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McPherson AL, Zuleger TM, Barber Foss KD, Warren SM, Hogg JA, Diekfuss JA, Myer GD. Does Neuromuscular Training Reduce the Risk of Lower-Extremity Musculoskeletal Injury in High School Female Athletes With a History of Sport-Related Concussion? J Sport Rehabil 2024:1-9. [PMID: 39106969 DOI: 10.1123/jsr.2023-0403] [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: 11/30/2023] [Revised: 04/04/2024] [Accepted: 05/16/2024] [Indexed: 08/09/2024]
Abstract
CONTEXT There is a well-established increased risk of lower-extremity (LE) musculoskeletal (MSK) injury following a sport-related concussion (SRC). Neuromuscular training programs improve biomechanics associated with LE MSK injury and reduce LE MSK injury incidence, but their relative effectiveness in athletes with history of SRC is unknown. The purpose of this study was to evaluate LE MSK injury incidence in female adolescent athletes with history of SRC following a neuromuscular training intervention. DESIGN Prospective case-control. METHODS Seventy-seven adolescent female athletes aged 12-18 years who participated in soccer, volleyball, or basketball were recruited from a single institutional sports medicine research and performance center to complete a 6-week neuromuscular training program prior to competitive athletic season. Group (Control, History of SRC) comparisons of athlete exposure and relative LE MSK injury risk and rates during the competitive athletic season were assessed. RESULTS Ten injuries were recorded by 9 athletes. Female athletes who reported history of SRC had increased injury risk (Risk Ratio 3.9, 95% CI, 1.1-13.8, P = .01) and increased injury rate (rate ratio 4.1, 95% CI, 1.1-15.8, P = .03) compared with female athletes without history of SRC. CONCLUSIONS Female adolescent athletes with history of SRC showed a greater risk of LE MSK injury compared with athletes with no history of SRC. Future work is still needed to understand the underlying mechanisms associated with future LE MSK injury following SRC and interventions that ameliorate elevated injury risk.
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Affiliation(s)
- April L McPherson
- Emory Sports Performance and Research Center (SPARC), Emory University, Flowery Branch, GA, USA
- Emory Sports Medicine Center, Emory University, Atlanta, GA, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Taylor M Zuleger
- Emory Sports Performance and Research Center (SPARC), Emory University, Flowery Branch, GA, USA
- Emory Sports Medicine Center, Emory University, Atlanta, GA, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
- Neuroscience Graduate Program, University of Cincinnati, Cincinnati, OH, USA
| | - Kim D Barber Foss
- Emory Sports Performance and Research Center (SPARC), Emory University, Flowery Branch, GA, USA
- Emory Sports Medicine Center, Emory University, Atlanta, GA, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Shayla M Warren
- Emory Sports Performance and Research Center (SPARC), Emory University, Flowery Branch, GA, USA
- Emory Sports Medicine Center, Emory University, Atlanta, GA, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer A Hogg
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center (SPARC), Emory University, Flowery Branch, GA, USA
- Emory Sports Medicine Center, Emory University, Atlanta, GA, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Emory University, Flowery Branch, GA, USA
- Emory Sports Medicine Center, Emory University, Atlanta, GA, USA
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, United Kingdom
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Xiong Q, Song DL. Neuromechanical proficiency in elite performance decision-making: An event-related potential (ERP) analysis. SLAS Technol 2024; 29:100171. [PMID: 39067818 DOI: 10.1016/j.slast.2024.100171] [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: 03/01/2024] [Revised: 06/07/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
This research focuses intensively on the neural mechanisms of action selection responses in elite athletes during high-stakes decision-making. It emphasizes the neuromechanical dimensions of these processes, contrasting the responses of expert and novice players within a theoretical framework of neural information processing in high-performance contexts. Utilizing advanced EEG technologies, including event-related potential (ERP) analysis, the study captures a comprehensive view of both behavioral and neurophysiological data. The central aim is to unravel the intricate neural underpinnings that distinguish elite athletes in their decision-making strategies. Key findings highlight: (1) Enhanced accuracy and swifter reaction times in elite athletes during the action selection phase; (2) Significant neurophysiological differences, marked by pronounced N1 peak amplitudes with prolonged latencies, reduced P2 peak amplitudes with stable latencies, decreased P3 peak amplitudes with reduced latencies, and increased average PSW amplitudes. These discoveries significantly advance our understanding of the neural foundations of expert decision-making in high-performance sports. This study not only sheds light on the cognitive and neural dynamics of elite sports performance but also provides a foundation for developing training and performance enhancement techniques in various high-stakes domains.
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Affiliation(s)
- Qiang Xiong
- The College of Physical Education, Minnan Normal University, Zhangzhou, Fujian, 363000, China; Sports Science Research Center, Minnan Normal University, Zhangzhou, Fujian,363000, China; Women's volleyball spirit Research Center, Minnan Normal University, Zhangzhou, Fujian, 363000, China
| | - Dan-Li Song
- Sports Coaching College, Beijing Sport University, 100084, China.
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Avedesian JM, Covassin T, Baez S, Nash J, Dufek JS. The Influence of Sports-Related Concussion on Cognition and Landing Biomechanics in Collegiate Athletes. Scand J Med Sci Sports 2024; 34:e14698. [PMID: 38984660 DOI: 10.1111/sms.14698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/06/2024] [Accepted: 06/30/2024] [Indexed: 07/11/2024]
Abstract
Injury surveillance data indicate that collegiate athletes are at greater risk for lower extremity (LE) injuries following sports-related concussion (SRC). While the association between SRC and LE injury appears to be clinically relevant up to 1-year post-SRC, little evidence has been provided to determine possible mechanistic rationales. Thus, we aimed to compare collegiate athletes with a history of SRC to matched controls on biomechanical and cognitive performance measures associated with LE injury risk. Athletes with a history of SRC (n = 20) and matched controls (n = 20) performed unanticipated bilateral land-and-cut tasks and cognitive assessments. Group-based analyses (ANOVA) and predictive modeling (C5.0 decision tree algorithm) were used to compare group differences on biomechanical and cognitive measures. Collegiate athletes with a history of SRC demonstrated approximately six degrees less peak knee flexion on both dominant (p = 0.03, d = 0.71) and nondominant (p = 0.02, d = 0.78) limbs during the land-and-cut tasks compared to controls. Verbal Memory, knee flexion, and Go/No Go total score (C5.0 decision tree algorithm) were identified as the strongest indicators of previous SRC injury history. Reduced knee flexion during sport-specific land-and-cut tasks may be a mechanism for increased LE injury risk in athletes with a history of SRC. There appears to be multiple biomechanical and cognitive predictors for identifying previous SRC in collegiate athletes, providing evidence to support a multifactorial SRC management strategy to reduce future injury risk.
