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Vintimilla A, Hooper T, James CR, Lu HC, Natesan K, Kapila J, Sizer P. The Effect of Exercise-Induced Central Fatigue on Cervical Spine Joint Position Error, Strength, and Endurance. Int J Sports Phys Ther 2024; 19:290-300. [PMID: 38439782 PMCID: PMC10909308 DOI: 10.26603/001c.92703] [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: 10/09/2023] [Accepted: 01/06/2024] [Indexed: 03/06/2024] Open
Abstract
Background Fatigue is common in sports, impairing performance and increasing injury risk, yet little is known regarding fatigue and concussion. Impaired neck neuromuscular function may contribute to concussion at baseline, where central fatigue may further impair neck function resulting in increased concussion risk. These effects may be magnified in athletes with a history of concussion. Purpose To determine the effect of exercise induced central fatigue on neck joint position error, strength, and endurance in healthy subjects and those with a history of concussion. The investigators hypothesized that EICF would have a negative effect on all variables. Study Design Healthy subjects were examined using a single factor, within-subjects repeated measures design. Concussion history subjects were examined using a single-subject design. Methods Nineteen healthy subjects and five subjects with a history of concussion were recruited for the study. Cervical joint position error, muscle strength, and neck flexor endurance were tested before and after exercise induced fatigue. Results There was a significant increase in constant (p = 0.0027) and absolute joint position error (JPE) (p < 0.001); decrease in neck flexor endurance (p < 0.001); and decrease neck strength into cervical flexion (p = 0.01) in healthy subjects following fatigue. Among concussion history subjects, five demonstrated a significant increase in absolute and constant JPE (p < 0.05); four demonstrated a significant decrease in neck flexor endurance (p < 0.05); one in neck flexion muscle strength (p < 0.05); and three in neck extension and rotation muscle strength (p < 0.05) following fatigue. Conclusions Cervical neuromuscular function deteriorated following fatigue in healthy subjects. Resulting impairments may affect force alterations in cervical control, potentially increasing concussion risk. Concussion history subjects descriptively demonstrated similar results, however further research should examine formal comparisons involving subjects with and without concussion history. Level of Evidence 3b.
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Affiliation(s)
| | - Troy Hooper
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - C Roger James
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - Ho Cheng Lu
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - Karthick Natesan
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - Jeegisha Kapila
- Rehabilitation Sciences Texas Tech University Health Sciences Center
| | - Phil Sizer
- Rehabilitation Sciences Texas Tech University Health Sciences Center
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Martini DN, Gera G, Brumbach BH, Campbell KR, Parrington L, Chesnutt J, King LA. Symptoms and Central Sensory Integration in People With Chronic mTBI: Clinical Implications. Mil Med 2023; 188:3553-3560. [PMID: 35657326 PMCID: PMC10629982 DOI: 10.1093/milmed/usac157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/27/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Balance deficits in people with chronic mild traumatic brain injury (mTBI; ≥3 months post-mTBI), thought to relate to central sensory integration deficits, are subtle and often difficult to detect. The purpose of this study was to determine the sensitivity of the instrumented modified clinical test of sensory integration for balance (mCTSIB) in identifying such balance deficits in people with symptomatic, chronic mTBI and to establish the associations between balance and mTBI symptom scores in the chronic mTBI group. METHODS The Institutional Review Board approved these study methods. Forty-one people with chronic mTBI and balance complaints and 53 healthy controls performed the mCTSIB (eyes open/closed on firm/foam surfaces; EoFi, EcFi, EoFo, and EcFo) with a wearable sensor on their waist to quantify sway area (m2/s4). Sensory reweighting variables were calculated for the firm and foam stance conditions. A stopwatch provided the clinical outcome for the mCTSIB (time). Each participant completed the Neurobehavioral Symptom Inventory (NSI), which quantifies mTBI-related symptoms and provides a total score, as well as sub-scores on affective, cognitive, somatic, and vestibular domains. RESULTS The mTBI group reported significantly higher symptom scores across each NSI sub-score (all Ps < .001). The mTBI group had a significantly larger sway area than the control group across all mCTSIB conditions and the mTBI group had significantly higher sensory reweighting scores compared to the control group on both the firm (P = .01) and foam (P = .04) surfaces. Within the mTBI group, the NSI vestibular score significantly related to the mCTSIB sway area EcFi (r = 0.38; P = .02), sway area EcFo (r = 0.43; P = .006), sensory reweighting firm (r = 0.33; P = .04), and sensory reweighting foam (r = 0.38; P = .02). The average sway area across the 4 mCTSIB conditions was significantly (area under the curve: 0.77; P < .001) better at differentiating groups than the mCTSIB clinical total score. The average sway area across the 4 mCTSIB conditions had a sensitivity of 73% and a specificity of 71%. The clinical mCTSIB outcome scores were not different between groups. CONCLUSION People with chronic mTBI appear to have central sensory integration deficits detectable by instrumented measures of postural assessment. These findings suggest that central sensory integration should be targeted in rehabilitation for people with chronic mTBI.
