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Mooney J, Cochrane GD, Gould S. Relationship Between Sensory Organization Testing Scores With Lower Extremity Injuries and Prior Concussion in Professional Soccer Players. Clin J Sport Med 2023; 33:246-251. [PMID: 36626305 PMCID: PMC10191870 DOI: 10.1097/jsm.0000000000001104] [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: 06/15/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate for associations between concussion history or lower extremity (LE) injury and computerized sensory organization testing (SOT) performance in professional soccer players. DESIGN Cross-sectional study. SETTING Tertiary care center. PARTICIPANTS Thirty-three, professional, male soccer players on an American club, between the years 2019 and 2021. ASSESSMENT OF RISK FACTORS Player age, history of reported LE injury (gluteal, hamstring, ankle, knee, hip, groin, and sports hernia), history of diagnosed concussion, and the number of prior concussions were documented for each player. MAIN OUTCOME MEASURES Baseline SOT of postural sway was conducted in 6 sensory conditions for all players. RESULTS Eleven athletes (33%) reported a previous concussion, and 15 (45%) reported a previous LE injury. There were no significant differences in SOT scores between those with and without a previous diagnosis of concussion ( P > 0.05). Those reporting a previous LE injury performed better on condition 3 (eyes open, unstable visual surround) than those who did not ( P = 0.03). Athletes aged 25 years or younger performed worse on condition 3 ( P = 0.01) and had worse, although not statistically significant, median performance on all other balance measures than those older than 25 years. Intraclass correlation coefficient for repeat SOT assessment was 0.58, indicating moderate reliability, without an evident practice effect. CONCLUSIONS Professional soccer players with a previous concussion or history of LE injury did not demonstrate long-term deficits in postural control, as assessed by multiyear computerized SOT baseline testing. The SOT was reliable over time with younger athletes exhibiting greater postural sway than older athletes.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, AL
| | - Graham D. Cochrane
- NIH Medical Scientist Training Program, University of Alabama at Birmingham Heersink School of Medicine, UAB, Birmingham, AL, USA
| | - Sara Gould
- Department of Orthopedic Surgery, University of Alabama at Birmingham, AL
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2
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Saalfield J, Piersol KL, Monaco R, Womack J, Weismiller SA, Esopenko C, Todaro SM, Conway FN, Brostrand K, Buckman JF. Comparison of Concurrent and Same-Day Balance Measurement Approaches in a Large Sample of Uninjured Collegiate Athletes. Int J Sports Phys Ther 2022; 17:228-236. [PMID: 35136692 PMCID: PMC8805106 DOI: 10.26603/001c.31178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Measures of postural stability are useful in assisting the diagnosing and managing of athlete concussion. Error counting using the Balance Error Scoring System (BESS) is the clinical standard, but has notable limitations. New technologies offer the potential to increase precision and optimize testing protocols; however, whether these devices enhance clinical assessment remains unclear. PURPOSE To examine the relationships between metrics of balance performance using different measurement systems in uninjured, healthy collegiate athletes. STUDY DESIGN Cross-sectional. METHODS Five hundred and thirty uninjured collegiate athletes were tested using the C3Logix app, which computes ellipsoid volume as a measure of postural stability during the six standard BESS conditions, while concurrently, errors were manually counted during each condition per standard BESS protocols. The association between concurrently measured ellipsoid volumes and error counts were examined with Spearman's correlations. From this sample, 177 participants also performed two double-leg conditions on the Biodex BioSway force plate