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Affiliation(s)
- Jason M Avedesian
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
- Department of Athletics, Clemson University, Clemson, South Carolina, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Shelby Baez
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer Nash
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Janet S Dufek
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Zuleger TM, Slutsky-Ganesh AB, Grooms DR, Yuan W, Barber Foss KD, Howell DR, Myer GD, Diekfuss JA. High magnitude exposure to repetitive head impacts alters female adolescent brain activity for lower extremity motor control. Brain Res 2024; 1828:148785. [PMID: 38272157 PMCID: PMC11110884 DOI: 10.1016/j.brainres.2024.148785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
Contact and collision sport participation among adolescent athletes has raised concerns about the potential negative effects of cumulative repetitive head impacts (RHIs) on brain function. Impairments from RHIs and sports-related concussions (SRC) may propagate into lingering neuromuscular control. However, the neural mechanisms that link RHIs to altered motor control processes remain unknown. The purpose of this study was to isolate changes in neural activity for a lower extremity motor control task associated with the frequency and magnitude of RHI exposure. A cohort of fifteen high school female soccer players participated in a prospective longitudinal study and underwent pre- and post-season functional magnetic resonance imaging (fMRI). During fMRI, athletes completed simultaneous bilateral ankle, knee, and hip flexion/extension movements against resistance (bilateral leg press) to characterize neural activity associated with lower extremity motor control. RHI data were binned into continuous categories between 20 g - 120 g (defined by progressively greater intervals), with the number of impacts independently modeled within the fMRI analyses. Results revealed that differential exposure to high magnitude RHIs (≥90 g - < 110 g and ≥ 110 g) was associated with acute changes in neural activity for the bilateral leg press (broadly inclusive of motor, visual, and cognitive regions; all p < 0.05 & z > 3.1). Greater exposure to high magnitude RHIs may impair lower extremity motor control through maladaptive neural mechanisms. Future work is warranted to extend these mechanistic findings and examine the linkages between RHI exposure and neural activity as it relates to subsequent neuromuscular control deficits.
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Affiliation(s)
- Taylor M Zuleger
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; University of Cincinnati, Neuroscience Graduate Program, Cincinnati, OH, USA.
| | - Alexis B Slutsky-Ganesh
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA; Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Science and Professions, Ohio University, Grover Center, Athens, OH, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kim D Barber Foss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA; Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA; Emory Sports Medicine Center, Atlanta, GA, USA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
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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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Zuleger TM, Slutsky-Ganesh AB, Anand M, Kim H, Warren SM, Grooms DR, Foss KDB, Riley MA, Yuan W, Gore RK, Myer GD, Diekfuss JA. The effects of sports-related concussion history on female adolescent brain activity and connectivity for bilateral lower extremity knee motor control. Psychophysiology 2023; 60:e14314. [PMID: 37114838 PMCID: PMC10523876 DOI: 10.1111/psyp.14314] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/17/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023]
Abstract
Sports-related concussions (SRCs) are associated with neuromuscular control deficits in athletes following return to play. However, the connection between SRC and potentially disrupted neural regulation of lower extremity motor control has not been investigated. The purpose of this study was to investigate brain activity and connectivity during a functional magnetic resonance imaging (fMRI) lower extremity motor control task (bilateral leg press) in female adolescent athletes with a history of SRC. Nineteen female adolescent athletes with a history of SRC and nineteen uninjured (without a history of SRC) age- and sport-matched control athletes participated in this study. Athletes with a history of SRC exhibited less neural activity in the left inferior parietal lobule/supramarginal gyrus (IPL) during the bilateral leg press compared to matched controls. Based upon signal change detected in the brain activity analysis, a 6 mm region of interest (seed) was defined to perform secondary connectivity analyses using psychophysiological interaction (PPI) analyses. During the motor control task, the left IPL (seed) was significantly connected to the right posterior cingulate gyrus/precuneus cortex and right IPL for athletes with a history of SRC. The left IPL was significantly connected to the left primary motor cortex (M1) and primary somatosensory cortex (S1), right inferior temporal gyrus, and right S1 for matched controls. Altered neural activity in brain regions important for sensorimotor integration and motor attention, combined with unique connectivity to regions responsible for attentional, cognitive, and proprioceptive processing, indicate compensatory neural mechanisms may underlie the lingering neuromuscular control deficits associated with SRC.
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Affiliation(s)
- Taylor M. Zuleger
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- University of Cincinnati, Neuroscience Graduate Program, Cincinnati, OH, USA
| | - Alexis B. Slutsky-Ganesh
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Manish Anand
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Mechanical Engineering, Indian Institute of Technology Madras, Chennai, TN, India
| | - HoWon Kim
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA
| | - Shayla M. Warren
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Science and Professions, Ohio University, Grover Center, Athens, OH, USA
| | - Kim D. Barber Foss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael A. Riley
- Department of Rehabilitation, Exercise, & Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Russell K. Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- Shepherd Center, Atlanta, GA, USA
| | - Gregory D. Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Jed A. Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
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Chmielewski TL, Suzuki S, Dubose D, Herman DC, Clugston JR, Horodyski M. Mild Quadriceps and Hamstring Strength Deficits Do Not Persist After Sport-Related Concussion. Sports Health 2023; 15:512-518. [PMID: 36517989 PMCID: PMC10293567 DOI: 10.1177/19417381221136140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Risk for lower extremity musculoskeletal injury increases after sport-related concussion (SRC) and may result from unresolved motor control deficits. Muscle weakness is a deficit that could contribute to musculoskeletal injury risk. HYPOTHESIS Athletes with SRC will demonstrate quadriceps and hamstring muscle weakness at the time of return to sport and 30 days later compared with controls. STUDY DESIGN Prospective matched cohort. LEVEL OF EVIDENCE Level 3. METHODS A total of 31 athletes with SRC (CONCUSSION) were matched by sex, age, and activity level to controls (CONTROL). Testing was conducted at initial assessment and 30 days later; initial assessment in CONCUSSION occurred when cleared for return to play. Isokinetic testing assessed quadriceps and hamstring strength of the dominant and nondominant legs at 60 and 180 deg/s. Peak torque values were normalized to body mass (N-m/kg). Data were analyzed with repeated measures general linear models (group × time), and effect sizes were calculated. RESULTS Analysis at 60 deg/s included 26 matched pairs (15 male per group) and at 180 deg/s included 30 matched pairs (17 males per group). Time from concussion to initial assessment was 21.3 (7.8) mean (standard deviation) days. No significant interactions or main effects were detected (P > 0.05). Across muscle groups, legs, and testing speeds, effect sizes at initial assessment were small (d = 0.117 to 0.353), equating to a strength deficit in CONCUSSION of 0.04 to 0.18 N-m/kg, and effect sizes were further reduced at 30-day follow-up (d = -0.191 to 0.252). CONCLUSION In athletes with SRC, quadriceps and hamstring strength were decreased only minimally at return to play compared with controls and the difference lessened over 30 days. CLINICAL RELEVANCE Strength deficits may not be a major contributor to increased lower extremity musculoskeletal injury risk after SRC. Strength training could be implemented before return to play after SRC to mitigate any strength deficits.
