ACL injury risk. The moderator analyses indicated cognitive demands (ie, working memory, inhibitory control tasks) affected frontal plane kinematics (p=0.009), but not sagittal plane kinematics and locomotion-related performance, between the concussion and non-concussion groups. CONCLUSION Following a recent concussion, individuals display decreased postural stability and slower locomotion-related performance, both of which are associated with LAS injury risk. Moreover, individuals within 2 years following a concussion also adopt a more erect landing posture with greater knee internal adduction moment, both of which are associated with ACL injury risk. While adding cognitive demands to jump-landing tasks affected frontal plane kinematics during landing, the altered movement patterns in locomotion and sagittal plane kinematics postconcussion persisted regardless of additional cognitive demands. PROSPERO REGISTRATION NUMBER CRD42021248916.
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Affiliation(s)
- Tsung-Yeh Chou
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Yu-Lun Huang
- Department of Physical Education and Sport, National Taiwan Normal University, Taipei, Taiwan
| | - Willie Leung
- Department of Health Sciences and Human Performance, The University of Tampa, Tampa, Florida, USA
| | - Cathleen N Brown
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Marc F Norcross
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
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Willwerth SB, Lempke LB, Lugade V, Meehan WP, Howell DR, DeJong Lempke AF. Ankle Sprain History Does Not Significantly Alter Single- and Dual-Task Spatiotemporal Gait Mechanics. J Sport Rehabil 2023; 32:903-909. [PMID: 37758257 DOI: 10.1123/jsr.2022-0445] [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: 12/16/2022] [Revised: 07/06/2023] [Accepted: 07/27/2023] [Indexed: 10/03/2023]
Abstract
CONTEXT Single- and dual-task walking gait assessments have been used to identify persistent movement and cognitive dysfunction among athletes with concussions. However, it is unclear whether previous ankle sprain injuries confound these outcomes during baseline testing. The purpose of this study was to determine the effects of (1) ankle sprain history and (2) time since prior ankle sprain injury on single- and dual-task spatiotemporal gait outcomes and cognitive measures. DESIGN Cross-sectional study. METHODS We assessed 60 college Division-I athletes (31 with ankle sprain history; 13 females and 18 males, 19.3 [0.8] y; 29 with no ankle sprain history, 14 females and 15 males, 19.7 [0.9] y) who completed injury history forms and underwent concussion baseline testing. Athletes completed single- and dual-task gait assessments by walking back and forth along an 8-m walkway for 40 seconds. Athletes wore a smartphone with an associated mobile application on their lumbar spine to record spatiotemporal gait parameters and dual-task cognitive performance. Separate multivariate analyses of variance were used to assess the effects of ankle sprain injury history on spatiotemporal measures, gait variability, and cognitive performance. We performed a multivariate regression subanalysis on athletes who reported time since injury (n = 23) to assess temporal effects on gait and cognitive performance. RESULTS Athletes with and without a history of ankle sprains had comparable spatiotemporal and gait variability outcomes during single- (P = .42; P = .13) and dual-task (P = .75; P = .55) conditions. Additionally, ankle sprain injury history did not significantly influence cognitive performance (P = .35). Finally, time since ankle sprain did not significantly affect single- (P = .75) and dual-task gait (P = .69), nor cognitive performance (P = .19). CONCLUSIONS Ankle sprain injury history did not significantly alter spatiotemporal gait outcomes nor cognitive performance during this common clinical assessment. Future studies may consider including athletes with ankle sprain injury history during concussion assessments.
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Affiliation(s)
- Sarah B Willwerth
- Micheli Center for Sports Injury Prevention, Waltham, MA,USA
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, Boston, MA,USA
| | - Landon B Lempke
- School of Kinesiology, University of Michigan, Ann Arbor, MI,USA
| | - Vipul Lugade
- Division of Physical Therapy, Binghamton University, Binghamton, NY,USA
| | - William P Meehan
- Micheli Center for Sports Injury Prevention, Waltham, MA,USA
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, Boston, MA,USA
- Harvard Medical School, Harvard, MA,USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO,USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO,USA
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7
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Hou X, Zhang Y, Fei X, Zhou Q, Li J. Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3604-3618. [PMID: 36799499 DOI: 10.1177/03635465221142855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents. PURPOSE To rigorously examine adolescents' cognitive function after SRC. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted. RESULTS A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: d = -0.21, 95% CI, -0.37 to -0.05, P = .012; executive function: d = -0.56, 95% CI, -1.07 to -0.06, P = .028; and symptoms: d = 1.17, 95% CI, 0.13 to 2.22, P = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory (d = 0.10; 95% CI, 0.03 to 0.17; P = .008) and processing speed (d = 0.17; 95% CI, 0.10 to 0.24; P < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, P < .001; 99.94% of the variance in verbal memory, P < .001; 99.88% of the variance in visual memory, P < .001; 39.84% of the variance in symptoms, P = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC. CONCLUSION This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.
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Affiliation(s)
- Xianyun Hou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yu Zhang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xueyin Fei
- Sport Science School, Beijing Sport University, Beijing, China
| | - Qian Zhou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jie Li
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
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8
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Lempke LB, Shumski EJ, Prato TA, Lynall RC. Reliability and Minimal Detectable Change of the Standardized Assessment of Reaction Time. J Athl Train 2023; 58:579-587. [PMID: 36252207 PMCID: PMC10496444 DOI: 10.4085/1062-6050-0391.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Postconcussion reaction time deficits are common, but existing assessments lack sport-related applicability. We developed the Standardized Assessment of Reaction Time (StART) tool to emulate the simultaneous cognitive and motor function demands in sport, but its reliability is unestablished. OBJECTIVES To determine the intrarater, interrater, and test-retest reliability of StART and to examine the dual-task effect, time effect, and relationships between StART and computerized and laboratory-based functional reaction time assessments. DESIGN Prospective cohort study. SETTING Clinical laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty healthy, physically active individuals (age = 20.3 ± 1.8 years, females = 12, no concussion history = 75%). MAIN OUTCOME MEASURE(S) Participants completed the StART, computerized reaction time (Stroop task via CNS Vital Signs), and laboratory-based jump landing and cutting reaction time under single-task and dual-task (subtracting by 6s or 7s) cognitive conditions at 2 testing sessions a median of 7 days apart. We used intraclass correlation coefficients (ICCs), repeated-measure analysis of variance, and Pearson r correlations to address our aims. RESULTS Overall, good to strong interrater (ICC [2,k] range = 0.83-0.97), intrarater (ICC [3,k] range = 0.91-0.98), and test-retest (ICC [3,k] range = 0.69-0.89) reliability were observed. A significant reaction time assessment-by-cognitive condition interaction was present (P = .018, ηp2 = 0.14), with StART having the largest dual-task effect. Main time effects for dual-task conditions were seen across all reaction time assessments (mean difference = -25 milliseconds, P = .026, ηp2 = 0.08) with improved performance at the second testing session. No StART outcomes correlated with computerized reaction time (P > .05), although some correlated with single-task (r range = 0.42-0.65) and dual-task (r range = 0.19-0.50) laboratory cutting reaction time. CONCLUSIONS The StART demonstrated overall reliable performance relative to other reaction time measures. Reliability coupled with a strong dual-task effect indicates that StART is a valid measure for examining functional reaction time and may have future utility for sport-related concussion return-to-play decision-making.
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Affiliation(s)
- Landon B. Lempke
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor
- Division of Sports Medicine, Boston Children’s Hospital, MA
- Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Eric J. Shumski
- UGA Concussion Research Laboratory and
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Thomas A. Prato
- UGA Concussion Research Laboratory and
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Robert C. Lynall
- UGA Concussion Research Laboratory and
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens
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Giessler-Gonzalez K, Tracy B, Davies PL, Stephens JA. Revised Dual Task Screen is a Valid Measure of Dual Task Performance: Developing a Motor and Cognitive Dual Task Measure with Healthy Female Athletes. Occup Ther Health Care 2023:1-15. [PMID: 36943802 PMCID: PMC10511656 DOI: 10.1080/07380577.2023.2191280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/11/2023] [Indexed: 03/23/2023]
Abstract
Multitasking measures, such as dual task assessments, are particularly useful in detecting subtle deficits that can influence occupational performance after injuries, like sports-related concussion (SRC). In past work, our research team developed and revised a dual task assessment, the Dual Task Screen (DTS). Here, we evaluated nineteen healthy athletes using the revised DTS to address two specific research objectives. First, to replicate pilot study findings and demonstrate that the revised DTS is sensitive to dual task motor costs (i.e. poorer motor performance under dual task conditions, compared to single task conditions). Second, to evaluate if the revised DTS is sensitive to dual task cognitive costs (i.e. poorer cognitive performance under dual task conditions, compared to single task conditions). We confirmed that the revised DTS was sensitive to both dual task motor and cognitive costs; thus it is a valid measure of dual task performance. These positive findings support its prospective, future use by occupational therapists to evaluate multitasking performance after injuries, like SRC, or other injuries and illnesses that elicit deficits affecting optimal occupational performance.
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Affiliation(s)
| | - Brian Tracy
- Health & Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Patricia L Davies
- Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Jaclyn A Stephens
- Occupational Therapy, Colorado State University, Fort Collins, CO, USA
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10
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Shumski EJ, Anderson MN, Oh J, Schmidt JD, Lynall RC. Computerized and functional reaction time in varsity-level female collegiate athletes with and without a concussion history. J Sci Med Sport 2023; 26:189-194. [PMID: 36906428 DOI: 10.1016/j.jsams.2023.02.008] [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: 04/25/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To 1) determine the association between computerized and functional reaction time, and 2) compare functional reaction times between female athletes with and without a concussion history. DESIGN Cross-sectional study. METHODS Twenty female college athletes with concussion history (age = 19.1 ± 1.5 years, height = 166.9 ± 6.7 cm, mass = 62.8 ± 6.9 kg, median total concussion = 1.0 [interquartile range = 1.0, 2.0]), and 28 female college athletes without concussion history (age = 19.1 ± 1.0 years, height = 172.7 ± 8.3 cm, mass = 65.4 ± 8.4 kg). Functional reaction time was assessed during jump landing and dominant and non-dominant limb cutting. Computerized assessments included simple, complex, Stroop, and composite reaction times. Partial correlations investigated the associations between functional and computerized reaction time assessments while covarying for time between computerized and functional reaction time assessments. Analysis of covariance compared functional and computerized reaction time, covarying for time since concussion. RESULTS There were no significant correlations between functional and computerized reaction time assessments (p-range = 0.318 to 0.999, partial correlation range = -0.149 to 0.072). Reaction time did not differ between groups during any functional (p-range = 0.057 to 0.920) or computerized (p-range = 0.605 to 0.860) reaction time assessments. CONCLUSIONS Post-concussion reaction time is commonly assessed via computerized measures, but our data suggest computerized reaction time assessments are not characterizing reaction time during sport-like movements in varsity-level female athletes. Future research should investigate confounding factors of functional reaction time.
