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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 PMCID: PMC11195850 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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Knapp CP, Papadopoulos E, Loweth JA, Raghupathi R, Floresco SB, Waterhouse BD, Navarra RL. Perturbations in risk/reward decision making and frontal cortical catecholamine regulation induced by mild traumatic brain injury. Behav Brain Res 2024; 467:115002. [PMID: 38636779 DOI: 10.1016/j.bbr.2024.115002] [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: 02/23/2024] [Revised: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
Mild traumatic brain injury (mTBI) disrupts cognitive processes that influence risk taking behavior. Little is known regarding the effects of repetitive mild injury (rmTBI) or whether these outcomes are sex specific. Risk/reward decision making is mediated by the prefrontal cortex (PFC), which is densely innervated by catecholaminergic fibers. Aberrant PFC catecholamine activity has been documented following TBI and may underlie TBI-induced risky behavior. The present study characterized the effects of rmTBI on risk/reward decision making behavior and catecholamine transmitter regulatory proteins within the PFC. Rats were exposed to sham, single (smTBI), or three closed-head controlled cortical impact (CH-CCI) injuries and assessed for injury-induced effects on risk/reward decision making using a probabilistic discounting task (PDT). In the first week post-final surgery, mTBI increased risky choice preference. By the fourth week, males exhibited increased latencies to make risky choices following rmTBI, demonstrating a delayed effect on processing speed. When levels of tyrosine hydroxylase (TH) and the norepinephrine reuptake transporter (NET) were measured within subregions of the PFC, females exhibited dramatic increases of TH levels within the orbitofrontal cortex (OFC) following smTBI. However, both males and females demonstrated reduced levels of OFC NET following rmTBI. These results indicate the OFC is susceptible to catecholamine instability after rmTBI and suggests that not all areas of the PFC contribute equally to TBI-induced imbalances. Overall, the CH-CCI model of rmTBI has revealed time-dependent and sex-specific changes in risk/reward decision making and catecholamine regulation following repetitive mild head injuries.
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Affiliation(s)
- Christopher P Knapp
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA.
| | - Eleni Papadopoulos
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Jessica A Loweth
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Stan B Floresco
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Barry D Waterhouse
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Rachel L Navarra
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA.
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Antonellis P, Weightman MM, Fino PC, Chen S, Lester ME, Hoppes CW, Dibble LE, King LA. Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2024; 105:868-875. [PMID: 37931890 DOI: 10.1016/j.apmr.2023.10.013] [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: 07/05/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DESIGN Multi-center, cross-sectional study. SETTING Three institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). PARTICIPANTS Data were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. INTERVENTIONS Not applicable. OUTCOME MEASURES Cognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. RESULTS Individuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. CONCLUSIONS Combining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.
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Affiliation(s)
| | | | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT
| | - Siting Chen
- School of Public Health, Oregon Health & Science University, Portland, OR
| | - Mark E Lester
- Department of Physical Therapy, University of Texas Rio Grande Valley, Harlingen, TX
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR
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Zwierko M, Jedziniak W, Popowczak M, Rokita A. Effects of six-week stroboscopic training program on visuomotor reaction speed in goal-directed movements in young volleyball players: a study focusing on agility performance. BMC Sports Sci Med Rehabil 2024; 16:59. [PMID: 38424539 PMCID: PMC10905827 DOI: 10.1186/s13102-024-00848-y] [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: 07/06/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND In team sports, deficits in visuomotor reaction speed are considered a significant and modifiable risk factor that can lead to decreased performance and an increased risk of injuries. Thus, identifying effective methods to enhance visuomotor abilities is crucial. The main objective of this research was to investigate the impact of a six-week stroboscopic intervention on visuomotor reaction speed in goal-directed specific movements based on agility among young volleyball players. Additionally, the study aimed to explore the impact of saccade dynamics on visuomotor reaction speed performance throughout the experiment. METHODS There were 50 athletes (26 males and 24 females) with an average age of 16.5 years (± 0.6) who participated in this study. Over a six-week training period, athletes performed volleyball-specific training either wearing stroboscopic glasses (intervention) or under normal visual conditions (control). Prior to and after the training period, the agility tests based on change-of-direction speed (CODS) and reactive agility (RA) were used to identify visuomotor reaction speed performance. To measure agility performance a five-repetition shuttle run to gates was conducted. The REAC-INDEX, which represents visuomotor reaction speed, was analyzed as the resulting difference between the CODS test and the RA test. To elicit saccadic dynamics, a laboratory visual search task was performed. RESULTS A significant GROUP×TIME interaction was observed for the REAC-INDEX (p = 0.012, ηp2 = 0.13). ANCOVA analyses revealed significant GROUP differences, indicating improved post-training REAC-INDEX results (p = 0.004, d = 0.87), regardless of gender. Training-induced modulations in saccade acceleration did not reach significance, but a significant relationship was observed between changes in saccade acceleration and changes in the REAC-INDEX (r = -0.281, p = 0.048), indicating that higher performance gains following training were associated with a stronger increase in saccade acceleration. CONCLUSIONS This study demonstrates that stroboscopic training effectively enhances visuomotor reaction speed in goal-directed movements based on agility. Furthermore, visuomotor reaction speed gains could potentially be mediated by saccade dynamics. These findings provide valuable insights into the effectiveness of stroboscopic eyewear for training sport-specific visuomotor skills among young volleyball players.