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Affiliation(s)
- Terese L. Chmielewski
- TRIA Orthopedic Center, Bloomington, Minnesota
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota
| | - Shuhei Suzuki
- TRIA Orthopedic Center, Bloomington, Minnesota
- ATP Tour Inc, Ponte Vedra Beach, Florida
| | - Dominique Dubose
- Department of Rehabilitative Sciences, Bethune-Cookman University, Daytona Beach, Florida
| | - Daniel C. Herman
- Department of Physical Medicine and Rehabilitation, University of California at Davis, Davis, California
| | - James R. Clugston
- Departments of Community Health & Family Medicine and Neurology, University of Florida, Gainesville, Florida
| | - MaryBeth Horodyski
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
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Roach MH, Aderman MJ, Ross JD, Kelly TF, Malvasi SR, Posner MA, Svoboda SJ, Pasquina PF, Cameron KL. Risk of Upper Extremity Musculoskeletal Injury Within the First Year After a Concussion. Orthop J Sports Med 2023; 11:23259671231163570. [PMID: 37197033 PMCID: PMC10184236 DOI: 10.1177/23259671231163570] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/20/2023] [Indexed: 05/19/2023] Open
Abstract
Background Emerging evidence suggests that athletes and military personnel are at increased risk for lower extremity musculoskeletal injury after a concussion; however, the association between concussion and subsequent upper extremity (UE) musculoskeletal injury is unknown. Purpose To prospectively examine the association between concussion and UE musculoskeletal injury risk within the first year after returning to unrestricted activity. Study Design Cohort study; Level of evidence, 3. Methods A total of 316 cases of concussion 42% (132/316 women) were observed among 5660 Concussion Assessment, Research and Education Consortium participants at the United States Military Academy from May 2015 to June 2018. Active injury surveillance within the cohort was conducted for 12 months after unrestricted return to activity to identify any incident cases of acute UE musculoskeletal injury. Injury surveillance during the follow-up period was also conducted for nonconcussed controls who were matched by sex and competitive sport level. Univariate and multivariable Cox proportional hazards regression models were used to estimate hazard ratios between concussed cases and nonconcussed controls for time to UE musculoskeletal injury. Results During the surveillance period, 19.3% of concussed cases and 9.2% of nonconcussed controls sustained a UE injury. In the univariate model, concussed cases were 2.25 times (95% CI, 1.45-3.51) more likely to sustain a UE injury during the 12-month follow-up period when compared with the nonconcussed controls. In the multivariable model, adjusted for history of concussion, sport level, somatization, and history of UE injury, concussed cases were 1.84 times (95% CI, 1.10-3.07) more likely to sustain a UE injury during the surveillance period compared with nonconcussed controls. Sport level remained an independent risk factor for UE musculoskeletal injury; however, concussion history, somatization, and history of UE injury were not independent risk factors. Conclusion Concussed cases were more than twice as likely to sustain an acute UE musculoskeletal injury within the first 12 months after unrestricted return to activity when compared with nonconcussed controls. The higher hazard of injury remained in the concussed group after adjusting for other potential risk factors.
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Affiliation(s)
- Megan H. Roach
- Extremity Trauma & Amputation Center of Excellence, Defense Health Agency, Falls Church, Virginia, USA
- Department of Clinical Investigations, Womack Army Medical Center, Fort Bragg, North Carolina, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Megan H. Roach, PhD, ATC, Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA () (Twitter: @houston_mn)
| | - Michael J. Aderman
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Jeremy D. Ross
- United States Military Academy, West Point, New York, USA
| | - Tim F. Kelly
- United States Military Academy, West Point, New York, USA
| | - Steven R. Malvasi
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Matthew A. Posner
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Steven J. Svoboda
- Medstar Orthopaedic Institute, Washington, District of Columbia, USA
| | - Paul F. Pasquina
- Walter Reed National Military Medical Center, Washington, District of Columbia, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, Maryland, USA
| | - Kenneth L. Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, Maryland, USA
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9
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Lower-Extremity Neuromuscular Function Following Concussion: A Preliminary Examination. J Sport Rehabil 2023; 32:31-39. [PMID: 35894887 DOI: 10.1123/jsr.2022-0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/03/2022] [Accepted: 05/21/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT Neuromuscular function is altered acutely following concussion and theoretically linked to the subsequent postconcussion musculoskeletal injury risk. Existing research has only examined voluntary muscle activation, limiting mechanistic understanding. Therefore, our study aimed to examine voluntary and involuntary muscle activation between college-aged, concussed individuals when symptom-free and healthy matched controls. DESIGN Prospective, cross-sectional cohort laboratory study. METHODS Concussed and healthy participants (n = 24; 58% male, age: 19.3 [1.1] y, mass: 70.3 [16.4] kg, height: 177.3 [12.7] cm) completed the superimposed burst (SB) neuromuscular assessment on their dominant limb within 72 hours after self-reporting asymptomatic (22.4 [20.2] d postinjury). Unnormalized and bodyweight-normalized quadriceps maximal voluntary isometric contraction torque (in newton meters), unnormalized and bodyweight-normalized electrically stimulated SB torque, pain (numeric 1-10) during SB, and the central activation ratio (in percentage) were assessed via the SB. Parametric and nonparametric analyses, 95% confidence intervals (95% CIs), and Hedges g (parametric) and Spearman ρ (nonparametric) effect sizes were used to examine group differences (α = .05). RESULTS The maximal voluntary isometric contraction torque (concussed: 635.60 N·m [300.93] vs control: 556.27 N·m [182.46]; 95% CI, -131.36 to 290.02; P = .443; d = 0.33), SB torque (concussed: 203.22 N·m [97.17], control: 262.85 N·m [159.07]; 95% CI, -171.22 to 51.97; P = .280; d = -0.47), and central activation ratio (concussed: 72.16% [17.16], control: 70.09% [12.63]; 95% CI, -10.68 to 14.83; P = .740; d = 0.14) did not differ between the concussed and control groups regardless of bodyweight normalization (P ≥ .344). Pain during the SB was significantly higher with a medium effect for participants with a concussion versus healthy controls (concussed: median = 7, control: median = 5; P = .046; ρ = -0.42). DISCUSSION These findings suggest concussed participants do not have statistically altered voluntary or involuntary quadricep neuromuscular function once asymptomatic compared with controls. Therefore, the elevated postconcussion musculoskeletal injury risk may not be attributed to lower-extremity muscle activation. Concussed participants displayed greater pain perception during the SB, which suggests somatosensory or perception changes requiring further examination.
