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Mitchell KM, Dalton KN, Cinelli ME. A treadmill running research protocol to assess dynamic visual acuity and balance for athletes with and without recent concussion history. BMC Sports Sci Med Rehabil 2024; 16:112. [PMID: 38760838 PMCID: PMC11101338 DOI: 10.1186/s13102-024-00900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024]
Abstract
Athletes interpret dynamic visual scenes quickly and accurately during physical exertion. It is important to understand how increased exertion may impact vision and cognition following sport-related concussion (SRC).Purpose To examine the effect of a treadmill running research protocol on the assessment of dynamic visual acuity (DVA) and balance for athletes with and without recent history of SRC.Methods Varsity athletes following recent SRC (CONC=12) were compared to athletes without SRC (ATHLETE=19). The DVA task presented a Tumbling 'E' target in four possible orientations during random walk (RW) or horizontal (H) motion at a speed of 30°/s. Participants performed DVA trials standing on a force plate (1000Hz) at four time points: 1) pre-exercise (PRE-EX), 2) immediately (POST1), 3) 10-minutes (POST10), and 4) 20-minutes post- exercise (POST20). Performance was calculated as a change in DVA score from PRE-EX and median response time (RT, ms). Balance control was analyzed using the root mean square of centre of pressure displacement (dCOP).Results Both groups maintained DVA scores for both motion types and exhibited immediate exercise-induced benefits on RT. Both groups had similar change in balance control strategy following treadmill exercise.Conclusion Both groups elicited similar exercise-induced benefits on DVA following exercise. A repeated measures assessment following vigorous exercise may provide meaningful insights about visual and neurocognitive functions for athletes returning to sport following concussion.
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Affiliation(s)
| | | | - Michael E Cinelli
- Wilfrid Laurier University, 75 University Ave. W., Waterloo, ON, N2L 3C5, Canada.
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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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Weightman MM, King LA, Fino PC, Dibble LE, Pelo R, Michielutti PG, Richard H, Parrington L, Lester ME, Hoppes CW. Reconsidering Vestibular/Ocular Motor Screening Cutoff Scores for Concussion. Mil Med 2024; 189:e714-e720. [PMID: 37856171 DOI: 10.1093/milmed/usad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Vestibular/Ocular Motor Screening (VOMS) is often part of a comprehensive evaluation to identify acute mild traumatic brain injury. Most of the reports describe the use of the VOMS in adolescents/young adults and not in older adults or military service members. The purpose of this study was to describe VOMS findings in healthy civilians and active duty military service members up to the age of 50 years. MATERIALS AND METHODS Seventy-seven healthy civilians between 18 and 50 years of age (22 males, age 31.8 [9.0] years) participated across three sites in addition to 40 healthy active duty service members (25 males, age 27.5 [4.9] years) from one site. Demographics, Neurobehavioral Symptom Inventory scores, mean near point convergence (NPC) distance, and Total Symptom Change (TSS) scores from the VOMS were evaluated. RESULTS For civilians, the group mean NPC distance was 4.98 (3.8) cm. For military service members, the group mean NPC distance was 6.17 (4.57) cm. For civilians, the mean TSS was 1.2 (2.3) with 53.2% reporting 0 TSS, 27.3% reporting one TSS, and 19.5% reporting two or more TSS. For military service members, the mean TSS was 0.20 (0.72) with 92.5% reporting 0 TSS, 0% reporting one TSS, and 7.5% reporting two or more TSS. Age did not correlate with the mean NPC distance and TSS in healthy civilians and active duty military service members. CONCLUSIONS Reconsideration of the Military Acute Concussion Evaluation, Version 2 cutoff value for abnormal mean NPC distance may be warranted to improve diagnostic accuracy in both civilian and military adult populations. Similarly, re-evaluating criteria for interpreting the TSS results of the VOMS, specifically in civilians, may be warranted.