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Affiliation(s)
- Douglas N Martini
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA 01003, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Geetanjali Gera
- Department of Physical Therapy, University of Kentucky, Lexington, KY 40536, USA
| | - Barbara H Brumbach
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR 97239, USA
| | - Kody R Campbell
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - James Chesnutt
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Family Medicine and Orthopedics & Rehabilitation, Oregon Health & Science University, Portland, OR 97239, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, OR 97239, USA
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Hume PA, Lewis GN, Brown SR, Rashid U, Theadom A, Taylor D. NZ-RugbyHealth Study: Current Postural Control Ability of Former Rugby Union and Non-contact Sport Players. Sports Med 2023; 53:2257-2266. [PMID: 37209367 DOI: 10.1007/s40279-023-01864-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Players in contact sports frequently experience mild traumatic brain (concussion) injuries (TBI). While there are known disruptions to balance following acute head trauma, it is uncertain if sport-related concussion injuries have a lasting impact on postural control. AIM To assess postural control in retired rugby players in comparison to retired non-contact sport players, and to evaluate any association with self-reported sport-related concussion history. METHODS Using a cross-sectional design, 75 players in the NZ-RugbyHealth study from three sports groups (44 ± 8 years; 24 elite rugby, 30 community rugby, 21 non-contact sport) took part in this study. The SMART EquiTest® Balance Master was used to assess participant's ability to make effective use of visual, vestibular and proprioceptive information using standardised tests. Postural sway was also quantified using centre of pressure (COP) path length. The relationship among sports group, sport-related concussion history and postural control was evaluated using mixed regression models while controlling for age and body mass index. RESULTS Limited significant differences in balance metrics were found between the sports groups. A statistically significant (p < 0.001) interaction indicated a relationship between COP path length and sport-related concussion history in the most challenging balance condition, such that path length increased as the number of previous sport-related concussions increased. CONCLUSION There was some evidence for a relationship between sport-related concussion recurrence in sports players and postural stability in challenging balance conditions. There was no evidence of impaired balance ability in retired rugby players compared with non-contact sport athletes.
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Affiliation(s)
- Patria A Hume
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
- Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand.
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
- Minderoo Tech & Policy Lab, The University of Western Australia, Perth, Australia.
| | - Gwyn N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Scott R Brown
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
- Department of Kinesiology, Aquinas College, Grand Rapids, MI, USA
| | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Troiano M, Thompson X, Boukhechba M, Hertel J, Resch JE. An Absence of Persistent Postural Stability Deficits Following a Sport Concussion in Collegiate Athletes. J Head Trauma Rehabil 2023; 38:425-433. [PMID: 36951470 DOI: 10.1097/htr.0000000000000873] [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: 03/24/2023]
Abstract
OBJECTIVE The purpose of our study was to determine whether persistent postural stability deficits exist in athletes following sport concussion (SC) in comparison with preinjury (baseline) values using Sample Entropy (SampEn). SETTING Sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS Participants consisted of 71 collegiate athletes (44 male, 27 female) with an average age of 19.9 ± 0.96 years who had a history of 1 concussion that occurred during their time as a collegiate athlete. DESIGN In our prospective, cohort design participants completed the Sensory Organization Test (SOT) at baseline, upon reporting symptom-free following a diagnosed SC, and upon establishing a new baseline prior to the start of the subsequent sport season. MAIN OUTCOME MEASURES The SOT's condition scores were calculated and analyzed in alignment with the manufacturer's instructions. SampEn was calculated in the anterior-posterior (AP) and medial-lateral (ML) directions from the center-of-pressure oscillations over the 20-second time series for each SOT condition. The SOT and SampEn outcome scores for each condition were analyzed with repeated-measures analyses of variance. RESULTS Significant main effects were observed for the SOT's conditions 3 ( F1.6, 114.8 = 7.83, P = .001, η2 = 0.10 [0.02-0.20]), 5 ( F1.8, 126.8 = 11.53, P < .001, η2 = 0.14 [0.04-0.25]), and 6 ( F1.9, 134.5 = 25.11, P < .001, η2 = 0.26 [0.14-0.37]), with significant improvements across time. Significant main effects were also observed for SampEn in the AP direction for conditions 3 ( F2, 140 = 7.59, P = .001, η2 = 0.10 [0.02-0.19]) and 6 ( F2, 140 = 6.22, P = .003, η2 = 0.08 [0.011-0.170]), with significant improvements across time. CONCLUSIONS Following a diagnosed SC, our results suggest that collegiate athletes returned if not exceeded baseline values at the symptom-free and new baseline assessments. The application of linear and nonlinear measures of postural stability following a SC yielded similar outcomes in conjunction with a baseline assessment. Our findings support the clinical utility of the baseline SC assessment when evaluating persisting balance deficits when using linear or nonlinear measures.