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Affiliation(s)
- Eric J Shumski
- Department of Kinesiology, UGA Concussion and Biomechanics Research Laboratory and Biomechanics Laboratory, University of Georgia, United States of America.
| | - Melissa N Anderson
- Department of Kinesiology and Applied Physiology, University of Delaware, United States of America
| | - Jeonghoon Oh
- Department of Neurosurgery, Center of Neuroregeneration, Houston Methodist Research Institute, United States of America
| | - Julianne D Schmidt
- Department of Kinesiology, UGA Concussion and Biomechanics Research Laboratory and Biomechanics Laboratory, University of Georgia, United States of America
| | - Robert C Lynall
- Department of Kinesiology, UGA Concussion and Biomechanics Research Laboratory and Biomechanics Laboratory, University of Georgia, United States of America
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Lempke LB, Hoch MC, Call JA, Schmidt JD, Lynall RC. Lower Extremity Somatosensory Function Throughout Concussion Recovery: A Prospective Cohort Study. J Head Trauma Rehabil 2023; 38:E156-E166. [PMID: 35687895 DOI: 10.1097/htr.0000000000000805] [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: 11/27/2022]
Abstract
OBJECTIVE Balance impairments may suggest somatosensory disruption beyond concussion clinical recovery, but somatosensory subsystems have never been directly assessed. Our objective was to examine somatosensory function between individuals with a concussion and healthy matched-controls at acute (<7 days) and asymptomatic (<72 hours of being symptom-free) time points. SETTING Laboratory. PARTICIPANTS Participants with a concussion and matched controls ( n = 24; 58% male, age: 19.3 ± 1.1 years, mass: 70.3 ± 16.4 kg, height: 177.3 ± 12.7 cm). DESIGN Prospective cohort. MAIN MEASURES Somatosensory assessments on the dominant limb at both time points included: (1) plantar touch sensation threshold via Semmes-Weinstein monofilaments, (2) plantar pressure pain threshold via algometry, and (3) knee absolute passive joint repositioning (PJR) error via Biodex across 3 arcs (105°-75°, 30°-60°, 90°-45° knee-flexion). We used mixed-model analyses of variance, post hoc Tukey honestly significant difference t tests with mean difference, 95% CI, and Hedges' g effect sizes to examine outcomes. RESULTS Touch sensation had a group effect with the concussion cohort needing 0.95 grams of force (gf) more relative to controls (95% CI: 0.03 to 1.87; P = .043). No touch sensation interaction was present, but medium and large effects were observed for greater gf needed among the concussed cohort at the acute (1.11 gf; 95% CI: 0.17 to 2.05; g = 0.96) and asymptomatic time points (0.79 gf; 95% CI: -0.15 to 1.73; g = 0.73). No plantar pressure pain threshold effects were observed ( P ≥ .311), with negligible pressure difference magnitudes at the acute (0.26 pound force [lbf]/cm 2 ; 95% CI: -1.54 to 2.06; g = 0.13) and medium magnitudes at the asymptomatic time points (0.99 lbf/cm 2 ; 95% CI: -0.81 to 2.80; g = 0.42) for the concussed cohort needing more pressure to detect pain. The 30° to 60° PJR had a time effect, with asymptomatic time point having 3.12° better accuracy (95% CI: 1.23° to 5.02; P = .002). The concussed cohort had small-to-medium magnitude differences relative to controls at the acute time point for PJR during 105° to 75° (0.89°; g = 0.30) and 90° to 45° (0.62°; g = 0.17), but not 30° to 60° (-1.75°; g = -0.40). CONCLUSIONS Individuals with a concussion exhibited large effects for diminished plantar touch sensation and small to medium effects for inhibited plantar pressure pain sensation compared with controls, which may indicate altered somatosensory function. Negligible PJR differences suggest knee joint position sense is not altered post-concussion. Pre- and postconcussion examination is warranted to understand causal somatosensory mechanisms.
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Affiliation(s)
- Landon B Lempke
- UGA Concussion Research Laboratory, University of Georgia, Athens (Drs Lempke, Schmidt, and Lynall); Department of Kinesiology, University of Georgia, Athens (Drs Lempke, Call, Schmidt, and Lynall); Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, and Micheli Center for Sports Injury Prevention, Waltham, Massachusetts (Dr Lempke); Sports Medicine Research Institute, University of Kentucky, Lexington (Dr Hoch); and Skeletal Muscle Dysfunction Laboratory, University of Georgia, Athens (Dr Call)
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12
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Lempke LB, Oldham JR, Passalugo S, Willwerth SB, Berkstresser B, Wang F, Howell DR, Meehan WP. Influential Factors and Preliminary Reference Data for a Clinically Feasible, Functional Reaction Time Assessment: The Standardized Assessment of Reaction Time. J Athl Train 2023; 58:112-119. [PMID: 35476022 PMCID: PMC10072093 DOI: 10.4085/1062-6050-0073.22] [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: 11/09/2022]
Abstract
CONTEXT Clinical reaction-time (RT) measures are frequently used when examining patients with concussion but do not correlate with functional movement RT. We developed the Standardized Assessment of RT (StART) to emulate the rapid cognitive demands and whole-body movement needed in sport. OBJECTIVE To assess StART differences across 6 cognitive-motor combinations, examine potential demographic and health history confounders, and provide preliminary reference data for healthy collegiate student-athletes. DESIGN Prospective, cross-sectional study. SETTING Clinical medicine facilities. PATIENTS OR OTHER PARTICIPANTS A total of 89 student-athletes (56 [62.9%] men, 33 [37.1%] women; age = 19.5 ± 0.9 years, height = 178.2 ± 21.7 cm, mass = 80.4 ± 24 kg; no concussion history = 64 [71.9%]). MAIN OUTCOME MEASURE(S) Student-athletes completed health history questionnaires and StART during preseason testing. The StART consisted of 3 movements (standing, single-legged balance, and cutting) under 2 cognitive states (single task and dual task [subtracting by 6's or 7's]) for 3 trials under each condition. The StART trials were calculated as milliseconds between penlight illumination and initial movement. We used a 3 × 2 repeated-measures analysis of variance with post hoc t tests and 95% CIs to assess StART cognitive and movement differences, conducted univariable linear regressions to examine StART performance associations, and reported StART performance as percentiles. RESULTS All StART conditions differed (P ≤ .03), except single-task standing versus single-task single-legged balance (P = .36). Every 1-year age increase was associated with an 18-millisecond (95% CI = 8, 27 milliseconds) slower single-task cutting RT (P < .001). Female athletes had slower single-task (15 milliseconds; 95% CI = 2, 28 milliseconds; P = .02) and dual-task (28 milliseconds; 95% CI = 2, 55 milliseconds; P = .03) standing RT than male athletes. No other demographic or health history factors were associated with any StART condition (P ≥ .056). CONCLUSIONS The StART outcomes were unique across each cognitive-motor combination, suggesting minimal subtest redundancy. Only age and sex were associated with select outcomes. The StART composite scores may minimize confounding factors, but future researchers should consider age and sex when providing normative data.
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Affiliation(s)
- Landon B. Lempke
- Division of Sports Medicine, Boston Children's Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Jessie R. Oldham
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond
| | - Scott Passalugo
- Division of Sports Medicine, Boston Children's Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Sarah B. Willwerth
- Division of Sports Medicine, Boston Children's Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | | | - Francis Wang
- Harvard University Health Service, Cambridge, MA
| | | | - William P. Meehan
- Division of Sports Medicine, Boston Children's Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
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Single-Leg Hop Stabilization Throughout Concussion Recovery: A Preliminary Biomechanical Assessment. J Sport Rehabil 2023:1-11. [PMID: 36812918 DOI: 10.1123/jsr.2022-0397] [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: 11/09/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023]
Abstract
CONTEXT Aberrant movement patterns among individuals with concussion history have been reported during sport-related movement. However, the acute postconcussion kinematic and kinetic biomechanical movement patterns during a rapid acceleration-deceleration task have not been profiled and leaves their progressive trajectory unknown. Our study aimed to examine single-leg hop stabilization kinematics and kinetics between concussed and healthy-matched controls acutely (≤7 d) and when asymptomatic (≤72 h of symptom resolution). DESIGN Prospective, cohort laboratory study. METHODS Ten concussed (60% male; 19.2 [0.9] y; 178.7 [14.0] cm; 71.3 [18.0] kg) and 10 matched controls (60% male; 19.5 [1.2] y; 176.1 [12.6] cm; 71.0 [17.0] kg) completed the single-leg hop stabilization task under single and dual task (subtracting by 6's or 7's) at both time points. Participants stood on a 30-cm tall box set 50% of their height behind force plates while in an athletic stance. A synchronized light was illuminated randomly, queuing participants to initiate the movement as rapidly as possible. Participants then jumped forward, landed on their nondominant leg, and were instructed to reach and maintain stabilization as fast as possible upon ground contact. We used 2 (group) × 2 (time) mixed-model analyses of variance to compare single-leg hop stabilization outcomes separately during single and dual task. RESULTS We observed a significant main group effect for single-task ankle plantarflexion moment, with greater normalized torque (mean difference = 0.03 N·m/body weight; P = .048, g = 1.18) for concussed individuals across time points. A significant interaction effect for single-task reaction time indicated that concussed individuals had slower performance acutely relative to asymptomatic (mean difference = 0.09 s; P = .015, g = 0.64), while control group performance was stable. No other main or interaction effects for single-leg hop stabilization task metrics were present during single and dual task (P ≥ .051). CONCLUSIONS Greater ankle plantarflexion torque coupled with slower reaction time may indicate stiff, conservative single-leg hop stabilization performance acutely following concussion. Our findings shed preliminary light on the recovery trajectories of biomechanical alterations following concussion and provide specific kinematic and kinetic focal points for future research.
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Lower-Extremity Neuromuscular Function Following Concussion: A Preliminary Examination. J Sport Rehabil 2023; 32:31-39. [PMID: 35894887 DOI: 10.1123/jsr.2022-0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/03/2022] [Accepted: 05/21/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT Neuromuscular function is altered acutely following concussion and theoretically linked to the subsequent postconcussion musculoskeletal injury risk. Existing research has only examined voluntary muscle activation, limiting mechanistic understanding. Therefore, our study aimed to examine voluntary and involuntary muscle activation between college-aged, concussed individuals when symptom-free and healthy matched controls. DESIGN Prospective, cross-sectional cohort laboratory study. METHODS Concussed and healthy participants (n = 24; 58% male, age: 19.3 [1.1] y, mass: 70.3 [16.4] kg, height: 177.3 [12.7] cm) completed the superimposed burst (SB) neuromuscular assessment on their dominant limb within 72 hours after self-reporting asymptomatic (22.4 [20.2] d postinjury). Unnormalized and bodyweight-normalized quadriceps maximal voluntary isometric contraction torque (in newton meters), unnormalized and bodyweight-normalized electrically stimulated SB torque, pain (numeric 1-10) during SB, and the central activation ratio (in percentage) were assessed via the SB. Parametric and nonparametric analyses, 95% confidence intervals (95% CIs), and Hedges g (parametric) and Spearman ρ (nonparametric) effect sizes were used to examine group differences (α = .05). RESULTS The maximal voluntary isometric contraction torque (concussed: 635.60 N·m [300.93] vs control: 556.27 N·m [182.46]; 95% CI, -131.36 to 290.02; P = .443; d = 0.33), SB torque (concussed: 203.22 N·m [97.17], control: 262.85 N·m [159.07]; 95% CI, -171.22 to 51.97; P = .280; d = -0.47), and central activation ratio (concussed: 72.16% [17.16], control: 70.09% [12.63]; 95% CI, -10.68 to 14.83; P = .740; d = 0.14) did not differ between the concussed and control groups regardless of bodyweight normalization (P ≥ .344). Pain during the SB was significantly higher with a medium effect for participants with a concussion versus healthy controls (concussed: median = 7, control: median = 5; P = .046; ρ = -0.42). DISCUSSION These findings suggest concussed participants do not have statistically altered voluntary or involuntary quadricep neuromuscular function once asymptomatic compared with controls. Therefore, the elevated postconcussion musculoskeletal injury risk may not be attributed to lower-extremity muscle activation. Concussed participants displayed greater pain perception during the SB, which suggests somatosensory or perception changes requiring further examination.