system on the same day. This system computes Sway Index as a measure of postural stability. The association of ellipsoid volume (C3Logix) and Sway Index (Biodex) was examined with Spearman's correlations. Individual-level data were plotted to visually depict the relationships. RESULTS C3Logix ellipsoid volume and concurrently recorded error counts were significantly correlated in five of the six BESS conditions (rs:.22-.62; p< 0.0001). C3Logix ellipsoid volume and Biodex Sway Index were significantly correlated in both conditions (rs=.22-.27, p< 0.004). However, substantial variability was shown in postural stability across all three measurement approaches. CONCLUSION Modest correlation coefficients between simultaneous and same-day balance assessments in uninjured collegiate athletes suggest a need to further optimize clinical protocols for concussion diagnosis. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Jessica Saalfield
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
| | - Kelsey L Piersol
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
| | | | - Jason Womack
- Department of Family Medicine & Community Health, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA; Department of Athletics, Rutgers University, New Brunswick, NJ, USA
| | - Scott A Weismiller
- Dept. of Internal Medicine, Penn State Health, Milton S. Hersey Medical Center, Hershey, PA, US
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Sabrina M Todaro
- Center of Alcohol and Substance Use Studies, Rutgers University, New Brunswick, NJ, USA
| | - Fiona N Conway
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Kyle Brostrand
- Robert Wood Johnson Barnabas Health - Rutgers Sports Medicine, Rutgers University, New Brunswick, NJ, USA
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA; Center of Alcohol and Substance Use Studies, Rutgers University, New Brunswick, NJ, USA
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Pieroth EM. Assessment and Management of Persistent Post-Concussion Symptoms. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sweeny M, Habib Perez O, Inness EL, Danells C, Chandra T, Foster E, Comper P, Bayley M, Mochizuki G. The Toronto concussion study: a cross-sectional analysis of balance deficits following acute concussion in community-dwelling adults. Brain Inj 2021; 35:587-595. [PMID: 33734923 DOI: 10.1080/02699052.2021.1891288] [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] [Indexed: 10/21/2022]
Abstract
Objective: To characterize balance deficits in community-dwelling adults following acute concussion.Design: Cross-sectional observational study.Methods: Individuals with acute concussion (n=100) and healthy controls (n=20) completed the BESS (Balance Error Scoring System) and quiet standing trials on forceplates with the eyes open, closed, or during a cognitive dual task. BESS score and centre-of-pressure root mean square and high-frequency power (0.4-3Hz) were used to characterize group differences. In a secondary analysis, participants were subdivided based on self-reported symptoms of balance problems and dizziness using the SCAT-3 (Sport Concussion Assessment Tool - Third Edition) Symptom Checklist.Results: In comparing individuals with concussion and controls, BESS score (16.0 ± 6.0 vs 12.6 ± 3.8; F(1,116) = 5.814, p = .017) and anteroposterior [F(1.78, 204.2) = 11.93, p < .001] and mediolateral [F(1, 114) = 10.05, p = .002] high-frequency power revealed significant group differences. Dividing individuals based on self-reported symptoms revealed significant differences in mediolateral high frequency power, such that participants reporting balance and dizziness problems as well as those participants not reporting balance or dizziness symptoms following concussion were less stable than controls.Conclusions: Deficits in clinical and posturographic measures of balance occur in community-dwelling adults with concussion. These measures do not align with self-reported balance symptoms. Future research and clinical practice aimed at careful selection of optimized balance assessment is recommended.