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Affiliation(s)
- Mia Troiano
- Departments of Kinesiology (Ms Troiano, Mr Thompson, and Drs Hertel and Resch) and Engineering Systems and Environment (Dr Boukhechba), University of Virginia, Charlottesville
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Teare-Ketter A, Ebert J, Todd H. The Implementation of a Return-to-Play Protocol with Standardized Physical Therapy Referrals in a Collegiate Football Program: PT's Role in Return-to-Play, A Clinical Commentary. Int J Sports Phys Ther 2023; 18:513-525. [PMID: 37020444 PMCID: PMC10069397 DOI: 10.26603/001c.73074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/28/2023] [Indexed: 04/03/2023] Open
Abstract
Sport-related concussions (SRCs) are multi-faceted injuries requiring coordinated care for return-to-play (RTP). Although the number of concussions in collegiate football is increasing annually, there is poor standardization among RTP protocols. Recent evidence suggests there is an increased risk of lower extremity injury, neuropsychiatric consequences, and re-injury after SRC, and risk factors for a prolonged recovery from SRC have also been identified. Evidence demonstrates a faster RTP and improved outcomes with early physical therapy intervention; however, this is not yet common practice in the treatment of acute SRC. There is little guidance available on the development and implementation of a multidisciplinary RTP rehabilitation protocol for SRC that incorporates standardized physical therapy. By describing an evidence-based RTP protocol with standardized physical therapy management, and measures taken to implement this protocol, this clinical commentary aims to identify steps in treating SRC that can be used to improve recovery. The purpose of this commentary is to: a) survey the current state of standardization of RTP protocols in collegiate football; b) highlight the development and implementation of a RTP protocol with standardized physical therapy referral and management in an NCAA Division II collegiate football program; and c) describe results of a full-season pilot study, including time to evaluation, time to RTP, rate of re-injury or lower extremity injury, and the clinical significance of protocol implementation. Level of Evidence Level V.
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Affiliation(s)
| | | | - Hunter Todd
- Physical Therapy and Rehabilitation Atrium Health Floyd
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Kinesiophobia Is Related to Acute Musculoskeletal Injury Incidence Following Concussion. J Sport Rehabil 2023; 32:145-150. [PMID: 36049743 DOI: 10.1123/jsr.2022-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
CONTEXT Athletes with a history of sport concussion (SC) have an increased risk of musculoskeletal injury (MSK); however, the underlying mechanisms have yet to be determined. The purpose of our study was to evaluate kinesiophobia in college athletes with or without a time-loss MSK within 180 days of unrestricted return to play following a SC. DESIGN This was a retrospective cohort study within a sports medicine facility. METHODS Participants were eligible if they were diagnosed with a SC, completed the Tampa Scale of Kinesiophobia (TSK), and completed an unrestricted return to play. Fifty-six college athletes (40 men and 16 women) with an average age of 19.5 (1.25) years, height of 183.5 (10.45) cm, and mass of 94.72 (24.65) kg, were included in the study. MSK participants were matched to non-MSK participants 1:1. Demographic and TSK outcome scores were compared using independent t tests. The proportion of participants in each group who scored above the clinical threshold (TSK ≥ 37) was compared using a chi-square analysis. Alpha was set at α = .05. RESULTS The MSK group (31.2 [6.30]) reported similar TSK scores to the matched group (28.9 [3.34]; t54 = 1.70, P = .10, d = 0.45 [-0.08 to 0.97]). A greater proportion of athletes who were diagnosed with an MSK-reported scores above the cutoff (χ2[1] = 6.49, P = .01). CONCLUSIONS Athletes diagnosed with SC had similar kinesiophobia values regardless of MSK status. However, a higher proportion of athletes with a time-loss MSK injury reported a TSK score greater than the clinical cutoff. Our results suggest that factors such as kinesiophobia should be considered following a SC.