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10
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Harper B, Shiraishi M, Soangra R. Reliability and Validity of Inertial Sensor Assisted Reaction Time Measurement Tools among Healthy Young Adults. SENSORS (BASEL, SWITZERLAND) 2022; 22:8555. [PMID: 36366253 PMCID: PMC9656344 DOI: 10.3390/s22218555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
The assessment of movement reaction time (RT) as a sideline assessment is a valuable biomarker for mild TBI or concussion. However, such assessments require controlled laboratory environments, which may not be feasible for sideline testing during a game. Body-worn wearable devices are advantageous as being cost-effective, easy to don and use, wirelessly transmit data, and ensure unhindered movement performance. This study aimed to develop a Drop-stick Test System (DTS) with a wireless inertial sensor and confirm its reliability for different standing conditions (Foam versus No Foam) and task types (Single versus Dual), and postures (Standing versus sitting). Fourteen healthy young participants (seven females, seven males; age 24.7 ± 2.6 years) participated in this study. The participants were asked to catch a falling stick attached to the sensor during a drop test. Reaction Times (RTs) were calculated from data for each trial from DTS and laboratory camera system (gold standard). Intraclass correlation coefficients (ICC 3,k) were computed to determine inter-instrument reliability. The RT measurements from participants using the camera system and sensor-based DTS showed moderate to good inter-instrument reliability with an overall ICC of 0.82 (95% CI 0.78-0.85). Bland-Altman plots and 95% levels of agreement revealed a bias where the DTS underestimated RT by approximately 50 ms.
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Affiliation(s)
- Brent Harper
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA
| | - Michael Shiraishi
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA
| | - Rahul Soangra
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
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11
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Daly E, Pearce AJ, Finnegan E, Cooney C, McDonagh M, Scully G, McCann M, Doherty R, White A, Phelan S, Howarth N, Ryan L. An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review. BMC Sports Sci Med Rehabil 2022; 14:125. [PMID: 35818048 PMCID: PMC9275058 DOI: 10.1186/s13102-022-00514-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022]
Abstract
Background Concussion in sport is an ongoing global concern. The head injury assessment (HIA) by the field of play is acknowledged as the first step in recognising and identifying concussion. While previous systematic literature reviews have evaluated the sensitivity of side-line screening tools and assessment protocols, no systematic review has evaluated the research designs and assessments used in a field setting. This systematic review investigated existing screening and diagnostic tools used in research as part of the HIA protocol to identify concussion that are currently used in professional, semi-professional and amateur (club) sports settings. Methods A systematic searching of relevant databases was undertaken for peer-reviewed literature between 2015 and 2020. Results Twenty-six studies met the inclusion criteria. Studies were of moderate to good quality, reporting a variety of designs. The majority of studies were undertaken in professional/elite environments with medical doctors and allied health practitioners (e.g., physical therapists) involved in 88% of concussion assessments. While gender was reported in 24 of the 26 studies, the majority of participants were male (77%). There was also a variety of concussion assessments (n = 20) with the sports concussion assessment tool (SCAT) used in less than half of the included studies. Conclusion The majority of studies investigating concussion HIAs are focused on professional/elite sport. With concussion an issue at all levels of sport, future research should be directed at non-elite sport. Further, for research purposes, the SCAT assessment should also be used more widely to allow for consistency across studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00514-1.
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Affiliation(s)
- Ed Daly
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Alan J Pearce
- College of Sport, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Emma Finnegan
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Ciara Cooney
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Maria McDonagh
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Grainne Scully
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Michael McCann
- Atlantic Technological University, Port Road, Letterkenny, Ireland
| | - Rónán Doherty
- Atlantic Technological University, Port Road, Letterkenny, Ireland
| | - Adam White
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Simon Phelan
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Nathan Howarth
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Lisa Ryan
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland.
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12
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Nusbickel AJ, Vasilopoulos T, Zapf AD, Tripp BL, Herman DC. The effect of concussion on subsequent musculoskeletal injury risk in high school athletes. PM R 2022; 14:597-603. [PMID: 35488457 DOI: 10.1002/pmrj.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Studies have demonstrated an increased risk of musculoskeletal (MSK) injury after concussion in collegiate and professional athletes, but there has been relatively little study of this relationship in younger athletes. OBJECTIVE To determine the odds of experiencing a subsequent MSK injury after concussion in high school athletes. It was hypothesized that concussion would increase the risk of MSK injury within 365 days of the concussion event. DESIGN Retrospective observational study. SETTING Twelve high school sports programs. PARTICIPANTS Athletes (n = 14,461) from athletic training room records queried between 2010 and 2017. INDEPENDENT VARIABLES History of concussion and history of concussion and MSK injury in the year preceding MSK injury. MAIN OUTCOME MEASURES General estimating equation analyses were conducted to examine the odds of MSK injury related to (1) concussion within the preceding 365 days of injury; and (2) concussion and MSK injury within the preceding 365 days of concussion. RESULTS Respectively, 8% and 8.3% of athletes were identified with a concussion and MSK injury. After controlling for gender and sport, athletes with a concussion and prior MSK injury (odds ratio = 2.19, 95% confidence interval: 1.02-4.67) and athletes with a concussion alone (odds ratio = 1.67, 95% confidence interval: 1.15-2.44) both had higher odds of experiencing a subsequent MSK injury compared to athletes without prior concussion. CONCLUSIONS High school athletes who sustain a concussion have elevated odds of MSK injury at rates comparable to those for collegiate athletes. These findings support the use of neuromuscular-based rehabilitation and injury prevention protocols in the post-concussion period. These findings may also suggest exploring methods to modify concussion return-to-play criteria with the goal to reduce the risk of future MSK injury.