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15
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Lempke LB, Passalugo S, Baranker BT, Hunt D, Berkstresser B, Wang F, Meehan WP, Howell DR. Relationship and Latent Factors Between Clinical Concussion Assessments and the Functional Standardized Assessment of Reaction Time (StART). Clin J Sport Med 2022; 32:e591-e597. [PMID: 35878887 PMCID: PMC9633339 DOI: 10.1097/jsm.0000000000001061] [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: 02/27/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the relationships and latent factors within the Standardized Assessment of Reaction Time (StART), and between StART and current clinical assessments. DESIGN Cross-sectional study. SETTING Clinical medicine facility. PARTICIPANTS Eighty-nine healthy collegiate student-athletes (63% male, age: 19.5 ± 0.9 years, 28% ≥1 concussion history). ASSESSMENT OF RISK FACTORS Student-athletes completed StART and clinical assessments during preinjury testing. MAIN OUTCOME MEASURES Standardized Assessment of Reaction Time consisted of 3 conditions (standing, single-leg balance, cutting) under 2 cognitive states (single task and dual task) for 3 trials each condition. Clinical assessments were the Sport Concussion Assessment Tool (SCAT) symptom checklist, Standardized Assessment of Concussion (SAC), tandem gait (single task and dual task), and Immediate PostConcussion Assessment and Cognitive Testing (ImPACT). We used Pearson- r correlation coefficients and exploratory factor analysis (EFA) to examine relationships and latent factors between StART and clinical assessments. RESULTS Null to moderate correlations presented among the StART outcomes (r range: 0.06-0.70), and null to small correlations between StART and clinical assessments (r range: -0.16 to 0.34). The three-factor EFA for solely StART explained 70.6% total variance: functional movement (cutting), static dual-task (standing and single-leg balance), and static single task (standing and single-leg balance). The five-factor EFA for StART and clinical assessments explained 65.8% total variance: gait (single-task and dual-task tandem gait), functional movement (StART single-task and dual-task cutting), static dual-task (StART standing, single-leg balance), neurocognitive (ImPACT verbal memory, visual memory, visual-motor speed), and static single task (StART standing, single-leg balance). No other outcomes met the factor loading threshold. CONCLUSIONS StART displayed 3 distinct categories and had minimal redundancy within its subtests. StART did not meaningfully correlate with clinical assessments, suggesting that StART provides unique information by examining more functional, reactive movement.
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Affiliation(s)
- Landon B. Lempke
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Scott Passalugo
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Ben T. Baranker
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Danielle Hunt
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | | | - Francis Wang
- Harvard University Health Service, Cambridge, MA, USA
| | - William P. Meehan
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - David R. Howell
- Sports Medicine Center, Children’s Hospital of Colorado, Aurora, CO, USA
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, CO, USA
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Williams AM, Hogg JA, Diekfuss JA, Kendall SB, Jenkins CT, Acocello SN, Liang Y, Wu D, Myer GD, Wilkerson GB. Immersive Real-Time Biofeedback Optimized With Enhanced Expectancies Improves Motor Learning: A Feasibility Study. J Sport Rehabil 2022; 31:1023-1030. [PMID: 35728805 PMCID: PMC11148808 DOI: 10.1123/jsr.2021-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT An Optimizing Performance through Intrinsic Motivation and Attention for Learning theory-based motor learning intervention delivering autonomy support and enhanced expectancies (EE) shows promise for reducing cognitive-motor dual-task costs, or the relative difference in primary task performance when completed with and without a secondary cognitive task, that facilitate adaptive injury-resistant movement response. The current pilot study sought to determine the effectiveness of an autonomy support versus an EE-enhanced virtual reality motor learning intervention to reduce dual-task costs during single-leg balance. DESIGN Within-subjects 3 × 3 trial. METHODS Twenty-one male and 24 female participants, between the ages of 18 and 30 years, with no history of concussion, vertigo, lower-extremity surgery, or lower-extremity injuries the previous 6 months, were recruited for training sessions on consecutive days. Training consisted of 5 × 8 single-leg squats on each leg, during which all participants mimicked an avatar through virtual reality goggles. The autonomy support group chose an avatar color, and the EE group received positive kinematic biofeedback. Baseline, immediate, and delayed retention testing consisted of single-leg balancing under single- and dual-task conditions. Mixed-model analysis of variances compared dual-task costs for center of pressure velocity and SD between groups on each limb. RESULTS On the right side, dual-task costs for anterior-posterior center of pressure mean and SD were reduced in the EE group (mean Δ = -51.40, Cohen d = 0.80 and SD Δ = -66.00%, Cohen d = 0.88) compared with the control group (mean Δ = -22.09, Cohen d = 0.33 and SD Δ = -36.10%, Cohen d = 0.68) from baseline to immediate retention. CONCLUSIONS These findings indicate that EE strategies that can be easily implemented in a clinic or sport setting may be superior to task-irrelevant AS approaches for influencing injury-resistant movement adaptations.
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Affiliation(s)
| | - Jennifer A Hogg
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN,USA
| | - Jed A Diekfuss
- Emory Sport Performance and Research Center, Flowery Branch, GA,USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA,USA
- Emory Sports Medicine Center, Atlanta, GA,USA
| | | | | | - Shellie N Acocello
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN,USA
| | - Yu Liang
- Department of Computer Science and Engineering, The University of Tennessee Chattanooga, Chattanooga, TN,USA
| | - Dalei Wu
- Department of Computer Science and Engineering, The University of Tennessee Chattanooga, Chattanooga, TN,USA
| | - Gregory D Myer
- Emory Sport Performance and Research Center, Flowery Branch, GA,USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA,USA
- Emory Sports Medicine Center, Atlanta, GA,USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA,USA
| | - Gary B Wilkerson
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN,USA
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Hogg JA, Riehm CD, Wilkerson GB, Tudini F, Peyer KL, Acocello SN, Carlson LM, Le T, Sessions R, Diekfuss JA, Myer GD. Changes in dual-task cognitive performance elicited by physical exertion vary with motor task. Front Sports Act Living 2022; 4:989799. [PMID: 36385777 PMCID: PMC9650128 DOI: 10.3389/fspor.2022.989799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Background Integrated movement and cognitive load paradigms are used to expose impairments associated with concussion and musculoskeletal injury. There is currently little information on the discriminatory nature of dual-task complexity and the relative influence of physical exertion on cognitive outcomes. Purpose Assess cognitive performance while under motor conditions of increasing complexity before and after a standardized exercise protocol. Methods 34 participants were recruited (17 male and 17 female; 24 ± 1.4 yrs). A modified Eriksen flanker test was used to assess cognitive performance under four conditions (seated, single-leg stance, walking, and lateral stepping) before and after a 20-min moderate-to vigorous intensity treadmill protocol. The flanker test consisted of 20 sets of 5-arrow configurations, appearing in random order. To complete the response to cognitive stimulus, participants held a smartphone horizontally and were instructed to respond as quickly and as accurately as possible by tilting the device in the direction corresponding to the orientation of the middle arrow. The metrics used for analysis included average reaction time (ms), inverse efficiency index (average reaction time penalized for incorrect responses), and conflict effect (the average time cost of responding to an incongruent repetition vs. a congruent repetition). Mixed effects (condition by time) RMANOVAs were conducted to examine the effects of motor task complexity and physical exertion on cognitive performance. Results There was a condition by time interaction for inverse efficiency index (p < 0.001), in which participants displayed higher cognitive efficiency for the pre-activity lateral stepping condition compared to the other three conditions (Cohen's d = 1.3–1.6). For reaction time and conflict effect, there were main effects for condition (p = 0.004 and 0.006, respectively), in which performance during lateral stepping was improved in relation to the seated condition (reaction time Cohen's d = 0.68; conflict effect Cohen's d = 0.64). Conclusion Participants tended to display better dual-task cognitive performance under more stimulating or complex motor tasks before physical exertion, likely associated with the inverted-U arousal-performance relationship. When using dual-task assessments, clinicians should be mindful of the accompanying motor task and baseline exertion levels and their potential to disrupt or optimize cognitive performance.
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Affiliation(s)
- Jennifer A. Hogg
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
- *Correspondence: Jennifer A. Hogg
| | - Christopher D. Riehm
- Emory Sports Performance And Research Center, Flowery Branch, GA, United States
- Emory Sports Medicine Center, Atlanta, GA, United States
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, United States
| | - Gary B. Wilkerson
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Frank Tudini
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Karissa L. Peyer
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Shellie N. Acocello
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Lynette M. Carlson
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Tan Le
- Upstream Rehabilitation, Raymond, MS, United States
| | - Ross Sessions
- Cornerstone Rehabilitation, Southaven, MS, United States
| | - Jed A. Diekfuss
- Emory Sports Performance And Research Center, Flowery Branch, GA, United States
- Emory Sports Medicine Center, Atlanta, GA, United States
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, United States
| | - Gregory D. Myer
- Emory Sports Performance And Research Center, Flowery Branch, GA, United States
- Emory Sports Medicine Center, Atlanta, GA, United States
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, United States
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
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Sports-Related Concussion Is a Personalized Issue—Evaluation of Medical Assessment and Subjective Feeling of the Athlete in a German Level 1 Trauma Center. J Pers Med 2022; 12:jpm12101596. [PMID: 36294735 PMCID: PMC9605563 DOI: 10.3390/jpm12101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
Abstract
Sports-related concussions (SRC) have developed into a highly discussed topic in sports medicine over the last few years and demonstrate a severe issue in the personalized treatment of patients. This retrospective cohort study investigated 86 patients with sports-related concussions in a level 1 trauma center, relating to the mechanism, symptoms, medical history, acute therapy including first assessment and the return to sport. The research is based on medical records as well as questionnaires six months after hospitalization. Loss of consciousness for under 30 min (41.2%), headache (36.5%) and amnesia (29.4%) were the most frequent symptoms when presenting in the emergency room. During the hospitalization, mainly headache and vertigo were documented. Most concussions occurred after incidents in equitation and cycling sports; the most common mechanism was falling to the ground with a subsequent impact (59.3%). At the time of discharge from hospital, in 13.4% of all cases, concussion symptoms were still documented in medical records, in contrast to 39.5% of the concerned athletes who reported symptoms for longer than 24 h, and 41.0% who reported ongoing post-concussion symptoms after six months. Concussions are difficult-to-treat disorders with a challenging diagnostic process and many symptoms in various values and levels of persistence. Therefore, a patient-involving treatment with a complaint-dependent return to sport process should be applied to concerned athletes.