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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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Aerodynamic Analysis and Training Research of an S-Shaped Arc Ball Based on Hydrodynamics. Appl Bionics Biomech 2022; 2022:1088906. [PMID: 36060562 PMCID: PMC9436619 DOI: 10.1155/2022/1088906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/24/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
The aerodynamic characteristics of S-shaped arc ball, such as poor combat performance and low intelligence, are studied and analyzed. In this paper, the aerodynamic analysis model of S-shaped arc soccer intelligent algorithm is established, and the dynamic tracking model of Soccer Tactics Based on fluid dynamics search algorithm is designed. The data information is collected from many aspects, such as the position of the players, the change of the arc ball movement, the trajectory of the football movement, and tactical flexibility. The results show that Benn's algorithm can start the layout mechanism effectively. It has high feasibility and accurate algorithm accuracy and can effectively improve the aerodynamic layout performance of the system. The aerodynamic analysis and training optimization method of the S-shaped arc ball based on ant colony optimization has sped up the intelligent training system of Chinese football tactics.
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Thompson XD, Erdman NK, Walton SR, Broshek DK, Resch JE. Reevaluating clinical assessment outcomes after unrestricted return to play following sport-related concussion. Brain Inj 2021; 35:1577-1584. [PMID: 34543089 DOI: 10.1080/02699052.2021.1975818] [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: 10/20/2022]
Abstract
PRIMARY OBJECTIVE The objective of this study was to examine neurocognition, postural control, and symptomology at multiple timepoints following concussion. We hypothesized that collegiate athletes would perform similar to or better than their baseline in terms of each outcome at both timepoints. RESEARCH DESIGN This was a retrospective study of 71 collegiate athletes (18.3 ± 0.89 years old; 182.2 ± 10.05 cm; 84.2 ± 20.07 kg) to observe changes in outcomes from a previously established clinical protocol. METHODS AND PROCEDURES Participants were administered ImPACT™, the Sensory Organization Test (SOT), and the revised head injury scale (HIS-r) prior to their seasons (baseline); upon reporting symptom-free following concussion (post-injury); and approximately 8-months after return-to-play to establish a new baseline. MAIN OUTCOMES AND RESULTS There were no changes in ImPACT scores or HIS-r reporting over time. ImPACT total symptom score (TSS) decreased over time (p = .002, ηp2 = 0.08). Significant main effects occurred for the SOT equilibrium score (p < .01, ηp2 = 0.34) and Vestibular sensory ratio (p < .001, ηp2 = 0.22). CONCLUSIONS Our data suggest no decline in neurocognition, balance, or symptom burden approximately eight months post-injury. As clinicians continue to explore "best practices" for concussion management and potential long-term implications of these injuries it is important to monitor outcome measures longitudinally.
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Affiliation(s)
- Xavier D Thompson
- UVA Department of Kinesiology, The University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas K Erdman
- Postdoctoral Research Fellow, George Mason University Sports Medicine, Research and Testing Lab, Fairfax, Virginia, USA
| | - Samuel R Walton
- Postdoctoral Research Associate, UNC Center for the Study of Retired Athletes & Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Chapel Hill, North Carolina, USA
| | - Donna K Broshek
- UVA Department of Psychiatry and Neurobehavioral Sciences, UVA Health, Charlottesville, Virginia, USA
| | - Jacob E Resch
- UVA Department of Kinesiology, The University of Virginia, Charlottesville, Virginia, USA
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Caccese JB, Bodt BA, Iverson GL, Kaminski TW, Bryk K, Oldham J, Broglio SP, McCrea M, McAllister T, Buckley TA. Estimated Age of First Exposure to Contact Sports and Neurocognitive, Psychological, and Physical Outcomes in Healthy NCAA Collegiate Athletes: A Cohort Study. Sports Med 2021; 50:1377-1392. [PMID: 32002824 DOI: 10.1007/s40279-020-01261-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Collegiate football players who started playing tackle football before age 12 years did not show worse neuropsychological test performance than those who started playing tackle football after age 12 years. It is unknown if beginning other contact sports, such as lacrosse, at a younger age is associated with worse