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Affiliation(s)
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Peter C Fino
- Department of Health & Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Ryan Pelo
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | | | - Holly Richard
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Lucy Parrington
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Mark E Lester
- Department of Physical Therapy, University of Texas-Rio Grande Valley, Edinburg, TX 78539, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
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Weston AR, Antonellis P, Fino PC, Hoppes CW, Lester ME, Weightman MM, Dibble LE, King LA. Quantifying Turning Tasks With Wearable Sensors: A Reliability Assessment. Phys Ther 2024; 104:pzad134. [PMID: 37802908 DOI: 10.1093/ptj/pzad134] [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: 12/19/2022] [Revised: 07/05/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE The aim of this study was to establish the test-retest reliability of metrics obtained from wearable inertial sensors that reflect turning performance during tasks designed to imitate various turns in daily activity. METHODS Seventy-one adults who were healthy completed 3 turning tasks: a 1-minute walk along a 6-m walkway, a modified Illinois Agility Test (mIAT), and a complex turning course (CTC). Peak axial turning and rotational velocity (yaw angular velocity) were extracted from wearable inertial sensors on the head, trunk, and lumbar spine. Intraclass correlation coefficients (ICCs) were established to assess the test-retest reliability of average peak turning speed for each task. Lap time was collected for reliability analysis as well. RESULTS Turning speed across all tasks demonstrated good to excellent reliability, with the highest reliability noted for the CTC (45-degree turns: ICC = 0.73-0.81; 90-degree turns: ICC = 0.71-0.83; and 135-degree turns: ICC = 0.72-0.80). The reliability of turning speed during 180-degree turns from the 1-minute walk was consistent across all body segments (ICC = 0.74-0.76). mIAT reliability ranged from fair to excellent (end turns: ICC = 0.52-0.72; mid turns: ICC = 0.50-0.56; and slalom turns: ICC = 0.66-0.84). The CTC average lap time demonstrated good test-retest reliability (ICC = 0.69), and the mIAT average lap time test-retest reliability was excellent (ICC = 0.91). CONCLUSION Turning speed measured by inertial sensors is a reliable outcome across a variety of ecologically valid turning tasks that can be easily tested in a clinical environment. IMPACT Turning performance is a reliable and important measure that should be included in clinical assessments and clinical trials.
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Affiliation(s)
- Angela R Weston
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, Texas, USA
| | - Prokopios Antonellis
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, Texas, USA
| | - Mark E Lester
- Department of Physical Therapy, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | | | - Leland E Dibble
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
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Miller Koop M, Rosenfeldt AB, Owen K, Zimmerman E, Johnston J, Streicher MC, Albright A, Penko AL, Alberts JL. The Microsoft HoloLens 2 Provides Accurate Biomechanical Measures of Performance During Military-Relevant Activities in Healthy Adults. Mil Med 2023; 188:92-101. [PMID: 37948237 DOI: 10.1093/milmed/usad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Augmented reality systems, like the HoloLens 2 (HL2), have the potential to provide accurate assessments of mild traumatic brain injury (mTBI) symptoms in military personnel by simulating complex military scenarios while objectively measuring the user's movements with embedded motion sensors. The aim of this project was to determine if biomechanical measures of marching and squatting, derived from the HL2 motion sensors, were statistically equivalent, within 5%, to metrics derived from the gold-standard three-dimensional motion capture (MoCap) system. MATERIALS AND METHODS Sixty-four adults (18-45 years; 34 males) completed a squatting and a marching task under single- (motor) and dual-task (motor + cognitive) conditions. Positional data from the HL2 and MoCap were simultaneously collected during the tasks and used to calculate and compare biomechanical outcomes. The HL2's augmented reality capabilities were utilized to deliver the cognitive component of the marching dual task. RESULTS Equivalence testing indicated the HL2 and MoCap measures were within 5% in all squatting metrics-trial time, squat duration, squat velocity, squat depth, and dwell time. Marching metrics, including trial time, step count, stepping rate, and step interval, were also equivalent between the two systems. The mean reaction time for responses during the Stroop test was 810 (125) milliseconds per response. CONCLUSIONS Biomechanical outcomes characterizing performance during two common military movements, squatting and marching, were equivalent between the HL2 and MoCap systems in healthy adults. Squatting and marching are two military-relevant tasks that require strength, motor coordination, and balance to perform, all of which are known to be affected by mTBI. Taken together, the data provide support for using the HL2 platform to deliver military-specific assessment scenarios and accurately measure performance during these activities. Utilizing objective and quantitative measures of motor function may enhance the management of military mTBI and reduce unnecessary risk to service members.