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Hunt DL, Oldham J, Aaron SE, Tan CO, Meehan WP, Howell DR. Dizziness, Psychosocial Function, and Postural Stability Following Sport-Related Concussion. Clin J Sport Med 2022; 32:361-367. [PMID: 34009789 PMCID: PMC8426409 DOI: 10.1097/jsm.0000000000000923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine if self-reported dizziness is associated with concussion symptoms, depression and/or anxiety symptoms, or gait performance within 2 weeks of postconcussion. DESIGN Cross-sectional study. SETTING Research laboratory. PARTICIPANTS Participants were diagnosed with a concussion within 14 days of initial testing (N = 40). Participants were divided into 2 groups based on their Dizziness Handicap Inventory (DHI) score: 36 to 100 = moderate/severe dizziness and 0 to 35 = mild/no dizziness. INTERVENTIONS Participants were tested on a single occasion and completed the DHI, hospital anxiety and depression scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and Post-Concussion Symptom Inventory (PCSI). Three different postural control tests were use: modified Balance Error Scoring System, single-/dual-task tandem gait, and a single-/dual-task instrumented steady-state gait analysis. MAIN OUTCOME MEASURES Comparison of patient-reported outcomes and postural control outcomes between moderate/severe (DHI ≥ 36) and mild/no (DHI < 36) dizziness groups. RESULTS Participants with moderate/severe dizziness (n = 19; age = 17.1 ± 2.4 years; 63% female) reported significantly higher symptom burden (PSCI: 43.0 ± 20.6 vs 22.8 ± 15.7; P = 0.001) and had higher median HADS anxiety (6 vs 2; P < 0.001) and depression (6 vs 1; P = 0.001) symptom severity than those with no/minimal dizziness (n = 21; age = 16.5 ± 1.9; 38% female). During steady-state gait, moderate/severe dizziness group walked with significantly slower single-task cadence (mean difference = 4.8 steps/minute; 95% confidence interval = 0.8, 8.8; P = 0.02) and dual-task cadence (mean difference = 7.4 steps/minute; 95% confidence interval = 0.7, 14.0; P = 0.04) than no/mild dizziness group. CONCLUSION Participants who reported moderate/severe dizziness reported higher concussion symptom burden, higher anxiety scores, and higher depression scores than those with no/mild dizziness. Cadence during gait was also associated with the level of dizziness reported.
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Affiliation(s)
- Danielle L. Hunt
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Jessie Oldham
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Stacey E. Aaron
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Can Ozan Tan
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - William P. Meehan
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Departments of Orthopedic Surgery and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - David R. Howell
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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20
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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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21
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D'Silva L, Chalise P, Rippee M, Devos H. Challenging the Vestibular System Affects Gait Speed and Cognitive Workload in Chronic Mild Traumatic Brain Injury and Healthy Adults. Front Neurol 2022; 13:819169. [PMID: 35812099 PMCID: PMC9259866 DOI: 10.3389/fneur.2022.819169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
People with persistent symptoms after mild traumatic brain injury (mTBI) report imbalance during walking with head movements. The purpose of this study was (1) to compare usual walk gait speed to walking with head turns (HT) between people with mTBI and controls, (2) to compare the cognitive workload from usual walk to HT walk between groups, and (3) to examine if gaze stability deficits and mTBI symptoms influence gait speed. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI (between 3 months to 2 years post-injury) were compared with 23 age and sex-matched controls. Participants walked a 12-inch wide, 60-foot walkway when looking ahead and when walking with HT to identify letters and their colors. Gait speed during usual walk and HT walk were calculated. Pupillary responses during both walks were converted to the Index of Cognitive Activity (ICA) as a measure of cognitive workload. Gaze stability was examined by the dynamic visual acuity (DVA) test in the yaw plane. The post-concussion symptom scale (PCSS) was used to collect symptom severity. Within group analysis showed that gait speed was lower during HT walk compared to usual walk in the people with mTBI (p < 0.001) as well as in controls (p < 0.001). ICA was higher with HT compared to usual walk in the mTBI group in the right eye (p = 0.01) and left eye (p = 0.001), and in controls in the right eye (p = 0.01) and left eye (p = 0.01). Participants in the mTBI group had slower usual (p < 0.001), and HT gait speed (p < 0.001) compared to controls. No differences were noted in ICA in the right or left eye during usual walk and HT walk between groups (p > 0.05). DVA loss in the yaw plane to the right and left was not different between groups (p > 0.05) and were not correlated with gait speed. PCSS scores were correlated with usual walk (r = −0.50, p < 0.001) and HT gait speed (r = −0.44, p = 0.002). Slower gait speed, poorer stability, and higher cognitive workload during walking with head turns may reduce community participation in people with mTBI and persistent symptoms.
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Affiliation(s)
- Linda D'Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
- *Correspondence: Linda D'Silva
| | - Prabhakar Chalise
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, MO, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Medical Center, Kansas City, MO, United States
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
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22
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Pang JCY, Tsang RSW. Reliability of three-dimensional motion analysis during single-leg side drop landing test after anterior cruciate ligament reconstruction: An in vivo motion analysis study. Hong Kong Physiother J 2022; 42:65-73. [PMID: 35782700 PMCID: PMC9244601 DOI: 10.1142/s1013702522500081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) injury is a common sport injury and investigation of landing biomechanics is helpful in injury prevention and rehabilitation. Recent study found a lateral single-leg drop landing test resulted in the highest peak knee valgus angle (PKVA), but its reliability on patients who received ACL reconstruction (ACLR) is unknown. Objective: This study aimed to investigate the reliability in both within and between days on the normalized vertical ground reaction force (NVGRF) and kinematics of lower limbs after receiving ACLR. The findings can form the cornerstone for further study related to lateral jumping-and-landing biomechanics in patients with ACLR. Methods: This was a test-retest reliability study. Twelve patients (four females and eight males) who received ACLR with mean age of 29.4 (SD ± 1.66) were recruited. The subjects were instructed to jump laterally from 30 cm height and landed with single-leg for five times. The procedure was conducted on both legs for comparison. The NVGRF and local maxima of the hip, knee and ankle angles during the first 100 ms in all three planes were analyzed. The measurement was conducted by the same assessor to evaluate the within-session reliability, and the whole procedure was repeated one week later for the evaluation of the between-session reliability. Intra-class correlation coefficient (ICC) test was used to assess the within- and between-session reliability by ICC (3, 1) and ICC (3, K) respectively. Results: The within-session reliability of NVGRF [ICC (3, 1)] was 0.899–0.936, and its between-session reliability [ICC (3, K)] was 0.947–0.923. Overall reliability for kinematics within-session [ICC (3, 1)] was 0.948–0.988, and the between-session reliability [ICC (3, K)] was 0.618–0.982, respectively. Good to excellent reliability for the lateral single-leg drop landing test was observed in most of the outcome measures for within- and between-session. The ICC value of NVGRF of ACLR leg was lower than that of the good leg in the within-session which may associate with lower neuromuscular control in ACLR leg than that of the good leg. Conclusion: The results of this study support the use of a lateral single-leg drop landing test to evaluate lower limb biomechanics for ACLR.
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Affiliation(s)
- Johnson Chun Yiu Pang
- School of Health Sciences, Caritas Institute of Higher Education, 2 Chui Ling Lane, Tseung Kwan O, N.T., HKSAR, China
| | - Rachel Suet Wai Tsang
- Shatin Hospital, Hospital Authority, 33 A Kung Kok Street, Ma On Shan, Shatin, NT, HKSAR, China
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23
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Pinto SM, Newman MA, Runyon MS, Gibbs M, Grafton LM, Hirsch MA. Mild Traumatic Brain Injury Is Associated With Increased Dual-Task Cost During Ambulation: A Preliminary Study. Am J Phys Med Rehabil 2022; 101:367-371. [PMID: 34173774 DOI: 10.1097/phm.0000000000001830] [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: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine the impact of dual-task conditions on mobility after mild traumatic brain injury. DESIGN Eleven adults with mild traumatic brain injury within 1 wk of injury and 10 age- and sex-matched healthy controls completed gait trials with a single-task condition and three separate dual-task conditions: counting by 1 (low), serial subtraction by 3 (medium), and alternating letters and numbers (high). Dual-task cost was calculated as dual-task cost = ([dual-task performance] - [single-task performance]) / [single-task performance] × 100%. RESULTS Participants with mild traumatic brain injury ambulated slower than control subjects (P < 0.001). Significant differences in dual-task cost were noted for both group (P < 0.001) and dual-task condition (P = 0.005). Dual-task cost was greater for those with mild traumatic brain injury compared with controls with significant group differences for the low and high cognitive loads (P < 0.05). Only 1 of the 11 individuals with mild traumatic brain injury and 1 of the 10 controls demonstrated gait speed less than 80 cm/sec, which is predictive of community mobility, during any dual-task condition. Dual-task cost exceeded 11.9%, previously determined to be the minimal detectable change in healthy adults, for 9 of the 11 individuals with mild traumatic brain injury compared with 3 of the 10 controls. CONCLUSIONS Dual-task cost may be a more sensitive measure for impairment during dual-task conditions than gait speed after mild traumatic brain injury.
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Affiliation(s)
- Shanti M Pinto
- From the Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina (SMP, MAN, MAH); Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina (MSR, MG); and Department of Physical Medicine and Rehabilitation, Penn State Medical Center, Hershey, Pennsylvania (LMG)
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24
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De Looze C, Williamson W, Demnitz N, O'Connor D, Hernández B, Kenny RA. Physical function, an adjunct to brain health score for phenotyping cognitive function trajectories in older age: Findings from the Irish Longitudinal Study on Ageing (TILDA). J Gerontol A Biol Sci Med Sci 2022; 77:1593-1602. [PMID: 35092436 DOI: 10.1093/gerona/glac024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence is limited regarding the cumulative effect of risk factors on cognitive decline and the added value of physical function for cognitive function trajectory stratification. We operationalise thirteen modifiable dementia risk factors in a scoring system and investigate the relationship between this brain health score, combined with simple measures of physical function, and risk of cognitive decline. METHODS Population-based cohort study of persons aged 50+ from the Irish Longitudinal Study on Ageing without a history of dementia at baseline who underwent repeated neuropsychological tests (8.08±0.3 year follow-up) were included in the analyses. Exposures were the number of brain health metrics (defined by the Lancet Commission on Dementia Prevention, Intervention and Care report) at recommended optimal levels. Physical function exposures included Timed Up and Go, dual-task walking speed and grip strength. Each health metric and physical function measure at the recommended level was assigned a value of 1 and combined to generate brain health scores. Relationship with group-based trajectories of global cognitive function (multi-domains composite score), estimated using K-means for Longitudinal data, were assessed via ordinal logistic regressions. RESULTS Among 2,327 participants (mean age, 61 years; 54% women), each additional optimal metric on the brain health score (Odds 0.67 [0.62;0.73]) was associated with reduced odds of cognitive decline. Adding Timed-Up and Go (Odds 0.71 [0.59;0.84]) and Dual-task walking speed (Odds 0.74 [0.63;0.89]) further improved model fit (ΔAIC=14.8). CONCLUSIONS These findings support the promotion and maintenance of physical function in addition to brain health strategies to reduce risk of cognitive decline.
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Affiliation(s)
- Céline De Looze
- The Irish Longitudinal Study of Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland
| | - Wilby Williamson
- The Irish Longitudinal Study of Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, Ireland.,Department of Physiology, School of Medicine, Trinity College Dublin, Ireland
| | - Naiara Demnitz
- Global Brain Health Institute, Trinity College Dublin, Ireland.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark
| | - Deirdre O'Connor
- The Irish Longitudinal Study of Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland
| | - Belinda Hernández
- The Irish Longitudinal Study of Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study of Ageing (TILDA), School of Medicine, Trinity College Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, Ireland.,Mercer's Institute for Successful Ageing (MISA), St James's Hospital, Dublin, Ireland
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25
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Smulligan KL, Wilson JC, Howell DR. INCREASED RISK OF MUSCULOSKELETAL INJURIES AFTER CONCUSSION. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Kreter N, Rogers CL, Fino PC. Anticipatory and reactive responses to underfoot perturbations during gait in healthy adults and individuals with a recent mild traumatic brain injury. Clin Biomech (Bristol, Avon) 2021; 90:105496. [PMID: 34607181 PMCID: PMC8633175 DOI: 10.1016/j.clinbiomech.2021.105496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following mild traumatic brain injury, individuals often exhibit quantifiable gait deficits over flat surfaces, but little is known about how they control gait over complex surfaces. Such complex surfaces require precise neuromotor control to anticipate and react to small disturbances in walking surfaces, and mild traumatic brain injury-related balance deficits may adversely affect these gait adjustments. METHODS This study investigates anticipatory and reactive gait adjustments for expected and unexpected underfoot perturbations in healthy adults (n = 5) and individuals with mild traumatic brain injury (n = 5). Participants completed walking trials with random unexpected or expected underfoot perturbations from a mechanized shoe and inertial measurement units collected kinematic data from the feet and sternum. Linear mixed-effects models assessed the effects of segment, group, and their interaction on standardized difference of accelerations between perturbation and non-perturbation trials. FINDINGS Both groups demonstrated similar gait strategies when perturbations were unexpected. During late swing phase before expected perturbations, persons with mild traumatic brain injury exhibited greater lateral acceleration of their perturbed foot and less lateral movement of their trunk compared with unperturbed gait. Control participants exhibited less lateral foot acceleration and no difference in mediolateral trunk acceleration compared with unperturbed gait during the same period. A significant group*segment interaction (p < 0.001) during this part of the gait cycle suggests the groups adopted different anticipatory strategies for the perturbation. INTERPRETATION Individuals with mild traumatic brain injury may be adopting cautious strategies for expected perturbations due to persistent neuromechanical deficits stemming from their injury.