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Affiliation(s)
- Alex J Nusbickel
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Terrie Vasilopoulos
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA.,Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Ashley D Zapf
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | - Brady L Tripp
- Department of Applied Kinesiology and Physiology, University of Florida, Gainesville, Florida, USA
| | - Daniel C Herman
- Department of Physical Medicine and Rehabilitation, University of California at Davis, Sacramento, California, USA
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13
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Howell DR, Seehusen CN, Carry PM, Walker GA, Reinking SE, Wilson JC. An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk: A Randomized Clinical Trial. Am J Sports Med 2022; 50:1120-1129. [PMID: 35060759 DOI: 10.1177/03635465211069372] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Existing data suggest that after concussion, athletes experience an increased risk of subsequent injury. Exploring methods that may reduce injury risk after successful postconcussion return to play may lead to new treatment approaches. PURPOSE To examine the efficacy of a neuromuscular training (NMT) intervention on acute sports-related time-loss injury over the subsequent year relative to standard of care. STUDY DESIGN Randomized clinical trial; Level of evidence, 1. METHODS A total of 27 youth athletes were assessed initially postconcussion (median, 7 days postconcussion; interquartile range [IQR], 5-10) and after return-to-play clearance (median, 40 days postconcussion; IQR, 15-52). After return-to-play clearance, they were randomly assigned to NMT intervention (n = 11; mean ± SD age, 14.7 ± 1.7 years; 36% female) or standard of care (n = 16; mean ± SD age, 15.3 ± 1.8 years; 44% female). The intervention (duration, 8 weeks; frequency, 2 times per week) included guided strength exercises with landing stabilization focus. Standard of care received no recommendations. For the subsequent year, athletes prospectively completed a monthly log of sports-related injuries and organized sports competitions. RESULTS During the first year after postconcussion return-to-play clearance, sports-related time-loss injuries were more common among standard of care relative to NMT intervention (75% [95% CI, 48%-93%] vs 36% [95% CI, 11%-69%]). After adjusting for age and sex, the hazard of subsequent injury in the standard-of-care group was 3.56 times (95% CI, 1.11-11.49; P = .0334) that of the NMT intervention group. Sports participation was similar between NMT intervention and standard of care during the year-long monitoring period (hours of organized sports per month; median, 12 [IQR, 2.6-32.1] vs 15.6 [IQR, 3.5-105.9]; P = .55). The age- and sex-adjusted incidence of injuries was 10.2 per 1000 competitive exposures (95% CI, 3.7-28.4) in the standard-of-care group as opposed to 3.4 per 1000 (95% CI, 0.9-13.4) in the NMT intervention group. After adjusting for age and sex, incidence of injuries was higher for standard of care vs NMT intervention (rate ratio, 2.96 [95% CI, 0.89-9.85]; P = .076). CONCLUSION Although preliminary, our findings suggest that an NMT intervention initiated after return-to-play clearance may significantly reduce sports-related time-loss injuries over the subsequent year. REGISTRATION NCT03917290 (ClinicalTrials.gov identifier).
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Corrine N Seehusen
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Patrick M Carry
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Gregory A Walker
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah E Reinking
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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14
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Bruce SL, Wilkerson GB. Whole-Body Reactive Agility Metrics to Identify Football Players With a Core and Lower Extremity Injury Risk. Front Sports Act Living 2021; 3:733567. [PMID: 34746776 PMCID: PMC8564038 DOI: 10.3389/fspor.2021.733567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Clinical prediction models are useful in addressing several orthopedic conditions with various cohorts. American football provides a good population for attempting to predict injuries due to their relatively high injury rate. Physical performance can be assessed a variety of ways using an assortment of different tests to assess a diverse set of metrics, which may include reaction time, speed, acceleration, and deceleration. Asymmetry, the difference between right and left performance has been identified as a possible risk factor for injury. The purpose of this study was to determine the whole-body reactive agility metrics that would identify Division I football players who were at elevated risk for core, and lower extremity injuries (CLEI). This cohort study utilized 177 Division I football players with a total of 57 CLEI suffered who were baseline tested prior to the season. Single-task and dual-task whole-body reactive agility movements in lateral and diagonal direction reacting to virtual reality targets were analyzed separately. Receiver operator characteristic (ROC) analyses narrowed the 34 original predictor variables to five variables. Logistic regression analysis determined the three strongest predictors of CLEI for this cohort to be: lateral agility acceleration asymmetry, lateral flanker deceleration asymmetry, and diagonal agility reaction time average. Univariable analysis found odds ratios to range from 1.98 to 2.75 for these predictors of CLEI. ROC analysis had an area under the curve of 0.702 for any combination of two or more risk factors produced an odds ratio of 5.5 for risk of CLEI. These results suggest an asymmetry of 8-15% on two of the identified metrics or a slowed reaction time of ≥0.787 s places someone at increased risk of injury. Sixty-three percent (36/57) of the players who sustained an injury had ≥2 positive predictors In spite of the recognized limitation, these finding support the belief that whole-body reactive agility performance can identify Division I football players who are at elevated risk for CLEI.
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Affiliation(s)
- Scott L Bruce
- Masters of Athletic Training Program, Arkansas State University, Jonesboro, AR, United States
| | - Gary B Wilkerson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
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15
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Wilkerson GB, Nabhan DC, Perry TS. A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes. Front Sports Act Living 2021; 3:729729. [PMID: 34661098 PMCID: PMC8517233 DOI: 10.3389/fspor.2021.729729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Standard clinical assessments of mild traumatic brain injury are inadequate to detect subtle abnormalities that can be revealed by sophisticated diagnostic technology. An association has been observed between sport-related concussion (SRC) and subsequent musculoskeletal injury, but the underlying neurophysiological mechanism is not currently understood. A cohort of 16 elite athletes (10 male, 6 female), which included nine individuals who reported a history of SRC (5 male, 4 female) that occurred between 4 months and 8 years earlier, volunteered to participate in a 12-session program for assessment and training of perceptual-motor efficiency. Performance metrics derived from single- and dual-task whole-body lateral and diagonal reactive movements to virtual reality targets in left and right directions were analyzed separately and combined in various ways to create composite representations of global function. Intra-individual variability across performance domains demonstrated very good SRC history classification accuracy for the earliest 3-session phase of the program (Reaction Time Dispersion AUC = 0.841; Deceleration Dispersion AUC = 0.810; Reaction Time Discrepancy AUC = 0.825, Deceleration Discrepancy AUC = 0.794). Good earliest phase discrimination was also found for Composite Asymmetry between left and right movement directions (AUC = 0.778) and Excursion Average distance beyond the minimal body displacement necessary for virtual target deactivation (AUC = 0.730). Sensitivity derived from Youden's Index for the 6 global factors ranged from 67 to 89% and an identical specificity value of 86% for all of them. Median values demonstrated substantial improvement from the first 3-session phase to the last 3-session phase for Composite Asymmetry and Excursion Average. The results suggest that a Composite Asymmetry value ≥ 0.15 and an Excursion Average value ≥ 7 m, provide reasonable qualitative approximations for clinical identification of suboptimal perceptual-motor performance. Despite acknowledged study limitations, the findings support a hypothesized relationship between whole-body reactive agility performance and functional connectivity among brain networks subserving sensory perception, cognitive decision-making, and motor execution. A complex systems approach appears to perform better than traditional data analysis methods for detection of subtle perceptual-motor impairment, which has the potential to advance both clinical management of SRC and training for performance enhancement.