neurocognitive performance, greater psychological distress, or worse postural stability in collegiate student athletes. OBJECTIVE The purpose of this study was to examine the association between estimated age of first exposure (eAFE) to repetitive head impacts (RHI) and these outcome measures in collegiate student athletes. METHODS 1891 female and 4448 male collision/contact (i.e., football, ice hockey, lacrosse, wrestling, soccer) and non-contact (i.e., golf, rifle, rowing/crew, swimming, tennis) sport athletes completed baseline testing, including the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Brief Symptom Inventory 18 (BSI-18), and Balance Error Scoring System (BESS). RESULTS For women, the eAFE-by-sport interaction was associated with ImPACT Verbal Memory and Visual Memory, whereby earlier eAFE to contact sports was associated with higher composite scores (B = - 0.397, B = - 0.485, respectively). For men, the eAFE-by-sport interaction was associated with BSI-18 Depression and Global Severity Index and symptom severity scores, whereby earlier eAFE to football was associated with lower psychological distress and symptom severity [Depression, Exp(B) = 1.057; Global Severity Index, Exp(B) = 1.047; Symptom Severity, Exp(B) = 1.046]. Parameter estimates were small suggesting these results may have minimal practical relevance. CONCLUSION Findings suggest that RHI during early adolescence is unrelated to brain health as measured by these specific outcome measures in collegiate student athletes.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W 10th Ave, Columbus, OH, 43210, USA
| | - Barry A Bodt
- College of Health Sciences, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, MassGeneral Hospital for Children Sports Concussion Program and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, USA.,Center for Health and Rehabilitation Research, 79/96 Thirteenth Street, Charlestown, MA, 20129, USA
| | - Thomas W Kaminski
- Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, 541 S. College Ave, Newark, DE, 19716, USA
| | - Kelsey Bryk
- Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, 100 Discovery Blvd, Newark, DE, 19713, USA
| | - Jessie Oldham
- The Micheli Center for Sports Injury Prevention, Boston Children's Hospital, 9 Hope Ave, Waltham, MA, 02453, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, 401 Washtenaw Ave, Ann Arbor, MI, 48104, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Thomas McAllister
- Indiana University School of Medicine, Goodman Hall, 355 W. 16th St., Suite 4800, Indianapolis, IN, 46202, USA
| | - Thomas A Buckley
- Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, 100 Discovery Blvd, Newark, DE, 19713, USA.
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Niedzielski JK, Kaczmarek M. Evaluation of selected balance indices on the stabilometric platform in children after mild head trauma. Arch Med Sci 2021; 17:1679-1685. [PMID: 34900049 PMCID: PMC8641494 DOI: 10.5114/aoms.2019.87370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/18/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The aim of the study was to investigate the occurrence of balance disorders in children after mild head trauma. MATERIAL AND METHODS Ninety patients after mild head trauma, aged 7-18 years, were examined on a stabilometric platform 48 h and 12 weeks after injury. The results were compared with 50 healthy children. Seven selected parameters of the stabilogram were measured and analyzed. RESULTS Children hospitalized after head trauma represented 3.78% of all surgical admissions and 6.6% of all patients after head trauma reporting to the emergency department. The values of all parameters in the entire study group 48 h after injury were significantly higher than 12 weeks later (p < 0.03), when they decreased to the level of the values in the controls. An inverse relationship between the value of each parameter and the child's age, both in the study group 48 h after injury (p < 0.014) and in the controls (p < 0.008), was found. The values of all parameters in children of the study group aged 11-15 years 48 h after the injury were significantly higher than 12 weeks later (p < 0.05), and significantly higher than in the controls (p < 0.05). The best indicators describing disorders and normalization of body balance control processes were the total path length of center of pressure (SP-EO), the average center of pressure deflection (MA-EO) and the average center of pressure sagittal deflection (MAAP-EO). CONCLUSIONS Minor head trauma clearly, though temporarily, disturbed body postural control, especially affecting children aged 11-15. However, all examined patients 3 months after injury controlled the body balance, like their healthy peers.