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Affiliation(s)
- Michelle Sweeny
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Olinda Habib Perez
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cynthia Danells
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tharshini Chandra
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada
| | - Evan Foster
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - George Mochizuki
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada.,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
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5
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Normative values for the Sensory Organization Test in an active duty military cohort. Gait Posture 2021; 85:31-37. [PMID: 33513530 DOI: 10.1016/j.gaitpost.2021.01.014] [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: 02/26/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computerized dynamic posturography is commonly used to assess balance in service members, but normative values for the military population have not been established. RESEARCH QUESTION What are the normative values for the Motor Control Test (MCT), Sensory Organization Test (SOT) and the enhanced SOT (eSOT) within the military population and at which point do they differ? METHODS Cross-sectional study. 237 active duty service members (78 % male) completed the MCT, SOT and the eSOT with the sway manipulated at a gain of 1.2, 1.4, 1.6, 1.8, or 2.0. A Mann-Whitney U test was used to compare the means of men and women for the SOT and MCT composite scores. A Kruskal-Wallis H test was used to compare the means of age groups for the SOT composite score. An independent t-test was used to compare the SOT composite scores from our military population to the manufacturer's normative (civilian) data. The means and standard deviations for the eSOT scores were reported for each gain. Paired-samples t-tests were performed to compare the SOT composite score with the eSOT composite score for each level of gain. RESULTS There was no difference between SOT composite scores for men and women (Mann-Whitney U = 4363.50, p = 0.19) or among age groups (Kruskal-Wallis = 2.77, p = 0.25). The mean SOT composite scores were not different from the manufacturer's normative values (p = 0.155). SOT composite scores were significantly higher than eSOT composite scores for gains of 1.4 (t = 3.16, p = 0.003), 1.6 (t = 5.73, p < 0.001), 1.8 (t = 5.26, p < 0.001) and 2.0 (t = 5.89, p < 0.001). MCT composite scores were lower in the 18-26 year old than the 36-45 year old age group (p = 0.013). SIGNIFICANCE This study establishes normative values for the MCT, SOT and eSOT in active duty military service members. The results suggest that the manufacturer's normal values are appropriate for making judgments about the postural stability of service members.
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Mang CS, Whitten TA, Cosh MS, Dukelow SP, Benson BW. Assessment of Postural Stability During an Upper Extremity Rapid, Bimanual Motor Task After Sport-Related Concussion. J Athl Train 2020; 55:1160-1173. [PMID: 33064821 DOI: 10.4085/1062-6050-378-19] [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: 11/09/2022]
Abstract
CONTEXT Sport-related concussion (SRC) often presents with multidimensional and subtle neurologic deficits that are difficult to detect with standard clinical tests. New assessment approaches that efficiently quantify deficits across multiple neurologic domains are needed. OBJECTIVE To quantify impairments in postural movements during an assessment of rapid, bimanual motor ability in athletes within 10 days of experiencing an SRC and evaluate relationships between impairments in upper extremity and postural performance. DESIGN Cohort study. SETTING Sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS Initial baseline assessments were completed for 711 athletes. Seventy-five athletes (age = 15.8 ± 3.3 years at baseline) sustained SRCs and were reassessed within 10 days. Seventy-eight athletes (age = 15.5 ± 2.0 years) completed 2 assessments in a healthy state. MAIN OUTCOME MEASURE(S) Athletes stood on force plates and performed a rapid, bimanual motor task, termed the object-hit task, delivered using a Kinesiological Instrument for Normal and Altered Reaching Movements endpoint robot. Measures of postural stability that quantified center-of-pressure movements and measures of upper extremity performance were used to characterize task performance. RESULTS Performance changes across assessments were converted to reliable change indices. We observed a difference in reliable change indices values between athletes with SRC and healthy control athletes on the combined postural measures (P = .01). Using measures to evaluate the change in postural movements from the early, easier portion of the task to the later, more difficult portion, we identified the highest levels of impairment (19%-25% of the sample impaired). We also noted a difference between individuals with concussion and healthy individuals on the combined upper extremity measures (P = .003), but these impairments were largely unrelated to those identified in the postural movements. CONCLUSIONS Measurement of postural movements during the object-hit task revealed impairments in postural stability that were not related to impairments in upper extremity performance. The findings demonstrated the benefits of using assessments that simultaneously evaluate multiple domains of neurologic function (eg, upper extremity and postural control) after SRC.