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Affiliation(s)
- Gary B Wilkerson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Dustin C Nabhan
- Oslo Sports Trauma Research Center, Norwegian School of Sport Science, Oslo, Norway
| | - Tyler S Perry
- Orthopedics and Sports Medicine, Emory Healthcare, Atlanta, GA, United States
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16
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Avedesian JM, Singh H, Diekfuss JA, Myer GD, Grooms DR. Loss of Motor Stability After Sports-Related Concussion: Opportunities for Motor Learning Strategies to Reduce Musculoskeletal Injury Risk. Sports Med 2021; 51:2299-2309. [PMID: 34339041 DOI: 10.1007/s40279-021-01527-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
Current best practices to direct recovery after sports-related concussion (SRC) typically require asymptomatic presentation at both rest and during a graduated exercise progression, and cognitive performance resolution. However, this standard of care results in a significantly elevated risk for musculoskeletal (MSK) injury after return-to-sport (RTS). The elevated risk is likely secondary to, in part, residual neurophysiological and dual-task motor stability deficits that remain despite RTS. These deficits present as a loss of autonomous control of gait and posture and an increased need for cognition for motor stability. Thus, the incorporation of strategies that can enhance motor stability and restore autonomous control of gait and posture during SRC recovery and RTS progression may facilitate a reduction of the elevated risk of secondary MSK injury. We provide a theoretical framework for the application of motor learning principles to restore autonomous gait and postural stability after SRC via incorporation, or targeted manipulation, of external focus, enhanced expectations, autonomy support, practice schedule variability, and dual-task strategies during rehabilitation and RTS training.
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Affiliation(s)
- Jason M Avedesian
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA.
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA.
| | - Harjiv Singh
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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17
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Evaluating the Spectrum of Cognitive-Motor Relationships During Dual-Task Jump Landing. J Appl Biomech 2021; 37:388-395. [PMID: 34271547 DOI: 10.1123/jab.2020-0388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 11/18/2022]
Abstract
Cognitive function plays a role in understanding noncontact anterior cruciate ligament injuries, but the research into how cognitive function influences sport-specific movements is underdeveloped. The purpose of this study was to determine how various cognitive tasks influenced dual-task jump-landing performance along with how individuals' baseline cognitive ability mediated these relationships. Forty female recreational soccer and basketball players completed baseline cognitive function assessments and dual-task jump landings. The baseline cognitive assessments quantified individual processing speed, multitasking, attentional control, and primary memory ability. Dual-task conditions for the jump landing included unanticipated and anticipated jump performance, with and without concurrent working memory and captured visual attention tasks. Knee kinematics and kinetics were acquired through motion capture and ground reaction force data. Jumping conditions that directed visual attention away from the landing, whether anticipated or unanticipated, were associated with decreased peak knee flexion angle (P < .001). No interactions between cognitive function measures and jump-landing conditions were observed for any of the biomechanical variables, suggesting that injury-relevant cognitive-motor relationships may be specific to secondary task demands and movement requirements. This work provides insight into group- and subject-specific effects of established anticipatory and novel working memory dual-task paradigms on the neuromuscular control of a sport-specific movement.
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18
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Archbold P, Rankin AT, Webb M, Davies R, Nicholas R, Eames NWA, Wilson RK, Vincent J, McKeever D, Duddy K, Matthews M, Bleakley C. Injury patterns in U15 rugby players in Ulster schools: A Rugby Injury Surveillance (RISUS) Study. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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19
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Chmielewski TL, Tatman J, Suzuki S, Horodyski M, Reisman DS, Bauer RM, Clugston JR, Herman DC. Impaired motor control after sport-related concussion could increase risk for musculoskeletal injury: Implications for clinical management and rehabilitation. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:154-161. [PMID: 33188963 PMCID: PMC7987572 DOI: 10.1016/j.jshs.2020.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 05/29/2023]
Abstract
This review presents a conceptual framework and supporting evidence that links impaired motor control after sport-related concussion (SRC) to increased risk for musculoskeletal injury. Multiple studies have found that athletes who are post-SRC have higher risk for musculoskeletal injury compared to their counterparts. A small body of research suggests that impairments in motor control are associated with musculoskeletal injury risk. Motor control involves the perception and processing of sensory information and subsequent coordination of motor output within the central nervous system to perform a motor task. Motor control is inclusive of motor planning and motor learning. If sensory information is not accurately perceived or there is interference with sensory information processing and cognition, motor function will be altered, and an athlete may become vulnerable to injury during sport participation. Athletes with SRC show neuroanatomic and neurophysiological changes relevant to motor control even after meeting return to sport criteria, including a normal neurological examination, resolution of symptoms, and return to baseline function on traditional concussion testing. In conjunction, altered motor function is demonstrated after SRC in muscle activation and force production, movement patterns, balance/postural stability, and motor task performance, especially performance of a motor task paired with a cognitive task (i.e., dual-task condition). The clinical implications of this conceptual framework include a need to intentionally address motor control impairments after SRC to mitigate musculoskeletal injury risk and to monitor motor control as the athlete progresses through the return to sport continuum.
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Affiliation(s)
| | | | - Shuhei Suzuki
- TRIA Orthopedic Center, Bloomington, MN 55431, USA; ATP Tour Inc., Ponte Vedra Beach, FL 32082, USA
| | - MaryBeth Horodyski
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32607, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32611, USA
| | - James R Clugston
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL 32603, USA
| | - Daniel C Herman
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32607, USA
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20
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Single- Versus Dual-Task Functional Movement Paradigms: A Biomechanical Analysis. J Sport Rehabil 2021; 30:774-785. [PMID: 33494045 DOI: 10.1123/jsr.2020-0310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Laboratory-based movement assessments are commonly performed without cognitive stimuli (ie, single-task) despite the simultaneous cognitive processing and movement (ie, dual task) demands required during sport. Cognitive loading may critically alter human movement and be an important consideration for truly assessing functional movement and understanding injury risk in the laboratory, but limited investigations exist. OBJECTIVE To comprehensively examine and compare kinematics and kinetics between single- and dual-task functional movement among healthy participants while controlling for sex. DESIGN Cross-sectional study. SETTING Laboratory. Patients (or Other Participants): Forty-one healthy, physically active participants (49% female; 22.5 ± 2.1 y; 172.5 ± 11.9 cm; 71.0 ± 13.7 kg) enrolled in and completed the study. INTERVENTION(S) All participants completed the functional movement protocol under single- and dual-task (subtracting by 6s or 7s) conditions in a randomized order. Participants jumped forward from a 30-cm tall box and performed (1) maximum vertical jump landings and (2) dominant and (3) nondominant leg, single-leg 45° cuts after landing. MAIN OUTCOME MEASURES The authors used mixed-model analysis of variances (α = .05) to compare peak hip, knee, and ankle joint angles (degrees) and moments (N·m/BW) in the sagittal and frontal planes, and peak vertical ground reaction force (N/BW) and vertical impulse (Ns/BW) between cognitive conditions and sex. RESULTS Dual-task resulted in greater peak vertical ground reaction force compared with single-task during jump landing (mean difference = 0.06 N/BW; 95% confidence interval [CI], 0.01 to 0.12; P = .025) but less force during dominant leg cutting (mean difference = -0.08 N/BW; 95% CI, -0.14 to -0.02; P = .015). Less hip-flexion torque occurred during dual task than single task (mean difference = -0.09 N/BW; 95% CI, -0.17 to -0.02). No other outcomes were different between single and dual task (P ≥ .053). CONCLUSIONS Slight, but potentially important, kinematic and kinetic differences were observed between single- and dual-task that may have implications for functional movement assessments and injury risk research. More research examining how various cognitive and movement tasks interact to alter functional movement among pathological populations is warranted before clinical implementation.