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Affiliation(s)
- Jerzy K Niedzielski
- Department of Pediatric Surgery and Urology, University Pediatric Centre, Central University Hospital, Medical University of Lodz, Poland
| | - Michał Kaczmarek
- Department of Pediatric Surgery and Urology, University Pediatric Centre, Central University Hospital, Medical University of Lodz, Poland
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Fino PC, Raffegeau TE, Parrington L, Peterka RJ, King LA. Head stabilization during standing in people with persisting symptoms after mild traumatic brain injury. J Biomech 2020; 112:110045. [PMID: 33011672 DOI: 10.1016/j.jbiomech.2020.110045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 01/28/2023]
Abstract
Increased postural sway is often observed in people with mild traumatic brain injury (mTBI), but our understanding of how individuals with mTBI control their head during stance is limited. The purpose of this study was to determine if people with mTBI exhibit increased sway at the head compared with healthy controls. People with persisting symptoms after mTBI (n = 59, 41 women) and control participants (n = 63, 38 women) stood quietly for one minute in four conditions: eyes open on a firm surface (EO-firm), eyes closed on a firm surface (EC-firm), eyes open on a foam pad (EO-foam), and eyes closed on foam (EC-foam). Inertial sensors at the head, sternum, and lumbar region collected tri-axial accelerations. Root-mean-square (RMS) accelerations in anteroposterior (AP) and mediolateral (ML) directions and sway ratios between the head and sternum, head and lumbar, and sternum and lumbar region were compared between groups. Temporal coupling of anti-phase motion between the upper and lower body angular accelerations was assessed with magnitude squared coherence and cross-spectral phase angles. People with mTBI demonstrated greater sway than controls across conditions and directions. During foam-surface conditions, the control group, but not the mTBI group, reduced ML sway at their head and trunk relative to their lumbar by increasing the expression of an anti-phase hip strategy within the frontal plane. These results are consistent with suggestions of inflexible or inappropriate postural control in people with mTBI.
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Affiliation(s)
- Peter C Fino
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, USA.
| | - Tiphanie E Raffegeau
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, USA
| | - Lucy Parrington
- Oregon Health Sciences University, Department of Neurology, Portland, OR, USA
| | - Robert J Peterka
- Oregon Health Sciences University, Department of Neurology, Portland, OR, USA; National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, USA
| | - Laurie A King
- Oregon Health Sciences University, Department of Neurology, Portland, OR, USA; National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, USA
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13
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Integrated linear and nonlinear trunk dynamics identify residual concussion deficits. Neurosci Lett 2020; 729:134975. [DOI: 10.1016/j.neulet.2020.134975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/18/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022]
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14
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Rosenblum DJ, Walton SR, Erdman NK, Broshek DK, Hart JM, Resch JE. If Not Now, When? An Absence of Neurocognitive and Postural Stability Deficits in Collegiate Athletes with One or More Concussions. J Neurotrauma 2020; 37:1211-1220. [PMID: 31910071 DOI: 10.1089/neu.2019.6813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A history of concussion has been associated with decreased neurocognitive function and postural control. The purpose of our study was to compare neurocognitive function and postural control in collegiate athletes with and without varying histories of concussion. Collegiate athletes were divided into groups based on 0 (n = 129), 1 (n = 91), 2 (n = 52), and 3+ (n = 34) prior concussions. Participants in each group were carefully matched by sport, sex, height, weight, and age. Athletes were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT™) and the Sensory Organization Test (SOT) as part of a standard of care pre-season assessment. Group ImPACT (Verbal and Visual Memory, Visual Motor Speed, and Reaction Time) and SOT (Equilibrium Score and Somatosensory, Visual, and Vestibular sensory ratios) outcome scores were compared using one-way analyses of variance (ANOVAs). Coefficients of variation (CVs) were also calculated for each outcome score and were compared using two-sample tests with 95% confidence intervals (CIs). Participants with and without a history of concussion were not significantly different for any ImPACT or SOT outcome score (p's > 0.10). Groups (0, 1, 2, and 3+ previous concussions) were not different from each other for any ImPACT or SOT outcome score (p's ≥ 0.11). Likewise, the CVs associated with each ImPACT and SOT outcome score did not vary significantly between outcome scores for any group comparison (p ≥ 0.09). Our findings suggest that a history of one or more concussions does not influence neurocognitive performance or postural stability in collegiate athletes at their pre-season baseline assessment.