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Affiliation(s)
- Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Kelsey Owen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Eric Zimmerman
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Joshua Johnston
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Matthew C Streicher
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Alec Albright
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Amanda L Penko
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH 44195, USA
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Loyd BJ, Dibble LE, Weightman MM, Pelo R, Hoppes CW, Lester M, King LA, Fino PC. Volitional Head Movement Deficits and Alterations in Gait Speed Following Mild Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:E223-E232. [PMID: 36731009 DOI: 10.1097/htr.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Unconstrained head motion is necessary to scan for visual cues during navigation, for minimizing threats, and to allow regulation of balance. Following mild traumatic brain injury (mTBI) people may experience alterations in head movement kinematics, which may be pronounced during gait tasks. Gait speed may also be impacted by the need to turn the head while walking in these individuals. The aim of this study was to examine head kinematics during dynamic gait tasks and the interaction between kinematics and gait speed in people with persistent symptoms after mTBI. SETTING A clinical assessment laboratory. DESIGN A cross-sectional, matched-cohort study. PARTICIPANTS Forty-five individuals with a history of mTBI and 46 age-matched control individuals. MAIN MEASURES All participants were tested at a single time point and completed the Functional Gait Assessment (FGA) while wearing a suite of body-mounted inertial measurement units (IMUs). Data collected from the IMUs were gait speed, and peak head rotation speed and amplitude in the yaw and pitch planes during the FGA-1, -3, and -4 tasks. RESULTS Participants with mTBI demonstrated significantly slower head rotations in the yaw ( P = .0008) and pitch ( P = .002) planes. They also demonstrated significantly reduced amplitude of yaw plane head rotations ( P < .0001), but not pitch plane head rotations ( P = .84). Participants with mTBI had significantly slower gait speed during normal gait (FGA-1) ( P < .001) and experienced a significantly greater percent decrease in gait speed than healthy controls when walking with yaw plane head rotations (FGA-3) ( P = .02), but not pitch plane head rotations (FGA-4) ( P = .11). CONCLUSIONS Participants with mTBI demonstrated smaller amplitudes and slower speeds of yaw plane head rotations and slower speeds of pitch plane head rotations during gait. Additionally, people with mTBI walked slower during normal gait and demonstrated a greater reduction in gait speed while walking with yaw plane head rotations compared with healthy controls.
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Affiliation(s)
- Brian J Loyd
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula (Dr Loyd); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City (Drs Dibble and Pelo); Courage Kenny Research Center-Allina Health, Minneapolis, Minnesota (Dr Weightman); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (Dr Hoppes); Department of Physical Therapy, Texas State University, Round Rock (Dr Lester); School of Medicine, Oregon Health & Sciences University, Portland (Dr King); and Department of Health and Kinesiology, University of Utah, Salt Lake City (Dr Fino)
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Fino PC, Michielutti PG, Pelo R, Parrington L, Dibble LE, Hoppes CW, Lester ME, Weightman MM, King LA. A Hybrid Assessment of Clinical Mobility Test Items for Evaluating Individuals With Mild Traumatic Brain Injury. J Neurol Phys Ther 2023; 47:84-90. [PMID: 36538333 PMCID: PMC10033306 DOI: 10.1097/npt.0000000000000427] [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: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE The Functional Gait Assessment (FGA) and High Level Mobility Assessment Tool (HiMAT) are clinical batteries used to assess people with mild traumatic brain injury (mTBI). However, neither assessment was specifically developed for people with mTBI; the FGA was developed to evaluate vestibular deficits, and the HiMAT was developed for individuals with more severe TBI. To maximize the sensitivity and reduce the time burden of these assessments, the purpose of this study was to determine the combination of FGA and HiMAT items that best discriminates persons with persistent symptoms from mTBI from healthy controls. METHODS Fifty-three symptomatic civilians with persistent symptoms from mTBI (21% male, aged 31 (9.5) years, 328 [267] days since concussion) and 57 healthy adults (28% male, aged 32 (9.6) years) participated across 3 sites. The FGA and HiMAT were evaluated sequentially as part of a larger study. To determine the best combination of items, a lasso-based generalized linear model (glm) was fit to all data. RESULTS The area under the curve (AUC) for FGA and HiMAT total scores was 0.68 and 0.66, respectively. Lasso regression selected 4 items, including FGA Gait with Horizontal Head Turns and with Pivot Turn, and HiMAT Fast Forward and Backward Walk, and yielded an AUC (95% confidence interval) of 0.71 (0.61-0.79) using standard scoring. DISCUSSION AND CONCLUSIONS The results provide initial evidence supporting a reduced, 4-Item Hybrid Assessment of Mobility for mTBI (HAM-4-mTBI) for monitoring individuals with mTBI. Future work should validate the HAM-4-mTBI and investigate its utility for tracking progression throughout rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A409 ).