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Dual-Task Gait Stability after Concussion and Subsequent Injury: An Exploratory Investigation. SENSORS 2020; 20:s20216297. [PMID: 33167407 PMCID: PMC7663806 DOI: 10.3390/s20216297] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022]
Abstract
Persistent gait alterations can occur after concussion and may underlie future musculoskeletal injury risk. We compared dual-task gait stability measures among adolescents who did/did not sustain a subsequent injury post-concussion, and uninjured controls. Forty-seven athletes completed a dual-task gait evaluation. One year later, they reported sport-related injuries and sport participation volumes. There were three groups: concussion participants who sustained a sport-related injury (n = 8; age =15.4 ± 3.5 years; 63% female), concussion participants who did not sustain a sport-related injury (n = 24; 14.0 ± 2.6 years; 46% female), and controls (n = 15; 14.2 ± 1.9 years; 53% female). Using cross-recurrence quantification, we quantified dual-task gait stability using diagonal line length, trapping time, percent determinism, and laminarity. The three groups reported similar levels of sports participation (11.8 ± 5.8 vs. 8.6 ± 4.4 vs. 10.9 ± 4.3 hours/week; p = 0.37). The concussion/subsequent injury group walked slower (0.76 ± 0.14 vs. 0.65 ± 0.13 m/s; p = 0.008) and demonstrated higher diagonal line length (0.67 ± 0.08 vs. 0.58 ± 0.05; p = 0.02) and trapping time (5.3 ± 1.5 vs. 3.8 ± 0.6; p = 0.006) than uninjured controls. Dual-task diagonal line length (hazard ratio =1.95, 95% CI = 1.05–3.60), trapping time (hazard ratio = 1.66, 95% CI = 1.09–2.52), and walking speed (hazard ratio = 0.01, 95% CI = 0.00–0.51) were associated with subsequent injury. Dual-task gait stability measures can identify altered movement that persists despite clinical concussion recovery and is associated with future injury risk.
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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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Schnittjer A, Simon JE, Yom J, Grooms DR. The Effects of a Cognitive Dual Task on Jump-landing Movement Quality. Int J Sports Med 2020; 42:90-95. [PMID: 32693426 DOI: 10.1055/a-1195-2700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Investigations on movement quality deficits associated with jump landing are numerous, however, these studies are often performed in laboratories with little distraction to the participant. This is contrary to how injury typically occurs secondary to sport-specific distraction where the athlete is cognitively loaded during motor performance. Thus, the purpose of this study was to determine the effect of a cognitive load on jump-landing movement quality. A dual-task design was used to determine the effects of a dual-task on tuck jump movement quality in 20 participants. There were three cognitive conditions (no cognitive task, easy-cognitive task, and difficult-cognitive task). The dual task elicited statistically significant changes in overall tuck jump score (movement quality) across the conditions with tuck jump score increasing from 3.52±1.64 baseline to 4.37±1.25 with the easy-cognitive task to 4.67±1.24 with the difficult-cognitive task. The findings of this study may be useful to screen for individuals at risk of lower extremity injury utilizing the tuck jump when paired with a cognitive task. The screening would then identify individuals who may have poor neuromuscular control when cognitively loaded.
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Affiliation(s)
| | - Janet E Simon
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.,Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
| | - Jae Yom
- Allied Health, University of Illinois at Springfield, Springfield, United States
| | - Dustin R Grooms
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.,Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
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Wilkerson GB, Nabhan DC, Crane RT. Concussion History and Neuromechanical Responsiveness Asymmetry. J Athl Train 2020; 55:594-600. [PMID: 32396473 DOI: 10.4085/1062-6050-0401.19] [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] [Indexed: 12/23/2022]
Abstract
CONTEXT Detection of subtle changes in brain sensorimotor processes may enable clinicians to identify athletes who would derive the greatest benefit from interventions designed to reduce the risk for future injury and progressive neurologic or musculoskeletal dysfunction. OBJECTIVE To develop a generalizable statistical model for identifying athletes who possess subtle alterations in sensorimotor processes that may be due to previous concussion. DESIGN Cross-sectional study. SETTING Residential Olympic Training Center sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS A primary cohort of 35 elite athletes and a secondary cohort of 40 elite athletes who performed identical tests the preceding year. INTERVENTION(S) Two upper extremity tests of visual-motor reaction time and 2 tests of whole-body reactive agility were administered. The whole-body tests required lateral or diagonal responses to virtual-reality targets, which provided measures of reaction time, speed, acceleration, and deceleration. MAIN OUTCOME MEASURE(S) Sport-related concussion history, which was reported by 54% (n = 19) of the athletes in the primary cohort and 45% (n = 18) of the athletes in the secondary cohort. RESULTS Univariable analyses identified 12 strong predictors of sport-related concussion history, which we combined to create a composite metric with maximum predictive value. Composite lateral asymmetry for whole-body reactive movements and persisting effects of previous musculoskeletal injury yielded a logistic regression model with exceptionally good discrimination (area under the curve = 0.845) and calibration (predicted-observed probabilities within 7 subgroups: r = 0.959, P = .001). Application of the derived model to compatible data acquired from another cohort of elite athletes demonstrated very good discrimination (area under the curve = 0.772) and calibration (within 8 subgroups: r = 0.849, P = .008). CONCLUSIONS Asymmetry in whole-body reactive movement capabilities may be a manifestation of a subtle abnormality in the functional connectivity of brain networks that might be relevant to previously reported associations between sport-related concussion history and musculoskeletal injury occurrence.