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Affiliation(s)
- Michał Zwierko
- Department of Team Sports Games, Wroclaw University of Health and Sport Sciences, Wroclaw, Poland.
| | - Wojciech Jedziniak
- Institute of Physical Culture Sciences, University of Szczecin, Szczecin, Poland
| | - Marek Popowczak
- Department of Team Sports Games, Wroclaw University of Health and Sport Sciences, Wroclaw, Poland
| | - Andrzej Rokita
- Department of Team Sports Games, Wroclaw University of Health and Sport Sciences, Wroclaw, Poland
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Oldham JR, Bowman TG, Walton SR, Beidler E, Campbell TR, Smetana RM, Munce TA, Larson MJ, Cullum CM, Bushaw MA, Rosenblum DJ, Cifu DX, Resch JE. Sport Type and Risk of Subsequent Injury in Collegiate Athletes Following Concussion: a LIMBIC MATARS Consortium Investigation. Brain Inj 2024:1-9. [PMID: 38317302 DOI: 10.1080/02699052.2024.2310782] [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: 03/01/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To investigate the association between sport type (collision, contact, non-contact) and subsequent injury risk following concussion in collegiate athletes. MATERIALS AND METHODS This retrospective chart review of 248 collegiate athletes with diagnosed concussions (age: 20.0 ± 1.4 years; height: 179.6 ± 10.9 cm; mass: 79.0 ± 13.6 kg, 63% male) from NCAA athletic programs (n = 11) occurred between the 2015-2020 athletic seasons. Acute injuries that occurred within six months following concussion were evaluated. Subsequent injuries were grouped by lower extremity, upper extremity, trunk, or concussion. The independent variable was sport type: collision, contact, non-contact. A Cox proportional hazard model was used to assess the risk of subsequent injury between sport types. RESULTS Approximately 28% (70/248) of athletes sustained a subsequent acute injury within six months post-concussion. Collision sport athletes had a significantly higher risk of sustaining any injury (HR: 0.41, p < 0.001, 95% CI: 0.28, 0.62), lower extremity (HR: 0.55, p = 0.04, 95% CI: 0.32, 0.97), and upper extremity (HR: 0.41, p = 0.01, 95% CI: 0.20, 0.81) injuries following concussion. No differences between sport types were observed for other injuries. CONCLUSION Collision sport athletes had a higher rate of any subsequent injury, lower, and upper extremity injuries following concussion. Future research should focus on sport-specific secondary injury prevention efforts.