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Affiliation(s)
- Nicholas Kreter
- Department of Health and Kinesiology, University of Utah, 250 South 1850 East Salt Lake City, UT 84112. United States of America.,Corresponding author.
| | - Claire L. Rogers
- Department of Biomedical Engineering, University of Utah, 36 South Wasatch Drive Salt Lake City, UT 84112. United States of America
| | - Peter C. Fino
- Department of Health and Kinesiology, University of Utah, 250 South 1850 East Salt Lake City, UT 84112. United States of America
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27
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Leddy JJ, Haider MN, Noble JM, Rieger B, Flanagan S, McPherson JI, Shubin-Stein K, Saleem GT, Corsaro L, Willer B. Clinical Assessment of Concussion and Persistent Post-Concussive Symptoms for Neurologists. Curr Neurol Neurosci Rep 2021; 21:70. [PMID: 34817724 DOI: 10.1007/s11910-021-01159-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Concussion produces a variety of signs and symptoms. Most patients recover within 2-4 weeks, but a significant minority experiences persistent post-concussive symptoms (PPCS), some of which may be from associated cervical or persistent neurologic sub-system (e.g., vestibular) dysfunction. This review provides evidence-based information for a pertinent history and physical examination of patients with concussion. RECENT FINDINGS The differential diagnosis of PPCS is based on the mechanism of injury, a thorough medical history and concussion-pertinent neurological and cervical physical examinations. The concussion physical examination focuses on elements of autonomic function, oculomotor and vestibular function, and the cervical spine. Abnormalities identified on physical examination can inform specific forms of rehabilitation to help speed recovery. Emerging data show that there are specific symptom generators after concussion that can be identified by a thorough history, a pertinent physical examination, and adjunct tests when indicated.
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Affiliation(s)
- John J Leddy
- UBMD, Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA.
| | - Mohammad Nadir Haider
- UBMD, Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA.,Department of Neuroscience, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | - James M Noble
- Department of Neurology, Taub Institute for Research On Alzheimer's Disease and the Aging Brain, and G.H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Brian Rieger
- Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Steven Flanagan
- Department of Rehabilitation Medicine, Rusk Institute of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Jacob I McPherson
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | | | - Ghazala T Saleem
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | - Louis Corsaro
- Northern Westchester and Southern Putnam County School Districts, New York, NY, USA
| | - Barry Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
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28
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Bruce SL, Wilkerson GB. Whole-Body Reactive Agility Metrics to Identify Football Players With a Core and Lower Extremity Injury Risk. Front Sports Act Living 2021; 3:733567. [PMID: 34746776 PMCID: PMC8564038 DOI: 10.3389/fspor.2021.733567] [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: 06/30/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Clinical prediction models are useful in addressing several orthopedic conditions with various cohorts. American football provides a good population for attempting to predict injuries due to their relatively high injury rate. Physical performance can be assessed a variety of ways using an assortment of different tests to assess a diverse set of metrics, which may include reaction time, speed, acceleration, and deceleration. Asymmetry, the difference between right and left performance has been identified as a possible risk factor for injury. The purpose of this study was to determine the whole-body reactive agility metrics that would identify Division I football players who were at elevated risk for core, and lower extremity injuries (CLEI). This cohort study utilized 177 Division I football players with a total of 57 CLEI suffered who were baseline tested prior to the season. Single-task and dual-task whole-body reactive agility movements in lateral and diagonal direction reacting to virtual reality targets were analyzed separately. Receiver operator characteristic (ROC) analyses narrowed the 34 original predictor variables to five variables. Logistic regression analysis determined the three strongest predictors of CLEI for this cohort to be: lateral agility acceleration asymmetry, lateral flanker deceleration asymmetry, and diagonal agility reaction time average. Univariable analysis found odds ratios to range from 1.98 to 2.75 for these predictors of CLEI. ROC analysis had an area under the curve of 0.702 for any combination of two or more risk factors produced an odds ratio of 5.5 for risk of CLEI. These results suggest an asymmetry of 8-15% on two of the identified metrics or a slowed reaction time of ≥0.787 s places someone at increased risk of injury. Sixty-three percent (36/57) of the players who sustained an injury had ≥2 positive predictors In spite of the recognized limitation, these finding support the belief that whole-body reactive agility performance can identify Division I football players who are at elevated risk for CLEI.
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Affiliation(s)
- Scott L Bruce
- Masters of Athletic Training Program, Arkansas State University, Jonesboro, AR, United States
| | - Gary B Wilkerson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
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29
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Maldonado-Rodriguez N, Crocker CV, Taylor E, Jones KE, Rothlander K, Smirl J, Wallace C, van Donkelaar P. Characterization of Cognitive-Motor Function in Women Who Have Experienced Intimate Partner Violence-Related Brain Injury. J Neurotrauma 2021; 38:2723-2730. [PMID: 34036801 DOI: 10.1089/neu.2021.0042] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intimate partner violence (IPV) affects at least one in three women worldwide, and up to 92% report symptoms consistent with brain injury (BI). Although a handful of studies have examined different aspects of brain structure and function in this population, none has characterized potential deficits in cognitive-motor function. This knowledge gap was addressed in the current study by having participants who had experienced IPV complete the bimanual Object Hit & Avoid (OHA) task in a Kinesiological Instrument for Normal and Altered Reaching Movement (KINARM) End-Point Laboratory. BI load, post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and history of abuse were also assessed. A stepwise multiple regression was undertaken to explore the relationship between BI load and task performance while accounting for comorbid psychopathologies. Results demonstrated that BI load accounted for a significant amount of variability in the number of targets hit and the average hand speed. PTSD, anxiety, and depression also contributed significantly to the variability in these measures as well as to the number and proportion of distractor hits, and the object processing rate. Taken together, these findings suggest that IPV-related BI, as well as comorbid PTSD, anxiety, and depression, disrupt the processing required to quickly and accurately hit targets while avoiding distractors. This pattern of results reflects the complex interaction between the physical injuries induced by the episodes of IPV and the resulting impacts that these experiences have on mental health.
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Affiliation(s)
- Naomi Maldonado-Rodriguez
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Clara Val Crocker
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Edward Taylor
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| | - K Elisabeth Jones
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Krystal Rothlander
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jon Smirl
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Colin Wallace
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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Utility of a Postural Stability/Perceptual Inhibition Dual Task for Identifying Concussion in Adolescents. J Sport Rehabil 2021; 30:1191-1196. [PMID: 34525453 DOI: 10.1123/jsr.2021-0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/24/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Research in the area of dual-task paradigms to assess sport-related concussion (SRC) status is growing, but additional assessment of this paradigm in adolescents is warranted. DESIGN This case-control study compared 49 adolescent athletes aged 12-20 years with diagnosed SRC to 49 age- and sex-matched controls on visual-spatial discrimination and perceptual inhibition (PIT) reaction time tasks performed while balancing on floor/foam pad conditions. METHODS The SRC group completed measures at a single time point between 1 and 10 days postinjury. Primary outcomes were dual-task reaction time, accuracy, and sway. General linear models evaluated differences between groups (P < .05). Logistic regression identified predictors of concussion from outcomes. Area under the curve evaluated discriminative ability of identifying SRC. RESULTS Results supported significantly higher anterior-posterior (AP) sway values in concussed participants for visual-spatial discrimination and PIT when balancing on the floor (P = .03) and foam pad (P = .03), as well as mediolateral sway values on the floor during visual-spatial discrimination (P = .01). Logistic regression analysis (R2 = .15; P = .001) of all dual-task outcomes identified AP postural sway during the PIT foam dual task as the only significant predictor of concussed status (ß = -2.4; P = .004). Total symptoms (area under the curve = 0.87; P < .001) and AP postural sway on foam (area under the curve = 0.70; P = .001) differentiated concussed from controls. CONCLUSION The AP postural sway on foam during a postural stability/PIT dual task can identify concussion in adolescents between 1 and 10 days from injury.
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Associations Between Neurochemistry and Gait Performance Following Concussion in Collegiate Athletes. J Head Trauma Rehabil 2021; 35:342-353. [PMID: 32881768 DOI: 10.1097/htr.0000000000000616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the strength of associations between single-task and dual-task gait measures and posterior cingulate gyrus (PCG) neurochemicals in acutely concussed collegiate athletes. SETTING Participants were recruited from an NCAA Division 1 University. PARTICIPANTS Nineteen collegiate athletes acutely (<4 days) following sports-related concussion. DESIGN We acquired magnetic resonance spectroscopy (MRS) in the PCG and gait performance measurements in the participants, acutely following concussion. Linear mixed-effects models were constructed to measure the effect of gait performance, in the single- and dual-task settings, and sex on the 6 neurochemicals quantified with MRS in mmol. Correlation coefficients were also calculated to determine the direction and strength of the relationship between MRS neurochemicals and gait performance, postconcussion symptom score, and number of previous concussions. MAIN MEASURES Average gait speed, average cadence, N-acetyl aspartate, choline, myo-inositol, glutathione, glutamate plus glutamine, and creatine. RESULTS Single-task gait speed (P = .0056) and cadence (P = .0065) had significant effects on myo-inositol concentrations in the PCG, independent of sex, in concussed collegiate athletes. Single-task cadence (P = .047) also had a significant effect on glutathione in the PCG. No significant effects were observed between dual-task gait performance and PCG neurochemistry. CONCLUSIONS These findings indicate that increased concentrations of neuroinflammatory markers in the PCG are associated with slower single-task gait performance within 4 days of sports-related concussion.
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Reliability and Minimal Detectable Change for a Smartphone-Based Motor-Cognitive Assessment: Implications for Concussion Management. J Appl Biomech 2021; 37:380-387. [PMID: 34257159 DOI: 10.1123/jab.2020-0391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022]
Abstract
Our purpose was to investigate the reliability and minimal detectable change characteristics of a smartphone-based assessment of single- and dual-task gait and cognitive performance. Uninjured adolescent athletes (n = 17; mean age = 16.6, SD = 1.3 y; 47% female) completed assessments initially and again 4 weeks later. The authors collected data via an automated smartphone-based application while participants completed a series of tasks under (1) single-task cognitive, (2) single-task gait, and (3) dual-task cognitive-gait conditions. The cognitive task was a series of continuous auditory Stroop cues. Average gait speed was consistent between testing sessions in single-task (0.98, SD = 0.21 vs 0.96, SD = 0.19 m/s; P = .60; r = .89) and dual-task (0.92, SD = 0.22 vs 0.89, SD = 0.22 m/s; P = .37; r = .88) conditions. Response accuracy was moderately consistent between assessments in single-task standing (82.3% accurate, SD = 17.9% vs 84.6% accurate, SD = 20.1%; P = .64; r = .52) and dual-task gait (89.4% accurate, SD = 15.9% vs 85.8% accurate, SD = 20.2%; P = .23; r = .81) conditions. Our results indicate automated motor-cognitive dual-task outcomes obtained within a smartphone-based assessment are consistent across a 1-month period. Further research is required to understand how this assessment performs in the setting of sport-related concussion. Given the relative reliability of values obtained, a smartphone-based evaluation may be considered for use to evaluate changes across time among adolescents, postconcussion.