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Affiliation(s)
- Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, SK, Canada
| | - Tara A Whitten
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Madeline S Cosh
- Benson Concussion Institute, Group23 Sports Medicine Clinic, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian W Benson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
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7
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The effects of repetitive head impacts on postural control: A systematic review. J Sci Med Sport 2020; 24:247-257. [PMID: 32948449 DOI: 10.1016/j.jsams.2020.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/24/2020] [Accepted: 09/01/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The purpose of our study was to investigate the association between repetitive head impact (RHI) exposure and postural control. DESIGN Systematic review. METHODS PubMed, Embase and PsycInfo were searched using a self-developed search term including the keywords balance OR postural control AND repetitive OR sub-concussive head impacts. Twenty-one studies excluding non-peer reviewed studies, secondary studies, cross-sectional studies, animal studies, and studies investigating concussion were included for further analyses. We rated Level of Evidence and quality using the Centre for Evidence-Based Medicine tool, the Quality Assessment for the Systematic Review of Effectiveness, and the Sub-concussion Specific Tool. RESULTS All included studies were grouped into Category I and II studies. Category I included trials investigating the effects of controlled soccer heading on postural control (n=8) and Category II studies were cohort studies investigating on-the-field changes between preseason and postseason assessments on postural control measures (n=13). Findings were heterogeneous, with a tendency towards no effects of RHI on clinical postural control measures. Most laboratory studies in Category I used instrumented assessments whereas on-the-field studies in Category II used both instrumented and non-instrumented assessments. CONCLUSIONS Due to heterogeneous findings, future studies aiming to investigate the effects of RHI on different athlete populations are needed on other participant cohorts. Furthermore, the combination of objective clinical balance measures may be a promising approach to accurately measure how, and to what degree, postural control may be affected by RHI.
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Abstract
OBJECTIVES To describe historic baseline session administration practices, to assess the utility of a practice trial (an acclimation trial) before the official balance session, and to examine the within-session reliability of the Sway Balance Mobile Application (SBMA). DESIGN Retrospective observational study. SETTING Middle schools, high schools, and colleges across the United States. PARTICIPANTS More than 17 000 student-athletes were included in the Sway Medical database with 7968 individuals meeting this study's inclusion criteria. INDEPENDENT VARIABLES The Sway Medical database included the following subject characteristics for each student-athlete: age, sex, weight, and height. MAIN OUTCOME MEASURES Balance assessment score generated by the SBMA. RESULTS Variable administration practices with significant differences between baseline session averages across methods were found. Individuals who performed an acclimation trial had a significantly higher baseline session average than those who did not. Within-session reliability estimates were in the low to adequate range (r = 0.53-0.78), with higher estimates found for 2 consecutive baseline tests (r = 0.75-0.78). CONCLUSIONS For maximum clinical utility, a standardized protocol for postural control baseline acquisition is necessary. Acclimation trial should be administered before a baseline session to minimize variability, especially with only 1 to 2 baseline tests. The highest reliability was observed across 2 consecutive baseline tests within the same baseline session. We suggest obtaining baseline balance measurements with an acclimation trial followed by a baseline session with 2 baseline tests. Prospective studies are required for validation.
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9
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Sweeny M, Inness EL, Singer J, Habib Perez O, Danells C, Chandra T, Foster E, Comper P, Bayley M, Mochizuki G. The Toronto Concussion Study: a longitudinal analysis of balance deficits following concussion in community-dwelling adults. Brain Inj 2020; 34:1384-1394. [DOI: 10.1080/02699052.2020.1802665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Michelle Sweeny
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth L. Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Singer
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | - Olinda Habib Perez
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Cynthia Danells
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tharshini Chandra
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Evan Foster
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Mochizuki
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
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Daniels KA, Henderson G, Strike S, Cosgrave C, Fuller C, Falvey É. The use of continuous spectral analysis for the assessment of postural stability changes after sports-related concussion. J Biomech 2019; 97:109400. [DOI: 10.1016/j.jbiomech.2019.109400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 02/02/2023]