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Affiliation(s)
- Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas R Campbell
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Racheal M Smetana
- Neuropsychology Assessment Clinic, University of Virginia Health, Charlottesville, Virginia, USA
| | - Thayne A Munce
- Environmental Influences on Health & Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - Michael J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Daniel J Rosenblum
- United States Navy, Virginia Beach, Virginia, USA
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- United States Navy, Virginia Beach, Virginia, USA
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Luo S, Deng L, Chen Y, Zhou W, Canavese F, Li L. Does enhanced cognitive performance reduce fracture risk? a Mendelian randomization study. Aging (Albany NY) 2023; 15:14985-14995. [PMID: 38112588 PMCID: PMC10781472 DOI: 10.18632/aging.205325] [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: 07/25/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE While observational studies have suggested a link between cognitive performance and fracture risk, the causality and site-specific nature are unclear. We applied Mendelian randomization (MR) to elucidate these associations. METHODS 147 single-nucleotide polymorphisms (SNPs) tied strongly to cognitive performance (p< 5e-8) were selected. We performed MR analysis to investigate the causal relationship between cognitive performance and fractures at specific sites, including the wrist, upper arm, shoulder, ribs, sternum, thoracic spine, lumbar spine, pelvis, femur, leg, and ankle. The primary estimate was determined using the inverse variance-weighted method. Additionally, we examined heterogeneity using the MR Pleiotropy RESidual Sum Outlier test and Cochran Q, and employed MR-Egger regression to identify horizontal pleiotropy. RESULTS MR analysis identified a causal association between cognitive performance and fractures at the lumbar-spine-pelvis (odds ratio [OR] = 0.727, 95% CI = 0.552-0.956, p = 0.023), and ribs-sternum-thoracic spine sites (OR = 0.774, 95% CI = 0.615-0.974, p = 0.029). However, no causal association was found for fractures at other sites. CONCLUSIONS This study provided evidence of a causal connection between cognitive performance and fracture risk at certain locations. These findings underline the potential of cognitive enhancement strategies as innovative and effective methods for fracture prevention.
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Affiliation(s)
- Shaoting Luo
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
| | - Linfang Deng
- Department of Nursing, Jinzhou Medical University, Jinzhou 121001, Liaoning, P.R. China
| | - Yufan Chen
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
| | - Weizheng Zhou
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, Lille 59000, Nord Department, France
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, P.R. China
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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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Teare-Ketter A, Ebert J, Todd H. The Implementation of a Return-to-Play Protocol with Standardized Physical Therapy Referrals in a Collegiate Football Program: PT's Role in Return-to-Play, A Clinical Commentary. Int J Sports Phys Ther 2023; 18:513-525. [PMID: 37020444 PMCID: PMC10069397 DOI: 10.26603/001c.73074] [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: 07/31/2022] [Accepted: 01/28/2023] [Indexed: 04/03/2023] Open
Abstract
Sport-related concussions (SRCs) are multi-faceted injuries requiring coordinated care for return-to-play (RTP). Although the number of concussions in collegiate football is increasing annually, there is poor standardization among RTP protocols. Recent evidence suggests there is an increased risk of lower extremity injury, neuropsychiatric consequences, and re-injury after SRC, and risk factors for a prolonged recovery from SRC have also been identified. Evidence demonstrates a faster RTP and improved outcomes with early physical therapy intervention; however, this is not yet common practice in the treatment of acute SRC. There is little guidance available on the development and implementation of a multidisciplinary RTP rehabilitation protocol for SRC that incorporates standardized physical therapy. By describing an evidence-based RTP protocol with standardized physical therapy management, and measures taken to implement this protocol, this clinical commentary aims to identify steps in treating SRC that can be used to improve recovery. The purpose of this commentary is to: a) survey the current state of standardization of RTP protocols in collegiate football; b) highlight the development and implementation of a RTP protocol with standardized physical therapy referral and management in an NCAA Division II collegiate football program; and c) describe results of a full-season pilot study, including time to evaluation, time to RTP, rate of re-injury or lower extremity injury, and the clinical significance of protocol implementation. Level of Evidence Level V.