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Oldham JR, Howell DR, Knight CA, Crenshaw JR, Buckley TA. Gait Performance Is Associated with Subsequent Lower Extremity Injury following Concussion. Med Sci Sports Exerc 2021; 52:2279-2285. [PMID: 33064402 DOI: 10.1249/mss.0000000000002385] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose was to examine gait characteristics between collegiate athletes who did and did not sustain a lower-extremity musculoskeletal (LEMSK) injury in the year after concussion. METHODS Thirty-four NCAA collegiate athletes with diagnosed concussions were divided into two groups based on if they did (n = 16) or did not (n = 18) sustain a LEMSK in the year after concussion. Participants completed baseline testing before the start of the season and again at return to play postconcussion. Injuries were tracked using an electronic medical database. Participants were instrumented with three APDM Opal triaxial accelerometers and performed five single-task (ST) and five dual-task (DT) gait trials. Participants traversed a 10-meter walkway, turned around a specified endpoint, and returned to the original line. During DT, participants simultaneously walked and answered mini-mental style questions. A linear mixed-effects model assessed interactions and/or main effects between groups for gait speed, double support time, cadence, stride length, and cognitive accuracy. RESULTS The LEMSK group walked slower (ST, 1.15 ± 0.10 m·s; DT, 1.01 ± 0.10 m·s) than the uninjured group (ST, 1.23 ± 0.11 m·s; DT, 1.10 ± 0.11 m·s) during both ST (P = 0.04) and DT (P = 0.03). The injury group spent longer in double support (ST, 20.19% ± 2.34%; DT, 21.92% ± 2.13%) than the uninjured group (ST, 18.16% ± 2.60%; DT, 20.00% ± 2.32%) during both ST (P = 0.02) and DT (P = 0.02). The injury group had a significantly lower cognitive accuracy (89.56% ± 6.48%) than the uninjured group (95.40% ± 7.08%) across time points (P = 0.02). CONCLUSIONS There were significant differences in gait characteristics and cognitive accuracy between those who did and did not sustain a LEMSK injury after concussion. The LEMSK group demonstrated a conservative gait strategy both before and after their concussive injury.
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Caccese JB, Santos FV, Yamaguchi FK, Buckley TA, Jeka JJ. Persistent Visual and Vestibular Impairments for Postural Control Following Concussion: A Cross-Sectional Study in University Students. Sports Med 2021; 51:2209-2220. [PMID: 33881749 DOI: 10.1007/s40279-021-01472-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine how concussion may impair sensory processing for control of upright stance. METHODS Participants were recruited from a single university into 3 groups: 13 participants (8 women, 21 ± 3 years) between 2 weeks and 6 months post-injury who initiated a return-to-play progression (under physician management) by the time of testing (recent concussion group), 12 participants (7 women, 21 ± 1 years) with a history of concussion (concussion history group, > 1 year post-injury), and 26 participants (8 women, 22 ± 3 years) with no concussion history (control group). We assessed sensory reweighting by simultaneously perturbing participants' visual, vestibular, and proprioceptive systems and computed center of mass gain relative to each modality. The visual stimulus was a sinusoidal translation of the visual scene at 0.2 Hz, the vestibular stimulus was ± 1 mA binaural monopolar galvanic vestibular stimulation (GVS) at 0.36 Hz, the proprioceptive stimulus was Achilles' tendon vibration at 0.28 Hz. RESULTS The recent concussion (95% confidence interval 0.078-0.115, p = 0.001) and the concussion history (95% confidence interval 0.056-0.094, p = 0.038) groups had higher gains to the vestibular stimulus than the control group (95% confidence interval 0.040-0.066). The recent concussion (95% confidence interval 0.795-1.159, p = 0.002) and the concussion history (95% confidence interval 0.633-1.012, p = 0.018) groups had higher gains to the visual stimulus than the control group (95% confidence interval 0.494-0.752). There were no group differences in gains to the proprioceptive stimulus or in sensory reweighting. CONCLUSION Following concussion, participants responded more strongly to visual and vestibular stimuli during upright stance, suggesting they may have abnormal dependence on visual and vestibular feedback. These findings may indicate an area for targeted rehabilitation interventions.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W. 10th Avenue, Columbus, OH, 43210, USA.
| | | | - Felipe K Yamaguchi
- Department of Kinesiology & Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713, USA
| | - Thomas A Buckley
- Department of Kinesiology & Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713, USA
| | - John J Jeka
- Department of Kinesiology & Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713, USA
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Matthews M, Johnston W, Bleakley CM, Davies RJ, Rankin AT, Webb M, Caulfield BC, Archbold H. Concussion History and Balance Performance in Adolescent Rugby Union Players. Am J Sports Med 2021; 49:1348-1354. [PMID: 33729858 PMCID: PMC8020306 DOI: 10.1177/0363546521998709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sports-related concussion is a worldwide problem. There is a concern that an initial concussion can cause prolonged subclinical disturbances to sensorimotor function that increase the risk of subsequent injury. The primary aim of this study was to examine whether a history of sports-related concussion has effects on static and dynamic balance performance in adolescent rugby players. HYPOTHESIS Dynamic balance would be worse in players with a history of concussion compared with those with no history of concussion. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Male adolescent rugby players aged 14 to 18 years from 5 schools were recruited before the start of the 2018-2019 playing season. Participants completed questionnaires and physical tests, including dynamic Y balance and single-leg static balance (eyes closed) tests, while performing single and dual tasks. Dynamic balance was assessed using inertial sensor instrumentation. Dependent variables were normalized reach distance and the sample entropy (SEn) of the 3 axes (x, y, and z). RESULTS Of the 195 participants, 100 reported a history of concussion. Those with a history of concussion demonstrated higher SEn in all directions, with highest values during anterior (standardized mean difference [SMD], 0.4; 95% CI, 0.0-0.7; P = .027) and posteromedial (SMD, 0.5; 95% CI, 0.2-0.9; P = .004) reach directions compared with those with no history. There was no difference between groups (concussion history vs control) in traditional Y balance reach distances in the anterior or posteromedial directions or single-leg static balance during both single- (P = .47) and dual-task (P = .67) conditions. CONCLUSION Adolescent rugby union athletes with a history of concussion had poorer dynamic balance during performance tasks compared with healthy controls. Static single-leg balance tests, either single or dual task, may not be sensitive enough to detect sensorimotor deficits in those with a history of concussion.
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Affiliation(s)
- Mark Matthews
- Sports and Exercise Science Research
Institute, Ulster University, Belfast, UK,Mark Matthews, PhD, Sport
and Exercise Science Research Institute, Ulster University, Belfast, BT370QB, UK
() (Twitter: @Mark_MatthewsNZ)
| | - William Johnston
- School of Public Health, Physiotherapy
and Sports Science, University College Dublin, Dublin, Ireland,Insight Centre for Data Analytics,
University College Dublin, Dublin, Ireland
| | | | | | | | | | - Brian C. Caulfield
- School of Public Health, Physiotherapy
and Sports Science, University College Dublin, Dublin, Ireland,Insight Centre for Data Analytics,
University College Dublin, Dublin, Ireland
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Burke T, Rooney B. Multi-Modal Dual-Task Measurement: A New Virtual Reality for Assessment. Front Psychol 2021; 11:635413. [PMID: 33679500 PMCID: PMC7933656 DOI: 10.3389/fpsyg.2020.635413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tom Burke
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Brendan Rooney
- School of Psychology, University College Dublin, Dublin, Ireland
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37
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Van Deventer KA, Seehusen CN, Walker GA, Wilson JC, Howell DR. The diagnostic and prognostic utility of the dual-task tandem gait test for pediatric concussion. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:131-137. [PMID: 32795624 PMCID: PMC7987555 DOI: 10.1016/j.jshs.2020.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND The tandem gait test has gained interest recently for assessment of concussion recovery. The purpose of our study was to determine the prognostic and diagnostic use of the single- and dual-task tandem gait test, alongside other clinical measures, within 10 days of pediatric concussion. METHODS We assessed 126 patients post-concussion (6.3 ± 2.3 days post-injury, mean ± SD) at a pediatric sports medicine clinic and compared them to 58 healthy controls (age: 15.6 ± 1.3 years; 43% female). We also compared the 31 patients with concussion who developed persistent post-concussion symptoms (PPCS) (age = 14.9 ± 2.0 years; 48% female) to the 81 patients with concussion who did not develop PPCS following the initial assessment (age: 14.1 ± 3.0 years; 41% female). All subjects completed a test battery, and concussion patients were monitored until they experienced concussion-symptom resolution. The test battery included tandem gait (single-task, dual-task (performing tandem gait while concurrently completing a cognitive test) conditions), modified Balance Error Scoring System (mBESS), and concussion symptom assessment (Health and Behavior Inventory). We defined PPCS as symptom resolution time > 28 days post-concussion for the concussion group. Measurement outcomes included tandem gait time (single- and dual-task), dual-task cognitive accuracy, mBESS errors (single/double/tandem stances), and symptom severity. RESULTS The concussion group completed the single-task (mean difference = 9.1 s, 95% confidential interval (95%CI): 6.1-12.1) and dual-task (mean difference = 12.7 s, 95%CI: 8.7-16.8) tandem gait test more slowly than the control group. Compared to those who recovered within 28 days of concussion, the PPCS group had slower dual-task tandem gait test times (mean difference = 7.9 s, 95%CI: 2.0-13.9), made more tandem-stance mBESS errors (mean difference = 1.3 errors, 95%CI: 0.2-2.3), and reported more severe symptoms (mean difference = 26.6 Health and Behavior Inventory rating, 95%CI: 21.1-32.6). CONCLUSION Worse dual-task tandem gait test time and mBESS tandem stance performance predicted PPCS in pediatric patients evaluated within 10 days of concussion. Tandem gait assessments may provide valuable information augmenting common clinical practices for concussion management.
