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McCulloch KL, Oh AS, Cecchini AS, Zhang W, Harrison C, Favorov O. Validity and Responsiveness of the Portable Warrior Test of Tactical Agility After Rehabilitation in Service Members With Mild Traumatic Brain Injury. Phys Ther 2023; 103:pzad100. [PMID: 37847662 PMCID: PMC10641927 DOI: 10.1093/ptj/pzad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/23/2023] [Accepted: 03/26/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a performance-based test designed to assess active-duty service members diagnosed with mild traumatic brain injuries (mTBIs) and could potentially inform return to duty decisions. To examine the validity and responsiveness of the POWAR-TOTAL measure, this study collected self-reported and performance measures by active-duty service members before and after an episode of physical therapist care. METHODS Seventy-four individuals, enrolled in care for mTBI symptoms at 1 of 2 concussion specialty Intrepid Spirit Centers, were examined the week that they initiated physical therapy with the intention to return to active duty. Self-reported measures of concussion symptoms, pain, posttraumatic stress, headache, dizziness, and sleep quality were used, as were concurrent measures of mobility and balance. The POWAR-TOTAL task (motor and cognitive skills in single and dual-task conditions) was administered. Forty-nine active-duty service members returned for posttherapy testing using the same test battery. Effect sizes for change in measures were calculated. Construct validity was assessed by correlating change scores on POWAR with concurrent self-report and mobility measures. Responsiveness was evaluated using an anchor-based approach. RESULTS Significant improvements in self-reported and performance-based measures, including POWAR, were observed after therapy with moderate to large effect sizes. Improvement in POWAR performance correlated with improvement in both performance and self-reported measures. After therapy, individuals who registered improvement on the Patient Global Impression of Change scale demonstrated significantly faster POWAR motor performance than those who rated little or no improvement in their condition. CONCLUSION The POWAR-TOTAL captured improvement on a military-specific task after completing physical therapy for mTBI and could serve as an indicator of physical recovery and readiness for return to duty. IMPACT Challenging cognitive and motor measures for service members may aid in the assessment of recovery and the ability to successfully return to duty after concussion as part of a comprehensive examination approach.
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Affiliation(s)
- Karen L McCulloch
- Curriculum in Human Movement Science and Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
| | - Annabell S Oh
- The Geneva Foundation, Joint Base Lewis-McChord, Madigan Army Medical Center, Intrepid Spirit Center, Tacoma, Washington, USA
| | - Amy S Cecchini
- The Geneva Foundation, Fort Liberty (Fort Bragg), Womack Army Medical Center, Intrepid Spirit Center, Fayetteville, North Carolina, USA
| | - Wanqing Zhang
- Office of Research and Scholarship, Department of Allied Health Sciences, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
| | - Courtney Harrison
- Curriculum in Human Movement Science and Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
| | - Oleg Favorov
- Department of Biomedical Engineering, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
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Silverberg ND, Iverson GL, Cogan A, Dams-O'Connor K, Delmonico R, Graf MJP, Iaccarino MA, Kajankova M, Kamins J, McCulloch KL, McKinney G, Nagele D, Panenka WJ, Rabinowitz AR, Reed N, Wethe JV, Whitehair V, Anderson V, Arciniegas DB, Bayley MT, Bazarian JJ, Bell KR, Broglio SP, Cifu D, Davis GA, Dvorak J, Echemendia RJ, Gioia GA, Giza CC, Hinds SR, Katz DI, Kurowski BG, Leddy JJ, Sage NL, Lumba-Brown A, Maas AIR, Manley GT, McCrea M, Menon DK, Ponsford J, Putukian M, Suskauer SJ, van der Naalt J, Walker WC, Yeates KO, Zafonte R, Zasler ND, Zemek R. The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2023:S0003-9993(23)00297-6. [PMID: 37211140 DOI: 10.1016/j.apmr.2023.03.