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Affiliation(s)
- Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Samuel R Walton
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas K Erdman
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Joeseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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15
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Johnston W, Heiderscheit B, Sanfilippo J, Brooks MA, Caulfield B. Athletes with a concussion history in the last two years have impairments in dynamic balance performance. Scand J Med Sci Sports 2020; 30:1497-1505. [PMID: 32311175 DOI: 10.1111/sms.13691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/05/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to determine if National Collegiate Athletics Association Division 1 American Football and Ice Hockey athletes with a history of concussion have impaired dynamic balance control when compared to healthy control athletes. This cross-sectional observational study recruited 146 athletes; 90 control athletes and 56 athletes with a history of concussion. Athletes were tested during a pre-season evaluation using the inertial-sensor instrumented Y Balance Test. Independent variables were normalized reach distance, gyroscope magnitude sample entropy, and jerk magnitude root mean square. Kruskal-Wallis H test and Dunn-Bonferroni analysis demonstrated that individuals with a concussion history within the last 2 years have statistically significantly lower jerk magnitude root mean square in the posteromedial (Z = 23.22, P = .015) and posterolateral (Z = 24.64, P = .010) reach directions, when compared to the control group. There was no significant difference between those who sustained a concussion longer than two years ago and the control group for the posteromedial (Z = -1.25; P = .889) and posterolateral (Z = 6.44; P = .469) directions. These findings show that athletes with a concussion history within the last two years possess dynamic balance deficits, when compared to healthy control athletes. Conversely, athletes whose injury occurred greater than 2 years ago possessed comparable performance to the healthy controls. This suggests that sensorimotor control deficits may persist beyond clinical recovery, for up to 2 years. Therefore, clinicians should integrate balance training interventions into the return-to-play process to accelerate sensorimotor recovery and mitigate the risk of future injury.
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Affiliation(s)
- William Johnston
- Insight Centre for Data Analytics, University College Dublin, Belfield, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland
| | - Bryan Heiderscheit
- Department of Orthopaedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.,Badger Athletic Performance, University of Wisconsin, Madison, WI, USA
| | | | - M Alison Brooks
- Department of Orthopaedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.,Badger Athletic Performance, University of Wisconsin, Madison, WI, USA
| | - Brian Caulfield
- Insight Centre for Data Analytics, University College Dublin, Belfield, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland
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Murray N, Belson E, Szekely B, Islas A, Cipriani D, Lynall RC, Buckley TA, Powell DW, Munkasy B. Baseline Postural Control and Lower Extremity Injury Incidence Among Those With a History of Concussion. J Athl Train 2020; 55:109-115. [PMID: 31935138 DOI: 10.4085/1062-6050-187-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Lower extremity musculoskeletal (LEMSK) injury may be more prevalent among those with a history of sport-related concussion (SRC). OBJECTIVE To investigate the relationship between baseline postural control metrics and the LEMSK injury incidence in National Collegiate Athletic Association Division I student-athletes with a history of SRC. SETTING National Collegiate Athletic Association Division I athletes. DESIGN Cohort study. PATIENTS OR OTHER PARTICIPANTS Of 84 total athletes (62 males), 42 had been previously diagnosed with an SRC, and 42 were matched controls based on age, sex, height, weight, and sport. MAIN OUTCOME MEASURE(S) During the preseason baseline evaluation, all participants performed 3 trials of eyes-open and eyes-closed upright quiet stance on a force platform. Medical charts were assessed for all the LEMSK injuries that occurred from preseason baseline to 1 year later. Center-of-pressure data in the anteroposterior and mediolateral directions were filtered before we calculated root mean square and mean excursion velocity; the complexity index was calculated from the unfiltered data. Factorial analysis-of-variance models were used to examine differences between groups and across conditions for root mean square; mean excursion velocity, complexity index, and tests of association to examine between-groups LEMSK differences; and logistic regression models to predict LEMSK. RESULTS Concussion history and injury incidence were related in the SRC group (P = .043). The complexity index of the SRC group was lower with eyes closed (14.08 ± 0.63 versus 15.93 ± 0.52) and eyes open (10.25 ± 0.52 vs 11.80 ± 0.57) in the mediolateral direction than for the control participants (P < .05). Eyes-open root mean square in the mediolateral direction was greater for the SRC group (5.00 ± 0.28 mm) than the control group (4.10 ± 0.22 mm). Logistic regression models significantly predicted LEMSK only in control participants. CONCLUSIONS These findings may suggest that LEMSK after SRC cannot be predicted from postural-control metrics at baseline.