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Affiliation(s)
| | - Corrine N Seehusen
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Gregory A Walker
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO 80045, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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Lempke LB, Lynall RC, Hoffman NL, Devos H, Schmidt JD. Slowed driving-reaction time following concussion-symptom resolution. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:145-153. [PMID: 32961301 PMCID: PMC7987557 DOI: 10.1016/j.jshs.2020.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/09/2020] [Accepted: 08/21/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Concussed patients have impaired reaction time (RT) and cognition following injury that may linger and impair driving performance. Limited research has used direct methods to assess driving-RT post-concussion. Our study compared driving RT during simulated scenarios between concussed and control individuals and examined driving-RT's relationship with traditional computerized neurocognitive testing (CNT) domains. METHODS We employed a cross-sectional study among 14 concussed (15.9 ± 9.8 days post-concussion, mean ± SD) individuals and 14 healthy controls matched for age, sex, and driving experience. Participants completed a driving simulator and CNT (CNS Vital Signs) assessment within 48 h of symptom resolution. A driving-RT composite (ms) was derived from 3 simulated driving scenarios: stoplight (green to yellow), evasion (avoiding approaching vehicle), and pedestrian (person running in front of vehicle). The CNT domains included verbal and visual memory; CNT-RT (simple-, complex-, Stroop-RT individually); simple and complex attention; motor, psychomotor, and processing speed; executive function; and cognitive flexibility. Independent t tests and Hedge d effect sizes assessed driving-RT differences between groups, Pearson correlations (r) examined driving RT and CNT domain relationships among cohorts separately, and p values were controlled for false discovery rate via Benjamini-Hochberg procedures (α = 0.05). RESULTS Concussed participants demonstrated slower driving-RT composite scores than controls (mean difference = 292.86 ms; 95% confidence interval (95%CI): 70.18-515.54; p = 0.023; d = 0.992). Evasion-RT (p = 0.054; d = 0.806), pedestrian-RT (p = 0.258; d = 0.312), and stoplight-RT (p = 0.292; d = 0.585) outcomes were not statistically significant after false-discovery rate corrections but demonstrated medium to large effect sizes for concussed deficits. Among concussed individuals, driving-RT outcomes did not significantly correlate with CNT domains (r-range: -0.51 to 0.55; p > 0.05). No correlations existed between driving-RT outcomes and CNT domains among control participants either (r-range: -0.52 to 0.72; p > 0.05). CONCLUSION Slowed driving-RT composite scores and large effect sizes among concussed individuals when asymptomatic signify lingering impairment and raise driving-safety concerns. Driving-RT and CNT-RT measures correlated moderately but not statistically, which indicates that CNT-RT is not an optimal surrogate for driving RT.
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Affiliation(s)
- Landon B Lempke
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA
| | - Nicole L Hoffman
- School of Kinesiology and Recreation, Illinois State University, Normal, IL 61790, USA
| | - Hannes Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA.
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The Influence of Cognitive Dual Tasks on Concussion Balance Test Performance. Motor Control 2021; 25:252-263. [PMID: 33567406 DOI: 10.1123/mc.2020-0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the influence of a cognitive dual task on postural sway and balance errors during the Concussion Balance Test (COBALT). METHODS Twenty healthy adults (12 females, eight males; aged 21.95 ± 3.77 years; height = 169.95 ± 9.95 cm; weight = 69.58 ± 15.03 kg) partook in this study and completed single- and dual-task versions of a reduced COBALT. RESULTS Sway velocity decreased during dual-task head rotations on foam condition (p = .021, ES = -0.57). A greater number of movement errors occurred during dual-task head rotations on firm surface (p = .005, ES = 0.71), visual field flow on firm surface (p = .008, ES = 0.68), and head rotations on foam surface (p < .001, ES = 1.61) compared with single-task conditions. Cognitive performance was preserved throughout different sensory conditions of the COBALT (p = .985). DISCUSSION Cognitive dual tasks influenced postural control and destabilized movements during conditions requiring advanced sensory integration and reweighting demands. Dual-task versions of the COBALT should be explored as a clinical tool to identify residual deficits past the acute stages of concussion recovery.
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Single- Versus Dual-Task Functional Movement Paradigms: A Biomechanical Analysis. J Sport Rehabil 2021; 30:774-785. [PMID: 33494045 DOI: 10.1123/jsr.2020-0310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Laboratory-based movement assessments are commonly performed without cognitive stimuli (ie, single-task) despite the simultaneous cognitive processing and movement (ie, dual task) demands required during sport. Cognitive loading may critically alter human movement and be an important consideration for truly assessing functional movement and understanding injury risk in the laboratory, but limited investigations exist. OBJECTIVE To comprehensively examine and compare kinematics and kinetics between single- and dual-task functional movement among healthy participants while controlling for sex. DESIGN Cross-sectional study. SETTING Laboratory. Patients (or Other Participants): Forty-one healthy, physically active participants (49% female; 22.5 ± 2.1 y; 172.5 ± 11.9 cm; 71.0 ± 13.7 kg) enrolled in and completed the study. INTERVENTION(S) All participants completed the functional movement protocol under single- and dual-task (subtracting by 6s or 7s) conditions in a randomized order. Participants jumped forward from a 30-cm tall box and performed (1) maximum vertical jump landings and (2) dominant and (3) nondominant leg, single-leg 45° cuts after landing. MAIN OUTCOME MEASURES The authors used mixed-model analysis of variances (α = .05) to compare peak hip, knee, and ankle joint angles (degrees) and moments (N·m/BW) in the sagittal and frontal planes, and peak vertical ground reaction force (N/BW) and vertical impulse (Ns/BW) between cognitive conditions and sex. RESULTS Dual-task resulted in greater peak vertical ground reaction force compared with single-task during jump landing (mean difference = 0.06 N/BW; 95% confidence interval [CI], 0.01 to 0.12; P = .025) but less force during dominant leg cutting (mean difference = -0.08 N/BW; 95% CI, -0.14 to -0.02; P = .015). Less hip-flexion torque occurred during dual task than single task (mean difference = -0.09 N/BW; 95% CI, -0.17 to -0.02). No other outcomes were different between single and dual task (P ≥ .053). CONCLUSIONS Slight, but potentially important, kinematic and kinetic differences were observed between single- and dual-task that may have implications for functional movement assessments and injury risk research. More research examining how various cognitive and movement tasks interact to alter functional movement among pathological populations is warranted before clinical implementation.
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Burke T, Rooney B. Multi-Modal Dual-Task Measurement: A New Virtual Reality for Assessment. Front Psychol 2021. [DOI: 10.3389/fpsyg.2021.635413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gait Assessment in College Athletes: Do Concussion History, Symptoms, Gender, and Type of Sport Matter? J Sport Rehabil 2021; 30:988-999. [PMID: 33418540 DOI: 10.1123/jsr.2019-0331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/20/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Though previous research has focused on examining the effects of concussion history using a dual-task paradigm, the influence of factors like symptoms (unrelated to concussion), gender, and type of sport on gait in college athletes is unknown. OBJECTIVE To examine the effect of concussion history, symptoms, gender, and type of sport (noncontact/limited contact/contact) individually on gait among college athletes. DESIGN Exploratory cross-sectional study. SETTING Laboratory. PARTICIPANTS In total, 98 varsity athletes (age, 18.3 [1.0] y; height, 1.79 [0.11] m; mass, 77.5 [19.2] kg; 27 with concussion history, 58 reported at least one symptom, 44 females; 8 played noncontact sports and 71 played contact sports) walked under single- and dual-task (walking while counting backward by 7) conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dual-task cost (DTC; % difference between single task and dual task) of gait speed, cadence, step length and width, percentage of swing and double-support phases, symptom score, and total symptom severity score. Independent samples t tests and 1-way analysis of variance were conducted (α value = .05). RESULTS Self-reported concussion history resulted in no significant differences (P > .05). Those who reported symptoms at testing time showed significantly greater DTC of step length (mean difference [MD], 2.7%; 95% confidence interval [CI], 0.3% to 5.1%; P = .012), % of swing phase (MD, 1.0%; 95% CI, -0.2 to 2.1%; P = .042), and % of double-support phase (MD, 3.9%; 95% CI, 0.2% to 7.8%; P = .019). Females demonstrated significantly higher DTC of gait speed (MD, 5.3%; 95% CI, 1.3% to 9.3%; P = .005), cadence (MD, 4.0%; 95% CI, 1.4% to 6.5%; P = .002), % of swing phase (MD, 1.2%; 95% CI, 0.1% to 2.3%; P = .019), and % of double-support phase (MD, 4.1%; 95% CI, 0.4% to 7.9%; P = .018). Noncontact sports athletes had significantly greater step width DTC than contact sports athletes (MD, 14.2%; 95% CI, 0.9% to 27.6%; P = .032). CONCLUSIONS Reporting symptoms at testing time may influence gait under dual-task conditions. Additionally, female athletes showed more gait changes during a dual task. Sports medicine professionals should be aware that these variables, while unrelated to injury, may affect an athlete's gait upon analysis.
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Dugan EL, Shilt JS, Masterson CM, Ernest KM. The use of inertial measurement units to assess gait and postural control following concussion. Gait Posture 2021; 83:262-267. [PMID: 33220659 DOI: 10.1016/j.gaitpost.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/04/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Impairments in gait and balance function are typical after concussion. There is evidence that these neuromuscular deficits persist past the typical time of symptom resolution. The ability to quantify these changes in gait and balance may provide useful information when making return to play decisions in clinical settings. RESEARCH QUESTION Are changes in gait function and postural control evident across the course of a concussion management program? METHODS A retrospective analysis of a convenience sample of 38 patients who were seen for concussion between October 2017 and May 2019 was performed. Gait and balance measures were assessed at their initial clinic visit post-injury and at their clearance visit using inertial measurement units. During dual-task walking trials, the medial-lateral motion of the center of mass and gait velocity were measured. Postural sway complexity and jerk index were measured during both eyes-open and eyes-closed balance trials. RESULTS Paired samples t-tests and Wilcoxon signed rank tests were used to determine whether statistically significant changes occurred for the gait and balance variables, respectively. Medial-lateral sway decreased (4.4 ± 1.3 cm to 4.0 ± 1.2 cm, p = 0.018) and gait velocity increased (0.78 ± 0.23 m/s to 0.91 ± 0.18 m/s, p < 0.001) from initial to clearance testing. Jerk index decreased (6.41 ± 11.06 m2/s5 to 5.73 ± 4.28 m2/s5, p = 0.031) and (11.87 ± 26.42 m2/s5 to 7.87 ± 8.38 m2/s5, p = 0.003) from initial to clearance testing for the eyes-open and eyes-closed conditions, respectively. Complexity index increased (2.38 ± 1.08-2.86 ± 0.72, p = 0.010) from initial to clearance testing for the eyes-closed condition. There was no change in complexity index for the eyes-open condition. SIGNIFICANCE These preliminary results support the potential use of measures of gait and postural control to assess recovery following a concussion in a clinical setting.
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Affiliation(s)
- Eric L Dugan
- Texas Children's Hospital, The Woodlands, TX 77384, USA; Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Jeffrey S Shilt
- Texas Children's Hospital, The Woodlands, TX 77384, USA; Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Kristin M Ernest
- Texas Children's Hospital, The Woodlands, TX 77384, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
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Howell DR, Oldham J, Lanois C, Koerte I, Lin AP, Berkstresser B, Wang F, Meehan WP. Dual-Task Gait Recovery after Concussion among Female and Male Collegiate Athletes. Med Sci Sports Exerc 2020; 52:1015-1021. [PMID: 31985574 DOI: 10.1249/mss.0000000000002225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Few studies have investigated recovery between sexes using objective outcome measures. Our purpose was to examine the independent association between biological sex and recovery of postconcussion gait among collegiate athletes. METHODS We evaluated participants with a diagnosed concussion <7 d postinjury, and approximately 1.5 months and 3.5 months postinjury. Participants completed a single/dual-task gait evaluation and symptom inventory. During dual-task trials, they completed a mental task (backward subtraction, spelling, or month recitation). The primary outcome measure was height-adjusted gait velocity recovery, defined as achieving normal gait velocity using established values: >0.56 and >0.50 gait velocity (m·s)/height (m) under single and dual-task conditions, respectively. We used a multivariable Cox proportional hazard model to identify associations between sex and dual-task recovery, controlling for age, concussion history, symptom severity, and loss of consciousness at the time of injury. RESULTS Ninety-four individuals participated in the study: 47 (50%) were female athletes (mean age = 20.1, SD = 1.3 yr) and 47 (50%) were male athletes (mean age = 20.3, SD = 1.3 yr). Sex was not independently associated with height-adjusted single-task gait velocity recovery after controlling for potential confounders (hazard ratio = 1.62, 95% confidence interval = 0.87-3.01). However, male sex was independently associated with longer dual-task gait recovery time after controlling for potential confounders (hazard ratio = 2.43, 95% confidence interval = 1.11-5.35). CONCLUSION Male athletes required a longer duration of time after concussion to achieve dual-task gait recovery than female athletes. Thus, functional dual-task abilities after concussion may be affected differentially by sex and should be accounted for within individualized concussion management strategies.