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To develop new diagnostic criteria for mild traumatic brain injury (TBI) that are appropriate for use across the lifespan and in sports, civilian trauma, and military settings. DESIGN Rapid evidence reviews on 12 clinical questions and Delphi method for expert consensus. PARTICIPANTS The Mild Traumatic Brain Injury Task Force of the American Congress of Rehabilitation Medicine Brain Injury Special Interest Group convened a Working Group of 17 members and an external interdisciplinary expert panel of 32 clinician-scientists. Public stakeholder feedback was analyzed from 68 individuals and 23 organizations. RESULTS The first two Delphi votes asked the expert panel to rate their agreement with both the diagnostic criteria for mild TBI and the supporting evidence statements. In the first round, 10 of 12 evidence statements reached consensus agreement. Revised evidence statements underwent a second round of expert panel voting, where consensus was achieved for all. For the diagnostic criteria, the final agreement rate, after the third vote, was 90.7%. Public stakeholder feedback was incorporated into the diagnostic criteria revision prior to the third expert panel vote. A terminology question was added to the third round of Delphi voting, where 30 of 32 (93.8%) expert panel members agreed that 'the diagnostic label 'concussion' may be used interchangeably with 'mild TBI' when neuroimaging is normal or not clinically indicated.' CONCLUSIONS New diagnostic criteria for mild TBI were developed through an evidence review and expert consensus process. Having unified diagnostic criteria for mild TBI can improve the quality and consistency of mild TBI research and clinical care.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia; Vancouver Coastal Health Research Institute; Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada; 2136 West Mall, Vancouver, British Columbia, Canada, V6T 1Z4.
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA; 79/96 Thirteenth Street, Charlestown Navy Yard, Charlestown, MA, 02129.
| | - Alison Cogan
- Center for the Study of Healthcare Innovation, Implementation & Policy; VA Greater Los Angeles Healthcare System; 11301 Wilshire Blvd, Los Angeles, CA 90073.
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance & Department of Neurology, Brain Injury Research Center of Mount Sinai, Box 1163, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029. kristen.dams-o'
| | - Richard Delmonico
- Kaiser Foundation Rehabilitation Center, The Permanente Medical Group, Kaiser Permanente, Northern California, 975 Sereno Drive, Vallejo, CA, USA 94589.
| | - Min Jeong P Graf
- Department of Physical Medicine and Rehabilitation, Hennepin Healthcare; Department of Rehabilitation Medicine, University of Minnesota, 701 Park Ave, Minneapolis, MN, USA 55415.
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, 300 1(st) Ave, Charlestown, MA, USA 02129; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, 300 1(st) Ave, Charlestown, MA, USA 02129.
| | - Maria Kajankova
- Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Box 1163, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029.
| | - Joshua Kamins
- UCLA Steve Tisch BrainSPORT Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, 300 Medical Plaza Ste B-200 Los Angeles, CA, USA 90095.
| | - Karen L McCulloch
- Division of Physical Therapy, Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, 3030 Bondurant Hall, CB# 7135, Chapel Hill, NC, USA 27599-7135.
| | - Gary McKinney
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, 1335 East West Highway, Silver Spring, MD, USA 20910.
| | - Drew Nagele
- School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, 4170 City Ave, Philadelphia, PA, USA 19131.
| | - William J Panenka
- British Columbia Neuropsychiatry Program; Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, UBC, Vancouver, BC, Canada, V6T2A1.
| | - Amanda R Rabinowitz
- Moss Rehabilitation Research Institute, 50 Township Line Rd., Elkins Park, PA, USA, 19027.
| | - Nick Reed
- Department of Occupational Science & Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, Canada, M5G1V7.
| | - Jennifer V Wethe
- Mayo Clinic School of Medicine, 13400 E Shea Blvd, Scottsdale, AZ, USA 85259.
| | - Victoria Whitehair
- MetroHealth Rehabilitation Institute and Case Western Reserve University; 2500 MetroHealth Drive, Cleveland, OH, USA 44109.
| | - Vicki Anderson
- Murdoch Children's Research Institute; The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052 Australia.
| | - David B Arciniegas
- University of New Mexico School of Medicine; University of Colorado School of Medicine; 1635 Aurora Ct, Aurora, CO, USA 80045.