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Sinnott AM, Elbin RJ, Collins MW, Reeves VL, Holland CL, Kontos AP. Persistent vestibular-ocular impairment following concussion in adolescents. J Sci Med Sport 2019; 22:1292-1297. [PMID: 31521485 DOI: 10.1016/j.jsams.2019.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/04/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The current study investigated the role of persistent vestibular-ocular symptoms and impairment following sport-related concussion on recovery time and clinical outcomes among adolescents. DESIGN Prospective cohort. METHODS 50 (F-22/M-28) adolescents aged 12-20 years completed a vestibular-ocular motor screening, neurocognitive assessment, and the Post-Concussion Symptom Scale (PCSS) at clinical assessments conducted at 0-10 and 11-21 days after concussion. Participants were assigned to: 1) persistent vestibular-ocular (PERSIST), 2) vestibular-ocular improvement (IMPROVE), or 3) no vestibular-ocular impairment (NONE) groups based on vestibular-ocular motor screening conducted during each assessment. A 3 (GROUP) X 2 (TIME) ANOVA was performed on neurocognitive and symptom scores, and a between-subjects ANOVA was performed for recovery time. RESULTS 49 subjects were identified among the PERSIST (n=17), IMPROVE (n=12) and NONE (n=20) groups. There were no neurocognitive performance differences between groups at 0-10 days post-concussion, but groups differed on PCSS at 11-21 days (p=.001), with the PERSIST (29.0±24.9) group reporting higher symptoms than the NONE (5.45±10.0; p=.005) group. The PERSIST group took significantly longer to recover (34.9±11.6 days) than the NONE (22.9±14.9 days) group (p=.03). All groups improved on verbal (p<.001) and visual memory (p=.028), visual motor speed (p=.005), and reaction time (p=.004) from 0-10 to 11-20 days following SRC and no significant group by time interactions for cognitive scores identified. CONCLUSIONS Persistent post-concussion vestibular-ocular symptoms and impairment may influence neurocognitive performance and clinical recovery following sport-related concussion.
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Affiliation(s)
- Aaron M Sinnott
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, USA
| | - R J Elbin
- Department of Health, Human Performance, and Recreation, Office for Sport Concussion Research, University of Arkansas, USA
| | - Michael W Collins
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, USA
| | - Valerie L Reeves
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, USA
| | - Cyndi L Holland
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, USA
| | - Anthony P Kontos
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, USA.
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Manaseer TS, Gross DP, Mrazik M, Schneider K, Whittaker JL. Re-conceptualizing postural control assessment in sport-related concussion: Transitioning from the reflex/hierarchical model to the systems model. Physiother Theory Pract 2019; 37:763-774. [PMID: 31370724 DOI: 10.1080/09593985.2019.1648624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: While postural control impairment is common following sport-related concussion, few investigations have studied the physiological basis for this impairment. Both the Reflex/Hierarchical Model and the Systems Model are commonly used to characterize the physiological basis of postural control.Purpose: To discuss the physiological basis of postural control impairment resulting from sport-related concussion based on these models and suggest directions for future research.Methods: Narrative literature review.Findings: Postural control impairment seen with sport-related concussion is a multifaceted construct that can result from deficits in numerous systems that underlie postural control as described by the Systems Model, rather than a unidimensional construct that stems from the central nervous systems' inability to integrate sensory input to control posture as per the Reflex/Hierarchical Model.Conclusion: We recommend a transition away from the Hierarchical/Reflex Model of postural control towards the Systems Model in the conceptualization of sport-related concussion. Future research on postural control following sport-related concussion should account for the multifaceted nature of the resulting postural control impairment based on the Systems Model. Clinically, there is a need for a clinical postural control test that allows examination across the affected systems under single-task, dual-task, and sport-specific paradigms.
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Affiliation(s)
- Thaer S Manaseer
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Department of Sport Rehabilitation, Faculty of Physical Education and Sport Sciences, Hashemite University, Al Zarqa'a, Jordan
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Martin Mrazik
- Department of Educational Psychology, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
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Abstract
A complex diagnosis such as concussion requires a multidisciplinary patient-centered approach to maximize health outcomes. There is growing evidence to support the role of the Physical Therapist as a key member of the team of healthcare professionals managing children and adolescents with a protracted recovery following concussion. Symptoms such as headache, dizziness, neck pain, gaze instability, balance dysfunction, and fatigue can be addressed through a multimodel approach. This article provides an overview of the targeted pathways of examination and treatment of individuals with a concussion through vestibular rehabilitation, cervicogenic rehabilitation, exertional training, and patient education.