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Affiliation(s)
| | | | | | | | - Alexander P Lin
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Francis Wang
- Harvard University Health Service, Cambridge, MA
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D'Silva L, Devos H, Hunt SL, Chen J, Smith D, Rippee MA. Concussion symptoms experienced during driving may influence driving habits. Brain Inj 2020; 35:59-64. [PMID: 33297775 DOI: 10.1080/02699052.2020.1857839] [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] [Indexed: 12/16/2022]
Abstract
Objective: To examine the symptoms experienced and the change in driving habits in individuals with concussion.Materials and methods: A survey was created by a team of rehabilitation professionals who see persons with concussion in their clinics. The survey captured demographics, mechanism of injury, date of injury, symptoms experienced during driving, if drivers felt safe when driving, and changes in driving habits since the concussion. Non-parametric tests were used to compare symptoms experienced and driving habits across three groups which were created based on time since injury.Results: Of the 140 participants, 74% (104/140) had resumed driving after concussion; of these 27% (28/104) reported that they felt unsafe while driving. Forty-four per cent (46/104) experienced symptoms while driving, of which headache, and difficulty concentrating were the most common symptoms experienced throughout the concussion spectrum (acute to chronic phase). Most drivers (78/104, 75%) with concussion had changed their driving habits by driving less often and shorter distances, and by avoiding nighttime driving and heavy traffic areas.Conclusions: Headache and concentration problems were experienced by drivers regardless of the time since injury. Most drivers had made changes to their driving habits. Clinicians should consider the symptom burden patients experience and discuss driving restrictions to ensure driving safety.
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Affiliation(s)
- L D'Silva
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas, USA
| | - H Devos
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas, USA
| | - S L Hunt
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas, USA
| | - J Chen
- Center for Concussion Management, University of Kansas Health System, Kansas City, Kansas, USA
| | - D Smith
- Center for Concussion Management, University of Kansas Health System, Kansas City, Kansas, USA
| | - M A Rippee
- Center for Concussion Management, University of Kansas Health System, Kansas City, Kansas, USA
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Dual-Task Gait Stability after Concussion and Subsequent Injury: An Exploratory Investigation. SENSORS 2020; 20:s20216297. [PMID: 33167407 PMCID: PMC7663806 DOI: 10.3390/s20216297] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022]
Abstract
Persistent gait alterations can occur after concussion and may underlie future musculoskeletal injury risk. We compared dual-task gait stability measures among adolescents who did/did not sustain a subsequent injury post-concussion, and uninjured controls. Forty-seven athletes completed a dual-task gait evaluation. One year later, they reported sport-related injuries and sport participation volumes. There were three groups: concussion participants who sustained a sport-related injury (n = 8; age =15.4 ± 3.5 years; 63% female), concussion participants who did not sustain a sport-related injury (n = 24; 14.0 ± 2.6 years; 46% female), and controls (n = 15; 14.2 ± 1.9 years; 53% female). Using cross-recurrence quantification, we quantified dual-task gait stability using diagonal line length, trapping time, percent determinism, and laminarity. The three groups reported similar levels of sports participation (11.8 ± 5.8 vs. 8.6 ± 4.4 vs. 10.9 ± 4.3 hours/week; p = 0.37). The concussion/subsequent injury group walked slower (0.76 ± 0.14 vs. 0.65 ± 0.13 m/s; p = 0.008) and demonstrated higher diagonal line length (0.67 ± 0.08 vs. 0.58 ± 0.05; p = 0.02) and trapping time (5.3 ± 1.5 vs. 3.8 ± 0.6; p = 0.006) than uninjured controls. Dual-task diagonal line length (hazard ratio =1.95, 95% CI = 1.05–3.60), trapping time (hazard ratio = 1.66, 95% CI = 1.09–2.52), and walking speed (hazard ratio = 0.01, 95% CI = 0.00–0.51) were associated with subsequent injury. Dual-task gait stability measures can identify altered movement that persists despite clinical concussion recovery and is associated with future injury risk.
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Corwin DJ, McDonald CC, Arbogast KB, Mohammed FN, Metzger KB, Pfeiffer MR, Patton DA, Huber CM, Margulies SS, Grady MF, Master CL. Clinical and Device-based Metrics of Gait and Balance in Diagnosing Youth Concussion. Med Sci Sports Exerc 2020; 52:542-548. [PMID: 31524833 DOI: 10.1249/mss.0000000000002163] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Evaluate the discriminatory ability of two clinical measures and one device-based measure of gait and balance for concussed youth. METHODS We enrolled 81 cases and 90 controls age 14-18 yr old from August 2017 to June 2018. Controls were recruited from a suburban high school, and cases were recruited from the concussion program of an academic pediatric tertiary care center. Tests included two clinical measures: 1) complex tandem gait, scored as sway/errors walking forward and backward eyes open and closed; 2) Modified Balance Error Scoring System (mBESS), scored as total number of errors on three standing tasks; and one device-based measure; 3) Modified Clinical Test of Sensory Interaction and Balance (mCTSIB) using the Biodex Biosway Balance System, scored as a sway index. Sensitivity, specificity, ideal cutpoint, and area under the receiver operating characteristic curve (AUC) were calculated for all test components. RESULTS Ideal cutpoint for total number of sway/errors for tandem gait = 5, sensitivity 41%, specificity 90%. Ideal cutpoint for total mBESS errors = 4, sensitivity 55%, specificity 75%. Ideal cutpoint for mCTSIB = 1.37, sensitivity 37%, specificity 88%. Among each test, some individual components outperformed overall composites, in particular tandem gait (specificity forward eyes open = 99%, sensitivity backward eyes closed = 81%). Among the 40 cases and 65 controls with all three assessments, AUC (95% CI) for tandem gait = 0.63 (0.52,0.75), mBESS = 0.70 (0.60,0.81), and mCTSIB = 0.54 (0.42,0.66). CONCLUSIONS A device-based measure of balance did not produce better discriminatory ability than two clinical assessments. Complex tandem gait has the additional benefit of being an easy-to-perform and graded test with highly sensitive and specific individual components.
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Affiliation(s)
| | | | | | - Fairuz N Mohammed
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Melissa R Pfeiffer
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Declan A Patton
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Colin M Huber
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
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Aumen AM, Oberg KJ, Mingils SM, Berkner CB, Tracy BL, Stephens JA. Revised and Neuroimaging-Compatible Versions of the Dual Task Screen. J Vis Exp 2020. [PMID: 33074251 DOI: 10.3791/61678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Dual task paradigms simultaneously assess motor and cognitive abilities, and they can detect subtle, residual impairments in athletes with recent mild traumatic brain injury (mTBI). However, past dual task paradigms have focused solely on lower extremity skills and have relied on cumbersome, expensive laboratory equipment - thus limiting their practicality for everyday mTBI evaluation. Subsequently, we developed the Dual Task Screen (DTS), which takes <10 minutes to administer and score, uses low-cost portable equipment, and includes lower extremity (LE) and upper extremity (UE) subtasks. The purpose of this manuscript was twofold. First, we describe the administration protocol for the revised DTS, which we revised to address the limitations of the original DTS. Specifically, the revisions included additions of smart devices to acquire more detailed gait data and inclusion of single cognitive conditions to test for disrupted cognitive performance under dual task conditions. Importantly, the revised DTS is a measure intended for future clinical use, and we present representative results from three male athletes to illustrate the type of clinical data that can be acquired from the measure. Importantly, we have yet to evaluate the sensitivity and specificity of the revised DTS in athletes with mTBI, which is the next research initiative. The second purpose of this manuscript is to describe a neuroimaging-compatible version of the DTS. We developed this version so we could evaluate the neural underpinnings of single and dual task performance, for a better empirical understanding of the behavioral deficits associated with mTBI. Thus, this manuscript also describes the steps we took to enable simultaneous functional near-infrared spectroscopy (fNIRS) measurement during the DTS, along with how we acquired and completed first-level processing of the fNIRS data.
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Affiliation(s)
- Allan M Aumen
- Molecular Cellular and Integrative Neuroscience Program, Colorado State University
| | - Kelly J Oberg
- Molecular Cellular and Integrative Neuroscience Program, Colorado State University
| | | | | | - Brian L Tracy
- Dept. of Health and Exercise Science, Colorado State University
| | - Jaclyn A Stephens
- Molecular Cellular and Integrative Neuroscience Program, Colorado State University; Dept. of Occupational Therapy, Colorado State University;
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Reilly N, Prebor J, Moxey J, Schussler E. Chronic impairments of static postural stability associated with history of concussion. Exp Brain Res 2020; 238:2783-2793. [DOI: 10.1007/s00221-020-05934-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/24/2020] [Indexed: 01/20/2023]
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A Proposal for Complex Gait Evaluation Using Dual-Task Gait Termination Time. J Sport Rehabil 2020; 30:525-530. [PMID: 32963127 DOI: 10.1123/jsr.2020-0080] [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] [Received: 02/18/2020] [Revised: 08/02/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Gait termination time (GTT) has been used to predict falls in older adults but has not been explored in the sport rehabilitation setting. The incorporation of a concurrent cognitive task as a complex measure of gait in this clinical population could lead to better health-related outcomes. OBJECTIVE To compare the effect of planned and unplanned gait termination with and without a concurrent cognitive task on reaction time (RT), gait velocity, and GTT. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Twenty young adults (females 60.0%, age 20.1 [0.9] y, height 169.5 [8.8] cm, mass 67.4 [10.8] kg). INTERVENTION Participants completed 6 planned and 6 unplanned gait termination trials on an instrumented gait mat with and without a cognitive task. MAIN OUTCOME MEASURES The authors measured RT (s), gait velocity (m/s), GTT (s), and normalized GTT (s2/m). A 2 (motor) × 2 (cognitive) repeated-measures analysis of variance (α = .05) was used; significant interaction effects were explored using Bonferroni-corrected t tests (α < .008). RESULTS Participants walked more slowly during dual-task trials compared with single-task trials (F1,19 = 4.401, P = .050). Participants walked significantly more slowly with a cognitive task during planned (P < .001, mean difference = -0.184 m/s, 95% CI, -0.256 to -0.111) and unplanned (P = .001, mean difference = -0.111 m/s, 95% CI, -0.173 to -0.050) gait termination. Participants walked significantly more slowly (P < .001, mean difference = -0.142 m/s, 95% CI, -0.210 to -0.075) when performing the most difficult task, unplanned termination with a cognitive task, than when performing the least difficult task, planned termination with no cognitive task. We observed a cognitive task main effect such that adding a cognitive task increased RT (F1,19 = 16.375, P = .001, mean difference = -0.118 s, 95% CI, -0.178 to -0.057) and slowed normalized GTT (F1,19 = 5.655, P = .028, mean difference = -0.167 s2/m, 95% CI, -0.314 to -0.020). CONCLUSIONS Overall, participants displayed more conservative gait strategies and slower RT, normalized GTT, and gait velocity as task difficulty increased. More investigation is needed to truly understand the clinical meaningfulness of these measures in athletic injuries.
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