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network; University of Toronto; Room 3-102-12, 550 University Avenue, Toronto, Ontario, Canada, M5G2A2.
| | - Jeffrey J Bazarian
- University of Rochester School of Medicine and Dentistry; 265 Crittenden Blvd Box 655c, Rochester, NY, USA 14642.
| | - Kathleen R Bell
- University of Texas Southwestern Medical Center; 5323 Harry Hines Blvd, Dallas, TX, USA, 75390.
| | - Steven P Broglio
- University of Michigan, Michigan Concussion Center; 830 N University Ave., Ann Arbor, MI, USA 48109.
| | - David Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine; U.S. Department of Veterans Affairs; 1223 East Marshall Street, Richmond, VA, USA 23298.
| | - Gavin A Davis
- Cabrini Health; Suite 53 - Neurosurgery, Cabrini Malvern, Victoria, 3144, Australia.
| | - Jiri Dvorak
- Schulthess Clinic, Department of Neurology, Swiss Concussion Center; Lengghalde 2, CH-8008, Switzerland.
| | - Ruben J Echemendia
- University Orthopedics Center, Concussion Care Clinic; University of Missouri-Kansas City, Kansas City, Missouri, USA. 107 Picadilly Rd., Port Matilda, PA, USA 16870.
| | - Gerard A Gioia
- Division of Neuropsychology/ SCORE Concussion Program, Children's National Hospital, George Washington University School of Medicine; 15245 Shady Grove Road #350, Rockville, MD, USA 20850.
| | - Christopher C Giza
- University of California at Los Angeles, Departments of Neurosurgery and Pediatrics, Steve Tisch BrainSPORT Program; Room 557 Wasserman, Department of Neurosurgery, 300 Stein Plaza, UCLA, Los Angeles, CA, USA 90095.
| | - Sidney R Hinds
- Uniformed Services University, Department of Neurology and Radiology, 4301 Jones Bridge Rd, Bethesda, MD 20814.
| | - Douglas I Katz
- Department of Neurology, Boston University School of Medicine; 72 E. Concord St. Robinson (B3), Boston University School of Medicine, Boston, MA, USA 02118.
| | - Brad G Kurowski
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Departments of Pediatrics, Neurology, and Rehabilitation Medicine, University of Cincinnati College of Medicine; 3333 Burnet Avenue, MLC 4009, Cincinnati, OH, USA 45229.
| | - John J Leddy
- UBMD Department of Orthopaedics and Sports Medicine; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences; 160 Farber Hall, Buffalo, NY, USA 14214.
| | - Natalie Le Sage
- Population Health and Optimal Health Practices Axis, CHU de Québec-Université Laval Research Centre; VITAM-Centre de recherche en santé durable; 1401, 18e rue, Québec, Canada, G1J 1Z4.
| | - Angela Lumba-Brown
- Department of Emergency Medicine, Stanford University; 900 Welch Road, Stanford, CA, USA 94303.
| | - Andrew I R Maas
- Antwerp University Hospital, Edegem, and University of Antwerp; Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California, San Francisco; 1001 Potrero Ave, San Francisco, CA, USA 94110.
| | - Michael McCrea
- Medical College of Wisconsin; 8701 Watertown Plank Road, Milwaukee, WI, USA 53226.
| | - David K Menon
- University of Cambridge; Box 93, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
| | - Jennie Ponsford
- Monash University; 18 Innovation Walk, Clayton campus, VIC 3800, Australia.
| | | | - Stacy J Suskauer
- Kennedy Krieger Institute and Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine; 707 North Broadway, Baltimore, MD, USA 21205.
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen; Netherlands.
| | - William C Walker
- Virginia Commonwealth University; 1223 East Marshall Street, 4(th) Fl., Box 980677, Richmond, VA, USA 23298-0677.
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary; 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital/Massachusetts General Hospital/Brigham and Women's Hospital/Harvard Medical School; 300 First Avenue, Boston, MA, USA 02129.
| | - Nathan D Zasler
- Concussion Care Centre of Virginia, Ltd.; 3721 Westerre Parkway, Suite B, Henrico, VA, USA 23233.