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Kruse AJ, Nugent AS, Peterson AR. Using sideline concussion tests in the emergency department. Open Access Emerg Med 2018; 10:113-121. [PMID: 30288131 PMCID: PMC6163013 DOI: 10.2147/oaem.s165995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Traumatic brain injury (TBI) is a significant cause of death and disability in the United States. Many patients with TBI are initially treated in the emergency department (ED), but there is no evidence-based method of detecting or grading TBI in patients who have normal structural neuroimaging. This study aims to evaluate the validity of two common sideline concussion tests. The Concussion Symptom Severity Score (CSSS) and modified Balance Error Scoring System (mBESS) tests are well-validated sideline tests for concussion, but have not been validated in the setting of non-sport-related concussion, in settings other than the sideline or athletic training room or in moderate or severe TBI. Patients and methods One hundred forty-eight subjects who had sustained a TBI within the previous 72 hours and 53 healthy control subjects were enrolled. CSSS and mBESS were administered. Clinical outcomes were followed up prospectively. Results The CSSS was collected in 147 TBI subjects but only 51 TBI subjects were able to complete the mBESS. The CSSS was collected for all 53 control subjects, and the mBESS was completed for 51 control subjects. The mean CSSS for TBI and control subjects was 32.25 and 2.70, respectively (P < 0.001). The average mBESS for TBI and control subjects was 7.43 and 7.20, respectively (P = 0.82). CSSS greater than 5.17 was 93.43% sensitive and 69.84% specific for TBI. Conclusion The mBESS is poorly tolerated and, among those who can complete the test, not sensitive to TBI in the ED. The CSSS is both sensitive to TBI and well tolerated.
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Affiliation(s)
- Adam J Kruse
- Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Andrew S Nugent
- Department of Emergency Medicine, The University of Iowa, Iowa City, IA, USA
| | - Andrew R Peterson
- Department of Pediatrics, The University of Iowa, Iowa City, IA, USA,
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Dierijck JK, Wright AD, Smirl JD, Bryk K, van Donkelaar P. Sub-concussive trauma, acute concussion, and history of multiple concussions: Effects on quiet stance postural control stability. Int J Psychophysiol 2018. [PMID: 29526776 DOI: 10.1016/j.ijpsycho.2018.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although balance control has been studied extensively following acute concussion, little is known regarding repetitive sub-concussive head impacts or chronic exposure to multiple concussive events. Quiet stance postural control was characterized in contact sport athletes at pre-season (n = 135) and post-season (n = 48) to evaluate the effects of subconcussive trauma to the head. To determine the impact of acute concussion on postural control, athletes diagnosed with a concussion during the season (n = 12) were tested at 72-h, 2-weeks, and 1-month post-injury. Because only 4 of the concussed athletes completed baseline testing, control athletes (n = 12) matched for sport, age, body mass index (BMI), and previous concussion history served as a comparison group. Finally, the effects of previous concussion history on quiet stance postural control were determined by comparing pre-season data in contact sport athletes with either zero (Hx0, n = 50) or three or more (Hx3+, n = 25) previous concussions. A force plate was used to compare changes in centre-of-pressure root-mean-square displacement (RMSdisp) and mean-velocity (COPvel) in the anterior/posterior (AP) and medial/lateral (ML) directions. One-minute trials were performed with feet hip-width apart, hands-on-hips, and A) eyes-open and B) eyes-closed. Biomechanical head-impact exposure (impacts over 10 g) was indexed over the season using mastoid-fixed impact sensors. In acutely injured athletes, repeated-measures ANOVA revealed a significant effect of time for RMSdisp AP with increased displacement at 2 weeks compared to 72 h (p = 0.008, 95% CI: -0.180, -0.310 cm). No other COP variables were affected by acute concussion. Moreover, there was no effect of concussion history or repeated sub-concussive impacts on any quiet stance metric. Additionally, head-impact exposure metrics were not correlated with COP metrics. Taken together, the data suggests alterations in COP sway during quiet stance persist in the acute 2-week period after injury. These findings were not present with either a history of multiple concussions or exposure to sub-concussive head impacts indicating acute concussion does not have appear to have long term effects for these measures.