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Affiliation(s)
- Nicholas Murray
- School of Community Health Sciences, University of Nevada, Reno
| | - Emily Belson
- Waters School of Health Professions, Georgia Southern University, Statesboro
| | | | | | - Daniel Cipriani
- Doctor of Physical Therapy Program, West Coast University Center for Graduate Studies, Los Angeles, CA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, University of Georgia, Athens
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark
| | - Douglas W Powell
- Exercise Neuroscience Research Laboratory, School of Health Studies, University of Memphis, TN
| | - Barry Munkasy
- Waters School of Health Professions, Georgia Southern University, Statesboro
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17
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Helmich I, Coenen J, Henckert S, Pardalis E, Schupp S, Lausberg H. Reduced frontopolar brain activation characterizes concussed athletes with balance deficits. NEUROIMAGE-CLINICAL 2020; 25:102164. [PMID: 31954336 PMCID: PMC6965737 DOI: 10.1016/j.nicl.2020.102164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/25/2022]
Abstract
Symptomatic athletes with balance deficits present reduced frontopolar oxygenation during postural control with closed eyes. Decreased brain oxygenation in the FPC of symptomatic individuals may characterize the deficit of shifting the focus from visual inputs towards proprioception.
Objectives Athletes with sport-related concussions (SRC) often demonstrate deficits in postural stability. Lower cerebral blood flow in frontal cortices has been documented in athletes with symptoms after SRC, however, it is unclear if functional brain oxygenation during postural control tasks is reduced in symptomatic athletes after SRC in the same manner. We therefore compared brain oxygenation patterns in frontal cortices of symptomatic and asymptomatic athletes with SRC during postural control tasks with the hypothesis that symptomatic athletes are characterized by reduced functional brain oxygenation during postural control. Methods 62 concussed athletes (n = 31 symptomatic, n = 31 asymptomatic) were investigated during four postural control tasks with eyes closed versus eyes opened conditions and stable vs. unstable surface conditions. Brain oxygenation was assessed using functional NearInfraRed Spectroscopy (fNIRS) on frontopolar cortices of each hemisphere. Postural sway was measured by the analysis of ground reaction forces. Results Symptomatic athletes showed greater postural sway when compared to asymptomatic athletes during postural control, particularly during closed eyes and/or unstable surface conditions. Changes of oxygenated hemoglobin (∆HbO2) within the left hemispheric frontopolar cortex were significantly reduced in symptomatic athletes when compared to asymptomatic athletes during the eyes closed condition. A stepwise linear regression analysis revealed that self-reported post-concussion symptoms such as headaches and sadness predict decreased brain oxygenation during postural control with closed eyes. Conclusion Symptomatic athletes with increased postural sway are characterized by decreased frontopolar brain oxygenation during postural control tasks, particularly during conditions with closed eyes. Because the frontopolar cortex showed to be involved in redistributing executive functions to novel task situations, we conclude that athletes with post-concussion symptoms suffer from a deficit in coordinating postural adjustments to balance control tasks with reduced sensory input.
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Affiliation(s)
- I Helmich
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - J Coenen
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany; Department of Sport and Health, Institute of Sport Medicine, Paderborn University, Warburger Str. 100, 33098 Paderborn, Germany
| | - S Henckert
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - E Pardalis
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - S Schupp
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - H Lausberg
- Department of Neurology, Psychosomatic Medicine and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University (GSU) Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
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18
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Manaseer TS, Gross DP, Mrazik M, Schneider K, Whittaker JL. Re-conceptualizing postural control assessment in sport-related concussion: Transitioning from the reflex/hierarchical model to the systems model. Physiother Theory Pract 2019; 37:763-774. [PMID: 31370724 DOI: 10.1080/09593985.2019.1648624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: While postural control impairment is common following sport-related concussion, few investigations have studied the physiological basis for this impairment. Both the Reflex/Hierarchical Model and the Systems Model are commonly used to characterize the physiological basis of postural control.Purpose: To discuss the physiological basis of postural control impairment resulting from sport-related concussion based on these models and suggest directions for future research.Methods: Narrative literature review.Findings: Postural control impairment seen with sport-related concussion is a multifaceted construct that can result from deficits in numerous systems that underlie postural control as described by the Systems Model, rather than a unidimensional construct that stems from the central nervous systems' inability to integrate sensory input to control posture as per the Reflex/Hierarchical Model.Conclusion: We recommend a transition away from the Hierarchical/Reflex Model of postural control towards the Systems Model in the conceptualization of sport-related concussion. Future research on postural control following sport-related concussion should account for the multifaceted nature of the resulting postural control impairment based on the Systems Model. Clinically, there is a need for a clinical postural control test that allows examination across the affected systems under single-task, dual-task, and sport-specific paradigms.
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Affiliation(s)
- Thaer S Manaseer
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Department of Sport Rehabilitation, Faculty of Physical Education and Sport Sciences, Hashemite University, Al Zarqa'a, Jordan
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Martin Mrazik
- Department of Educational Psychology, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
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