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa; Children's Hospital of Eastern Ontario; 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1.
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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: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Cecchini AS, Prim J, Zhang W, Harrison CH, McCulloch KL. The Portable Warrior Test of Tactical Agility: A Novel Functional Assessment That Discriminates Service Members Diagnosed With Concussion From Controls. Mil Med 2023; 188:e703-e710. [PMID: 34414438 PMCID: PMC10026616 DOI: 10.1093/milmed/usab346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Return-to-duty (RTD) readiness assessment for service members (SM) following concussion requires complex clinical considerations. The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a functional assessment which improves on previous laboratory-based RTD assessments. METHODS Sixty-four SM diagnosed with concussion and 60 healthy control (HC) SM participated in this study. Group differences were analyzed to validate the POWAR-TOTAL. The High-level Mobility Assessment Test (HiMAT) was used to examine concurrent construct validity. An exploratory logistic regression analysis examined predictive validity. RESULTS The groups were demographically well-matched except for educational level. POWAR-TOTAL measures were statistically significantly different between the groups with moderate to large effect sizes. Concussed participants were less likely to be able to complete all trials of the POWAR-TOTAL. Motor scores correlated highly with HiMAT scores. POWAR-TOTAL motor task performance and membership in the control group was significantly associated with self-reported physical readiness to deploy. CONCLUSION The POWAR-TOTAL is a clinically feasible, military relevant assessment that is sensitive to differences between concussed and HC SM. This analysis supports the discriminant and construct validity of the POWAR-TOTAL, and may be useful for medical providers evaluating RTD readiness for SM who have sustained a concussion.
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Affiliation(s)
- Amy Seal Cecchini
- Geneva Foundation, Ft. Bragg Intrepid Spirit Center, Womack Army Medical Center, Fayetteville, NC 28310, USA
| | - Julianna Prim
- Division of Physical Therapy and Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine UNC-Chapel Hill, Chapel Hill, NC 27599-7135, USA
| | - Wanqing Zhang
- Office of Research, Department of Allied Health Sciences, School of Medicine UNC-Chapel Hill, Chapel Hill, NC 27599-7120, USA
| | - Courtney H Harrison
- Division of Physical Therapy and Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine UNC-Chapel Hill, Chapel Hill, NC 27599-7135, USA
| | - Karen L McCulloch
- Division of Physical Therapy and Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine UNC-Chapel Hill, Chapel Hill, NC 27599-7135, USA
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Affiliation(s)
- Sydney Y Schaefer
- School of Biological and Health Systems Engineering (S.Y.S.), Arizona State University, Tempe; Division of Physical Therapy (K.L.M.), Department of Allied Health Sciences, School of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina; and Physical Therapy, Occupational Therapy, Neurology (C.E.L.), Washington University School of Medicine, St Louis, Missouri
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Prim JH, Davila MI, McCulloch KL. A pilot study on exertional tasks with physiological measures designed for the assessment of military concussion. Concussion 2021; 6:CNC88. [PMID: 33976903 PMCID: PMC8097503 DOI: 10.2217/cnc-2020-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Guidelines for clinicians treating military concussion recommend exertional testing before return-to-duty, yet there is currently no standardized task or inclusion of an objective physiological measure like heart rate variability (HRV). Methodology & results: We pilot-tested two clinically feasible exertional tasks that include HRV measures and examined reliability of a commercially available heart rate monitor. Testing healthy participants confirmed that the 6-min step test and 2-min pushup test evoked the targeted physiological response, and the Polar H10 was reliable to the gold-standard electrocardiogram. Conclusion: Both tasks are brief assessments that can be implemented into primary care setting including the Polar H10 as an affordable way to access HRV. Additional research utilizing these tasks to evaluate concussion recovery can validate standardized exertional tasks for clinical use.