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Affiliation(s)
- Peter C Fino
- Departments of Health & Kinesiology (P.C.F.) and Physical Therapy & Athletic Training (R.P., L.E.D.), The University of Utah, Salt Lake City, Utah; Courage Kenny Research Center, Allina Health, Minneapolis, Minnesota (P.G.M., M.M.W.); Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia (L.P.); Department of Neurology, Oregon Health & Science University, Portland, Oregon (L.P., L.A.K.); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (C.W.H., M.E.L.); and Department of Physical Therapy, Texas State University, Round Rock, Texas (M.E.L.)
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Miner D, Harper B. Combined Neurocognitive and Exercise Tolerance Testing Improves Objectivity of Buffalo Concussion Treadmill Test. J Sport Rehabil 2023:1-7. [PMID: 36940684 DOI: 10.1123/jsr.2022-0354] [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: 09/30/2022] [Revised: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 03/23/2023]
Abstract
CONTEXT The Buffalo Concussion Treadmill Test (BCTT) is a standard assessment of exercise tolerance utilized for exercise prescription following concussion and to inform decisions regarding return to play. One limitation of the BCTT is that interpretation of test results is dependent on individuals' self-report of symptom exacerbation with exertion. Symptoms following concussion are significantly underreported or unreported. Combining objective neurocognitive assessment with exercise tolerance testing may enable clinicians to objectively identify those requiring further assessment or rehabilitation before return to play. The purpose of this study was to investigate how performance on a neurocognitive assessment battery is affected by provocative exercise testing. DESIGN Prospective cohort study, pretest/posttest. METHODS A total of 30 participants included 13 women (43.3%), age 23.4 (1.93) years, height 173.56 (10) cm, weight 77.35 (16.3) kg, and 11 (36.7%) with history of concussion. All participants completed a neurocognitive assessment battery, including the Stroop Test and standardized assessments of working memory, attention, and information processing speed/accuracy in single-task (seated position) and dual-task conditions (walking on a treadmill at 2.0 miles per hour). The neurocognitive assessment battery was performed at baseline and after the standard BCTT test protocol. RESULTS BCTT: Average percentage of heart rate maximum (%HRmax) = 93.97% (4.8%); average maximum rating of perceived exertion = 18.6 (1.5). Time-based performance in single-task and dual-task conditions significantly improved from baseline (P < .05) following maximal exercise testing on the BCTT for the following neurocognitive assessments: concentration-reverse digits, Stroop congruent, and Stroop incongruent. CONCLUSIONS Healthy participants demonstrated improvements across multiple domains of neurocognitive performance following the exercise tolerance testing on the BCTT. Understanding normal responses in neurocognitive performance for healthy individuals following exercise tolerance testing may allow clinicians to more objectively monitor the trajectory of recovery following sports-related concussion.
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Affiliation(s)
- Daniel Miner
- Department of Physical Therapy, Radford University Carilion, Roanoke, VA,USA
| | - Brent Harper
- Department of Physical Therapy, Chapman University, Irvine, CA,USA
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Favorov O, Kursun O, Challener T, Cecchini A, McCulloch KL. Wearable Sensors Detect Movement Differences in the Portable Warrior Test of Tactical Agility After mTBI in Service Members. Mil Med 2023; 188:e637-e645. [PMID: 34476483 PMCID: PMC10026617 DOI: 10.1093/milmed/usab361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 08/17/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Assessment of functional recovery of service members following a concussion is central to their return to duty. Practical military-relevant performance-based tests are needed for identifying those who might need specialized rehabilitation, for evaluating the progress of recovery, and for making return-to-duty determinations. One such recently developed test is the 'Portable Warrior Test of Tactical Agility' (POWAR-TOTAL) assessment designed for use following concussion in an active duty population. This agility task involves maneuvers used in military training, such as rapid stand-to-prone and prone-to-stand transitions, combat rolls, and forward and backward running. The effect of concussion on the performance of such maneuvers has not been established. MATERIALS AND METHODS The Institutional Review Board-approved study was conducted at Ft. Bragg, North Carolina, on 57 healthy control (HC) service members (SMs) and 42 well-matched SMs who were diagnosed with concussion and were referred for physical therapy with the intent to return to duty. Each study participant performed five consecutive trials of the POWAR-TOTAL task at full exertion while wearing inertial sensors, which