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Affiliation(s)
- J K Dierijck
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - A D Wright
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada; MD/PhD Program, University of British Columbia, 2894 Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada; Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, 1088 Discovery Avenue, Kelowna, BC V1V 1V7, Canada; Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - J D Smirl
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - K Bryk
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada; Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - P van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada.
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Reliability of the Sway Balance Mobile Application: A Retrospective Analysis. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2018. [DOI: 10.1123/ijatt.2016-0114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
OBJECTIVES We quantified the length of recovery time by week in a cohort of pediatric sports-related concussion patients treated at concussion clinics, and examined patient and injury characteristics associated with prolonged recovery. DESIGN A retrospective, cohort design. SETTING Seven concussion clinics at a Midwest children's hospital. PATIENTS Patients aged 10 to 17 years with a diagnosed sports-related concussion presenting to the clinic within 30 days of injury. MAIN OUTCOME MEASURES Length of recovery by week. METHODS Unadjusted and adjusted multinomial logistic regression analyses were used to model the effect of patient and injury characteristics on length of recovery by week. RESULTS Median length of recovery was 17 days. Only 16.3% (299/1840) of patients recovered within one week, whereas 26.4% took longer than four weeks to recover. By 2 months postinjury, 6.7% of patients were still experiencing symptoms. Higher symptom scores at injury and initial visit were significantly associated with prolonged symptoms by week. Patients who presented to the clinic more than 2 weeks postinjury or who had 2 or more previous concussions showed increased risk for prolonged recovery. Females were at greater risk for prolonged recovery than males (odds ratio = 2.08, 95% confidence interval = 1.49-2.89). Age was not significantly associated with recovery length. CONCLUSIONS High symptom scores at injury and initial visit, time to initial clinical presentation, presence of 2 or more previous concussions, and female sex are associated with prolonged concussion recovery. Further research should aim to establish objective measures of recovery, accounting for treatment received during the recovery. CLINICAL RELEVANCE The median length of recovery is 17 days among pediatric sports-related concussion patients treated at concussion clinics. Only 16.3% of patients recovered within one week, whereas 26.4% took longer than 4 weeks to recover.
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Thomas RE, Alves J, Vaska Mlis MM, Magalhaes R. Therapy and rehabilitation of mild brain injury/concussion: Systematic review. Restor Neurol Neurosci 2017; 35:643-666. [DOI: 10.3233/rnn-170761] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Roger E. Thomas
- Department of Family Medicine, Faculty of Medicine, Health Sciences Centre, University of Calgary, Calgary, AB, Canada
| | - Jorge Alves
- CEREBRO – Brain Health Center, Braga, Portugal
| | | | - Rosana Magalhaes
- Instituto de Psicologia e Ciências da Educação, Universidade Lusíada – Norte (Porto), Porto, Portugal
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Wright WG, McDevitt J, Tierney R, Haran FJ, Appiah-Kubi KO, Dumont A. Assessing subacute mild traumatic brain injury with a portable virtual reality balance device. Disabil Rehabil 2016; 39:1564-1572. [PMID: 27718642 DOI: 10.1080/09638288.2016.1226432] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Balance impairment is a common sensorimotor symptom in mild traumatic brain injury (mTBI). We designed an affordable, portable virtual reality (VR)-based balance screening device (Virtual Environment TBI Screen [VETS]), which will be validated relative to the Neurocom Sensory Organization Test (SOT) to determine if it can replace commonly used postural assessments. METHODS This preliminary study examines healthy adults (n = 56) and adults with mTBI (n = 11). Participants performed six upright postural tasks on the VETS and the SOT. Analysis of variance was used to determine between-group differences. Pearson's correlations were used to establish construct validity. Known-groups approach was used to establish classification accuracy. RESULTS The mTBI cohort performed significantly worse than the healthy cohort on the new device (p = 0.001). The new device has 91.0% accuracy and an ROC curve with a significant area-under-the-curve (AUC = 0.865, p < 0.001). Conditions with dynamic visual stimulation were the most sensitive to health status. The SOT had an 84.8% accuracy and AUC =0.703 (p = 0.034). CONCLUSIONS The new VR-based device is a valid measure for detecting balance impairment following mTBI and can potentially replace more expensive and cumbersome equipment. Assessments that test visual-vestibular processing, such as VETS, increase sensitivity to mTBI-related balance deficits, which can be used to guide rehabilitation. Implications for rehabilitation Emerging technology using virtual reality can be economically integrated into the clinical setting for easy testing of postural control in neurologically impaired populations. Tailoring postural assessments to include tasks that rely on visual and vestibular integration will increase the accuracy of detecting balance impairment following mild traumatic brain injury.