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Affiliation(s)
- Julianna H Prim
- Department of Allied Health Sciences, Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Maria I Davila
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karen L McCulloch
- Department of Allied Health Sciences, Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Allied Health Sciences, Division of Physical Therapy, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Silverberg ND, Iverson GL, Arciniegas DB, Bayley MT, Bazarian JJ, Bell KR, Broglio SP, Cifu D, Davis GA, Dvorak J, Echemendia RJ, Gioia GA, Giza CC, Hinds SR, Katz DI, Kurowski BG, Leddy JJ, Le Sage N, Lumba-Brown A, Maas AI, Manley GT, McCrea M, McCrory P, Menon DK, Putukian M, Suskauer SJ, van der Naalt J, Walker WC, Yeates KO, Zafonte R, Zasler N, Zemek R, Brown J, Cogan A, Dams-O’Connor K, Delmonico R, Park Graf MJ, Iaccarino MA, Kajankova M, Kamins J, McCulloch KL, McKinney G, Nagele D, Panenka WJ, Rabinowitz AR, Reed N, Wethe JV, Whitehair V. Expert Panel Survey to Update the American Congress of Rehabilitation Medicine Definition of Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2021; 102:76-86. [DOI: 10.1016/j.apmr.2020.08.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/08/2020] [Accepted: 08/15/2020] [Indexed: 12/20/2022]
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Register-Mihalik JK, Ranapurwala SI, Guskiewicz KM, Gildner P, Marshall SW, McCulloch KL, Mihalik JP, McCrea MA. Concussion History And Contact Sport Participation Influence Post-concussion Psychological Distress: Active Rehab Study Findings. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676980.03013.bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Remigio-Baker RA, Gregory E, Cole WR, Bailie JM, McCulloch KL, Cecchini A, Stuessi K, Andrews TR, Mullins L, Ettenhofer ML. Beliefs About the Influence of Rest During Concussion Recovery May Predict Activity and Symptom Progression Within an Active Duty Military Population. Arch Phys Med Rehabil 2020; 101:1204-1211. [PMID: 32234413 DOI: 10.1016/j.apmr.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate relationships between beliefs about the impact of rest and the level of activities and symptoms over time among active duty Service members sustaining concussion, and whether these relationships vary by provision of concussion education. DESIGN Longitudinal study using multilevel modeling to assess the relationship between beliefs about rest within 72 hours of concussion and change in activity and symptom level over time, as well as interaction by concussion education at the initial clinic visit. SETTING Three military treatment facilities. PARTICIPANTS Study participants included active duty Service members diagnosed with a concussion (N=111; median age, 24 y). Individuals with previous history of concussion within 12 months of study enrollment were excluded. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Activity questionnaire and the Neurobehavioral Symptom Inventory assessed within 72 hours of concussion; at 1 week; and at 1, 3, and 6 month(s) postinjury. RESULTS Receipt of concussion education from providers was significantly associated with greater belief that rest influences concussion recovery. Greater belief that rest influences symptom recovery at the acute stage of concussion was associated with a greater increase in activities over time, but only among those who received education from their provider. Additionally, greater belief about the influence of rest was related to a more rapid decrease in symptoms over time. CONCLUSIONS Concussed Service members who underestimate the influence of rest during acute recovery may be at risk for poorer recovery. Treatment of Service members with postconcussive symptoms should consider patient knowledge and/or beliefs about rest and recovery, which may influence prognosis. Our results support the provider's use of concussion education to correct potential misconceptions that may negatively impact symptom recovery.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Hospital Camp Pendleton, Camp Pendleton, CA; Henry M. Jackson Foundation, Bethesda, MD.