were used to identify the constituent task maneuvers, or phases, and measure their durations. Statistical analyses were performed on durations of three main phases: (1) rising from prone and running, (2) lowering from vertical to prone, and (3) combat rolls. RESULTS None of the three phases showed significant correlation with age (range 18-45 years) in either group. Gradual improvement in all three phase durations across five trials was observed in the HC group, but not in the concussed group. On average, control subjects performed significantly faster (P < .004 or less) than concussed subjects in all trials in the lowering and rolling phases, but less so in the rising/running phase. Membership in the concussed group had a strong effect on the lowering phase (Cohen's d = 1.05), medium effect on the rolling phase (d = 0.72), and small effect on the rising/running phase (d = 0.49). Individuals in the HC group who had a history of prior concussions were intermediate between the concussed group and the never-concussed group in the lowering and rolling phases. Duration of transitional movements (lowering from standing to prone and combat rolls) was better at differentiating individuals' performance by group (receiver operating characteristic area under the curve [AUC] = 0.83) than the duration of the entire POWAR-TOTAL task (AUC = 0.71). CONCLUSIONS Inertial sensor analysis reveals that rapid transitional movements (such as lowering from vertical to prone position and combat rolls) are particularly discriminative between SMs recovering from concussion and their concussion-free peers. This analysis supports the validity of POWAR-TOTAL as a useful tool for therapists who serve military SMs.
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Affiliation(s)
- Oleg Favorov
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7575, USA
| | - Olcay Kursun
- Department of Computer Science, University of Central Arkansas, Conway, AR 72305, USA
| | - Timothy Challener
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7575, USA
| | - Amy Cecchini
- Geneva Foundation, Intrepid Spirit Center, Fort Bragg, NC 28307, USA
| | - Karen L McCulloch
- CB 7135, Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7135, USA
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Parrington L, King LA, Hoppes CW, Klaiman MJ, Michielutti P, Fino PC, Dibble LE, Lester ME, Weightman MM. Exploring Vestibular Ocular Motor Screening in Adults With Persistent Complaints After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:E346-E354. [PMID: 35067602 DOI: 10.1097/htr.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to (1) explore differences in vestibular ocular motor screening (VOMS) symptoms between healthy adults and adults with persistent symptoms after mild traumatic brain injury (mTBI), and (2) explore the relationships between VOMS symptoms and other measures (self-reported vestibular symptoms, clinical measures of balance and gait, and higher-level motor ability tasks). SETTING Research laboratory setting. PARTICIPANTS Fifty-three persons with persistent symptoms (>3 weeks) following mTBI and 57 healthy controls were recruited. Eligibility for participation included being 18 to 50 years of age and free of medical conditions that may affect balance, with the exception of recent mTBI for the mTBI group. DESIGN Cross-sectional. MAIN MEASURES The primary outcomes were the VOMS symptom scores and near point of convergence (NPC) distance. Secondary outcomes included the Dizziness Handicap Inventory (DHI) total and subdomain scores, sway area, Functional Gait Analysis total score, gait speed, and modified Illinois Agility Task completion time, and Revised High-Level Mobility Assessment Tool total score. RESULTS The mTBI group reported more VOMS symptoms ( z range, -7.28 to -7.89) and a further NPC ( t = -4.16) than healthy controls (all P s < .001). DHI self-reported symptoms (total and all subdomain scores) were strongly associated with the VOMS symptom scores (rho range, 0.53-0.68; all P s < .001). No significant relationships existed between VOMS symptoms and other measures. CONCLUSION Significant group differences support the relevance of the VOMS for mTBI in an age-diverse sample with persistent symptoms. Furthermore, strong association with DHI symptoms supports the ability of the VOMS to capture vestibular complaints in this population.
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Affiliation(s)
- Lucy Parrington
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Victoria, Australia (Dr Parrington); Department of Neurology, Oregon Health & Science University, Portland (Drs Parrington and King); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (Drs Hoppes and Lester); Courage Kenny Research Center, Allina Health, Minneapolis, Minnesota (Mr Klaiman and Drs Michielutti and Weightman); Departments of Health and Kinesiology (Dr Fino) and Physical Therapy & Athletic Training (Dr Dibble), University of Utah, Salt Lake City; Department of Physical Therapy, Texas State University, Round Rock (Dr Lester)
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