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Wilkerson GB, Nabhan DC, Prusmack CJ, Moreau WJ. Detection of Persisting Concussion Effects on Neuromechanical Responsiveness. Med Sci Sports Exerc 2019; 50:1750-1756. [PMID: 29683918 DOI: 10.1249/mss.0000000000001647] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Assessment of various indices of neuromechanical responsiveness for association with concussion history. METHODS An observational cohort study included 48 elite athletes (34 males: 23.8 ± 4.4 yr; 14 females: 25.4 ± 4.5 yr) who performed visuomotor reaction time (VMRT) tests involving rapid manual contact with illuminated target buttons that included two dual-task conditions: 1) simultaneous oral recitation of scrolling text (VMRT+ST) and 2) simultaneous verbal responses to identify the right or left direction indicated by the center arrow of the Eriksen flanker test (VMRT+FT). A whole-body reactive agility (WBRA) test requiring side-shuffle movements in response to visual targets was used to assess reaction time, speed, acceleration, and deceleration. RESULTS Concussion occurrence at 2.0 ± 2.3 yr before testing was reported by 21 athletes. Strong univariable associations were found for VMRT+FT left minus right difference ≥15 ms (odds ratio [OR], 7.14), VMRT+ST outer two-ring to inner three-ring ratio ≥1.28 (OR, 4.58), and WBRA speed asymmetry ≥7.7% (OR, 4.67). A large VMRT+FT by VMRT+ST interaction effect was identified (OR, 25.00). Recursive partitioning identified a three-way VMRT+FT by VMRT+ST by WBRA interaction that had 100% positive predictive value for identification of athletes with concussion history, whereas negative status on all three factors had 90% negative predictive value. CONCLUSIONS Performance on dual-task VMRT tests and the WBRA test identified neuromechanical responsiveness deficiencies among elite athletes who reported a history of concussion.
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Affiliation(s)
| | - Dustin C Nabhan
- US Olympic Committee, US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO
| | | | - William J Moreau
- US Olympic Committee, US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO
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Grafton ST, Ralston AB, Ralston JD. Monitoring of postural sway with a head-mounted wearable device: effects of gender, participant state, and concussion. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:151-164. [PMID: 31118838 PMCID: PMC6503189 DOI: 10.2147/mder.s205357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/20/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess the utility of a head-mounted wearable inertial motion unit (IMU)-based sensor and 3 proposed measures of postural sway to detect outliers in athletic populations at risk of balance impairments. Methods: Descriptive statistics are used to define a normative reference range of postural sway (eyes open and eyes closed) in a cross-sectional sample of 347 college students using a wireless head-mounted IMU-based sensor. Three measures of postural sway were derived: linear sway power, eyes closed vs eyes open sway power ratio (Ec/Eo ratio), and weight-bearing asymmetry (L-R ratio), and confidence intervals for these measures were calculated. Questionnaires were used to identify potentially confounding state variables. A prospective study of postural sway changes in 47 professional, college, and high school athletes was then carried out in on-field settings to provide estimates of session-to-session variability and the influence of routine physical activity on sway measures. Finally, pre-post-injury changes in sway are measured for a participant who was diagnosed with a concussion. Results: Despite the heterogenous population and sampling environments, well-defined confidence intervals were established for all 3 sway measures. Men demonstrated significantly greater sway than women. Two state variables significantly increased sway: the use of nicotine and prescription medications. In the athletes, session-to-session variability and changes due to routine physical activity remained well within 95% confidence intervals defined by the cross-sectional sample for all 3 sway measures. The increase in sway power following a diagnosed concussion was more than an order of magnitude greater than the increases due to session-to-session variability, physical activity, or other participant state variables. Conclusion: The proposed postural sway measures and head-mounted wearable sensor demonstrate analytic utility for on-field detection of abnormal sway that could be potentially useful when making remove-from-activity and return-to-activity decisions for athletes at risk of impact-induced balance impairments.
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Affiliation(s)
- Scott T Grafton
- Department of Psychological & Brain Sciences, UC Santa Barbara, Santa Barbara, CA 93106-9660, USA
| | - Andreas B Ralston
- Clinical Studies Department, Protxx Inc, Menlo Park, CA, 94025-4317, USA
| | - John D Ralston
- Clinical Studies Department, Protxx Inc, Menlo Park, CA, 94025-4317, USA
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Howell DR, Myer GD, Grooms D, Diekfuss J, Yuan W, Meehan WP. Examining Motor Tasks of Differing Complexity After Concussion in Adolescents. Arch Phys Med Rehabil 2018; 100:613-619. [PMID: 30193950 DOI: 10.1016/j.apmr.2018.07.441] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES (1) To determine the effects of concussion-related motor impairments at different task complexities in isolation and with a cognitive dual-task and (2) to determine if self-reported balance deficits after concussion are associated with gait, quiet stance, or cognitive dual-task impairments. DESIGN Cross-sectional study. SETTING Sports medicine clinic. PARTICIPANTS Adolescent athletes clinically diagnosed with a sport-related concussion and those without concussion. Forty-nine patients with concussion (mean age=14.9±1.9y; 51% female; tested 7.0±3.0d postinjury) and 65 control participants (mean age=14.9±1.6y; 52% female) completed the study (N=114). INTERVENTIONS Athletes with concussion completed a single-task and dual-task standing and walking protocol within 14 days of injury and were compared to those without concussion. MAIN OUTCOME MEASURES Outcome measures included gait speed, quiet stance (root mean square [RMS] coronal/sagittal plane sway), and cognitive performance (accuracy). Dual-task costs were calculated as the percentage change between single-task and dual-task conditions. Participants with concussion were then stratified by those who did and did not report subjective balance problems at the time of testing and compared using objective balance and gait metrics. RESULTS The concussion group walked slower during dual-task gait than controls (0.83±0.17 m/s vs 0.92±0.15 m/s; Cohen's d=0.53). Dual-task quiet stance RMS sway values were similar for concussion and control groups in coronal (1.20±0.52 m/s-2 vs 1.26±0.65 m/s-2; d=0.09) and sagittal (0.56±0.24 m/s-2 vs 0.73±0.44 m/s-2; d=0.20) movement planes. The concussion participants with subjectively-reported balance problems had significantly greater walking speed dual-task costs than concussion participants without self-reported balance problems (-25±10% vs -19±9%; P=.02). CONCLUSIONS Following concussion, adolescents demonstrate slower gait speeds, but similar quiet stance values relative to those without concussion. The study results indicate that tasks requiring greater motor coordination may elicit greater alterations following a concussion.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO; The Micheli Center for Sports Injury Prevention, Waltham, MA.
| | - Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dustin Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH
| | - Jed Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; University of Cincinnati College of Medicine, Cincinnati, OH
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA; Division of Sports Medicine, Boston Children's Hospital, Boston, MA; Departments of Orthopaedic Surgery and Pediatrics, Harvard Medical School, Boston, MA
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