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, MD
| | - Wesley R Cole
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Womack Army Medical Center, Fort Bragg, NC
| | - Jason M Bailie
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Hospital Camp Pendleton, Camp Pendleton, CA; General Dynamics Health Solutions, Silver Spring, MD
| | - Karen L McCulloch
- Henry M. Jackson Foundation, Bethesda, MD; Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amy Cecchini
- Womack Army Medical Center, Fort Bragg, NC; Geneva Foundation, Tacoma, WA
| | - Keith Stuessi
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Hospital Camp Pendleton, Camp Pendleton, CA; General Dynamics Health Solutions, Silver Spring, MD
| | - Taylor R Andrews
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Medical Center San Diego, San Diego, CA
| | - Lynita Mullins
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Medical Center San Diego, San Diego, CA
| | - Mark L Ettenhofer
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Medical Center San Diego, San Diego, CA; American Hospital Services Group LLC, Exton, PA
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Prim JH, Favorov OV, Cecchini AS, Scherer MR, Weightman MM, McCulloch KL. Clinical Utility and Analysis of the Run-Roll-Aim Task: Informing Return-to-Duty Readiness Decisions in Active-Duty Service Members. Mil Med 2020; 184:e268-e277. [PMID: 30690450 DOI: 10.1093/milmed/usy425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/12/2018] [Accepted: 12/10/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The Assessment of Military Multitasking Performance (AMMP1) consists of six dual-task and multitask military-relevant performance-based assessments which were developed to provide assistance in making return-to-duty decisions after concussion or mild traumatic brain injury (mTBI.) The Run-Roll-Aim (RRA) task, one component of the AMMP, was developed to target vulnerabilities following mTBI including attention, visual function, dynamic stability, rapid transition, and vestibular function. One aim of this study was to assess the known-group and construct validity of the RRA, and additionally to further explore reliability limitations reported previously. MATERIALS AND METHODS A cross-sectional study consisting of 84 Active Duty service members in two groups (healthy control - HC and individuals experiencing persistent mTBI symptoms) completed neurocognitive tests and the RRA. The RRA task requires a high level of mobility and resembles military training activities in a maneuver that includes combat rolls, fast transitions, obstacle avoidance, and visual search. Observational and inertial sensor data were compared between groups and performance across four trial times was compared within groups. Correlations between RRA results and neurocognitive test scores were analyzed. RESULTS Simple observational measures (time, errors) did not differ between groups. Spectral power analysis of the inertial sensor data showed significant differences in motor performance between groups. Within group one-way ANOVAs showed that in HC trial 1, time was significantly different than trials 2,3 and 4 (F(3,47) = 4.60, p < 0.01, Tukey HSD p < 0.05) while the mTBI group showed no significant difference in time between trials. During testing individuals with mTBI were less likely to complete the multiple test trials or required additional rest between trials than HCs (χ2 = 10.78, p < 0.01). Small but significant correlations were seen with two neurocognitive tests of attention and RRA performance time. CONCLUSION While observational scores were not sensitive to group differences, inertial sensor data showed motor performance on the forward run, combat roll, and backward run differed significantly between groups. The RRA task appeared challenging and provoked symptoms in the mTBI group, causing 8 of 33 mTBI participants to stop the task or require additional rest between trials while none of the HC participants had to stop. Individuals with mTBI demonstrated slower learning of the complex motor sequence compared to HCs who had significant improvement after one trial of RRA. Complex novel training maneuvers like RRA may aid clinicians in informing return to duty decisions.
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Affiliation(s)
- Julianna H Prim
- Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, 3070 Bondurant Hall, 321 S. Columbia St. Chapel Hill, NC
| | - Oleg V Favorov
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, NC
| | - Amy S Cecchini
- Intrepid Spirit Clinic, Contractor for The Geneva Foundation, Fort Bragg, NC
| | - Matthew R Scherer
- Clinical and Rehabilitative Medicine Research Program, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD
| | | | - Karen L McCulloch
- Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, NC
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11
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Silverberg ND, Iaccarino MA, Panenka WJ, Iverson GL, McCulloch KL, Dams-O’Connor K, Reed N, McCrea M, Cogan AM, Park Graf MJ, Kajankova M, McKinney G, Weyer Jamora C. Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines. Arch Phys Med Rehabil 2020; 101:382-393. [DOI: 10.1016/j.apmr.2019.10.179] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/13/2019] [Accepted: 10/09/2019] [Indexed: 12/14/2022]