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Affiliation(s)
- W Geoffrey Wright
- a Department of Physical Therapy , Temple University , Philadelphia , PA , USA.,e Department of Bioengineering , Temple University , Philadelphia , PA , USA
| | - Jane McDevitt
- b Department of Athletic Training , East Stroudsburg University , East Stroudsburg , PA , USA.,c Department of Kinesiology , Temple University , Philadelphia , PA , USA
| | - Ryan Tierney
- c Department of Kinesiology , Temple University , Philadelphia , PA , USA
| | - F Jay Haran
- d Department of Kinesiology , University of North Carolina-Greensboro , Greensboro , NC , USA
| | | | - Alex Dumont
- e Department of Bioengineering , Temple University , Philadelphia , PA , USA
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Logsdon AF, Lucke-Wold BP, Turner RC, Huber JD, Rosen CL, Simpkins JW. Role of Microvascular Disruption in Brain Damage from Traumatic Brain Injury. Compr Physiol 2015; 5:1147-60. [PMID: 26140712 PMCID: PMC4573402 DOI: 10.1002/cphy.c140057] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Traumatic brain injury (TBI) is acquired from an external force, which can inflict devastating effects to the brain vasculature and neighboring neuronal cells. Disruption of vasculature is a primary effect that can lead to a host of secondary injury cascades. The primary effects of TBI are rapidly occurring while secondary effects can be activated at later time points and may be more amenable to targeting. Primary effects of TBI include diffuse axonal shearing, changes in blood-brain barrier (BBB) permeability, and brain contusions. These mechanical events, especially changes to the BBB, can induce calcium perturbations within brain cells producing secondary effects, which include cellular stress, inflammation, and apoptosis. These secondary effects can be potentially targeted to preserve the tissue surviving the initial impact of TBI. In the past, TBI research had focused on neurons without any regard for glial cells and the cerebrovasculature. Now a greater emphasis is being placed on the vasculature and the neurovascular unit following TBI. A paradigm shift in the importance of the vascular response to injury has opened new avenues of drug-treatment strategies for TBI. However, a connection between the vascular response to TBI and the development of chronic disease has yet to be elucidated. Long-term cognitive deficits are common amongst those sustaining severe or multiple mild TBIs. Understanding the mechanisms of cellular responses following TBI is important to prevent the development of neuropsychiatric symptoms. With appropriate intervention following TBI, the vascular network can perhaps be maintained and the cellular repair process possibly improved to aid in the recovery of cellular homeostasis.
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Affiliation(s)
- Aric F Logsdon
- Department of Pharmaceutical Sciences, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
- Department of Neurosurgery, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
- Center for Neuroscience, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
| | - Brandon P Lucke-Wold
- Department of Neurosurgery, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
- Center for Neuroscience, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
| | - Ryan C Turner
- Department of Neurosurgery, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
- Center for Neuroscience, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
| | - Jason D Huber
- Department of Pharmaceutical Sciences, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
- Department of Neurosurgery, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
- Center for Neuroscience, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
| | - Charles L Rosen
- Department of Neurosurgery, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
- Center for Neuroscience, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
| | - James W Simpkins
- Department of Physiology and Pharmacology, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
- Center for Neuroscience, West Virginia University, Health Sciences Center, Morgantown, West Virginia, USA
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