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Affiliation(s)
| | | | - Hunter Todd
- Physical Therapy and Rehabilitation Atrium Health Floyd
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9
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Das J, Morris R, Barry G, Celik Y, Godfrey A, McDonald C, Walker R, Vitorio R, Stuart S. Technological solution for the assessment and rehabilitation of visuo-cognition in Parkinson's disease. Expert Rev Med Devices 2023; 20:253-257. [PMID: 36927272 DOI: 10.1080/17434440.2023.2192869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Julia Das
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Yunus Celik
- Department of Computer and Inf006Frmation Science, Northumbria University, Newcastle upon Tyne, UK
| | - Alan Godfrey
- Department of Computer and Inf006Frmation Science, Northumbria University, Newcastle upon Tyne, UK
| | | | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Rodrigo Vitorio
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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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, 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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Mental Fatigue Uniquely Influences Drop Landing Biomechanics for Individuals With a Concussion History. J Sport Rehabil 2023; 32:353-360. [PMID: 36716746 DOI: 10.1123/jsr.2022-0252] [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: 07/01/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 02/01/2023]
Abstract
CONTEXT Induced mental fatigue negatively impacts sport performance and neurocognition. However, it is unclear how induced mental fatigue influences landing biomechanics. The purpose of this study was to examine the influence of mental fatigue on drop landing biomechanics in individuals with and without a concussion history. DESIGN Crossover design. METHODS Forty-eight (24 per group) recreationally active individuals were matched on age (±3 y), sex, and body mass index (±1 kg/m2). All participants completed an experimental (30-min Stroop task) and control (30-min reading magazines) intervention on separate days separated by a minimum of 24 hours. Drop landings were performed before and after both interventions. Outcomes included peak vertical ground reaction force (vGRF), vertical loading rate (VLR), knee flexion angle, knee abduction angle, external knee flexion moment, external knee abduction moment, and initial ground contact knee flexion and knee abduction angles. Separate 2 (group) × 2 (intervention) between-within analyses of covariance compared drop landing outcomes. Each group's average pre-Stroop and premagazine outcomes were covariates. RESULTS There was a significant interaction for vGRF (P = .033, ηp2=.097) and VLR (P = .0497, ηp2=.083). The vGRF simple effects were not statistically significantly (P range = .052-.325). However, individuals with a concussion history displayed a medium effect size for greater vGRF post-Stroop compared with their own postmagazine vGRF (mean difference (95% confidence interval [95% CI] = 0.163 (-0.002 to 0.327) bodyweight (BW), p = .052, ηp2=.081. In contrast, the control group displayed a small effect size (mean difference [95% CI] = 0.095 [-0.069 to 0.259] BW, p = .251, ηp2=.029). Individuals with a concussion history displayed greater VLR post-Stroop compared with controls (mean difference [95% CI], 26.29 [6.19 to 46.40] BW/s, P = .012, ηp2=.134) and their own postmagazine values (mean difference [95% CI] = 32.61 [7.80 to 57.42] BW/s, p = .011, ηp2=.135). CONCLUSION Mental fatigue leads to greater VLR for individuals with a concussion history. Athletic competition and activities of daily living can increase mental fatigue. Training programs may seek to teach mental fatigue reducing strategies to athletes with a concussion history.
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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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Computerized Cognitive Function Does Not Correlate With Choice Reaction Time During a Hopping Task. J Sport Rehabil 2023; 32:462-466. [PMID: 36791727 DOI: 10.1123/jsr.2022-0345] [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: 09/21/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 02/16/2023]
Abstract
CONTEXT Cognitive performance has been shown to be associated with musculoskeletal injury risk. Cognitive assessments are often administered in controlled environments despite sport settings challenging cognition in uncontrolled, less predictable environments. Cognitive assessments should be representative of sport demands; thus, integrating motor with cognitive assessments may be more clinically relevant. Accordingly, the purpose of this research was to investigate the relationship between tablet-based cognitive tests and choice reaction time during a hopping task. DESIGN Cross-sectional. METHODS A total of 20 healthy participants volunteered to participate. Participants completed 3 tablet-based cognitive assessments. Average raw response time and fully corrected scores were used for analysis. In addition, participants completed a choice reaction hopping task to capture neuromuscular-cognitive reaction time. Participants completed a forward hop over a hurdle, landing on a single limb. Light sensors were utilized for the choice reaction component to capture reaction time in seconds, cue them when to hop, and indicate the landing limb. The relationship between the tablet-based cognitive assessments and reaction time during a hopping task was examined with Pearson correlations (α = .05). RESULTS The choice reaction time from the hop task had a negligible correlation (r = -.20-.07) to the fully corrected tablet-based cognitive tests. The choice reaction time from the hop task had a negligible correlation (r = .02) to the average response time of the Pattern Comparison Processing Speed Test and a low correlation (r = .34-.36) to the Dimensional Change Card Sort Test and Flanker Inhibitory Control and Attention Test. CONCLUSIONS This study determined that tablet-based cognitive assessments had trivial relationships to choice reaction time during a hopping task. This research has implications as clinicians aim to evaluate and analyze cognitive performance. Although reaction time was a critical component of all the assessments in this study, an individual's performance on a tablet-based assessment does not indicate performance during a functional reaction time assessment.
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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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