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Cole WR, Cecchini AS, Remigio-Baker RA, Gregory E, Bailie JM, Ettenhofer ML, McCulloch KL. “Return to duty” as an outcome metric in military concussion research: Problems, pitfalls, and potential solutions. Clin Neuropsychol 2020; 34:1156-1174. [DOI: 10.1080/13854046.2020.1715484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Wesley R. Cole
- Intrepid Spirit, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Amy S. Cecchini
- Intrepid Spirit, Womack Army Medical Center, Fort Bragg, NC, USA
- Geneva Foundation, Tacoma, WA, USA
| | - Rosemay A. Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
- Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Jason M. Bailie
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
- General Dynamics Health Solutions, Falls Church, VA, USA
| | - Mark L. Ettenhofer
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Medical Center San Diego, San Diego, CA, USA
- American Hospital Services Group, Exton, PA, USA
- University of California San Diego, San Diego, CA, USA
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13
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Prim JH, Ahn S, Davila MI, Alexander ML, McCulloch KL, Fröhlich F. Targeting the Autonomic Nervous System Balance in Patients with Chronic Low Back Pain Using Transcranial Alternating Current Stimulation: A Randomized, Crossover, Double-Blind, Placebo-Controlled Pilot Study. J Pain Res 2019; 12:3265-3277. [PMID: 31849514 PMCID: PMC6912089 DOI: 10.2147/jpr.s208030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
Background Chronic low back pain (CLBP) is characterized by an alteration in pain processing by the central nervous system that may affect autonomic nervous system (ANS) balance. Heart rate variability (HRV) reflects the balance of parasympathetic and sympathetic ANS activation. In particular, respiratory sinus arrhythmia (RSA) solely reflects parasympathetic input and is reduced in CLBP patients. Yet, it remains unknown if non-invasive brain stimulation can alter ANS balance in CLBP patients. Objective To evaluate if non-invasive brain stimulation modulates the ANS, we analyzed HRV metrics collected in a previously published study of transcranial alternating current stimulation (tACS) for the modulation of CLBP through enhancing alpha oscillations. We hypothesized that tACS would increase RSA. Methods A randomized, crossover, double-blind, sham-controlled pilot study was conducted to investigate the effects of 10Hz-tACS on metrics of ANS balance calculated from electrocardiogram (ECG). ECG data were collected for 2 mins before and after 40 mins of 10Hz-tACS or sham stimulation. Results There were no significant changes in RSA or other frequency-domain HRV components from 10Hz-tACS. However, exploratory time-domain HRV analyses revealed a significant increase in the standard deviation of normal intervals between R-peaks (SDNN), a measure of ANS balance, for 10Hz-tACS relative to sham. Conclusion Although tACS did not significantly increase RSA, we found in an exploratory analysis that tACS modulated an integrated HRV measure of both ANS branches. These findings support the further study of how the ANS and alpha oscillations interact and are modulated by tACS. ClinicalTrials.gov Transcranial Alternating Current Stimulation in Back Pain – Pilot Study, NCT03243084.
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Affiliation(s)
- Julianna H Prim
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sangtae Ahn
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Maria I Davila
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Morgan L Alexander
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karen L McCulloch
- Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Flavio Fröhlich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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14
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Bailie JM, Remigio-Baker RA, Cole WR, McCulloch KL, Ettenhofer ML, West T, Ahrens A, Sargent P, Cecchini A, Malik S, Mullins L, Stuessi K, Qashu FM, Gregory E. Use of the Progressive Return to Activity Guidelines May Expedite Symptom Resolution After Concussion for Active Duty Military. Am J Sports Med 2019; 47:3505-3513. [PMID: 31718246 DOI: 10.1177/0363546519883259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinical recommendations for concussion management encourage reduced cognitive and physical activities immediately after injury, with graded increases in activity as symptoms resolve. Empirical support for the effectiveness of such recommendations is needed. PURPOSE To examine whether training medical providers on the Defense and Veterans Brain Injury Center's Progressive Return to Activity Clinical Recommendation (PRA-CR) for acute concussion improves patient outcomes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS This study was conducted from 2016 to 2018 and compared patient outcomes before and after medical providers received an educational intervention (ie, provider training). Patients, recruited either before or after intervention, were assessed at ≤72 hours, 1 week, 1 month, 3 months, and 6 months after a concussion. The participant population included 38 military medical providers and 106 military servicemembers with a diagnosed concussion and treated by one of the military medical providers: 58 patient participants received care before the intervention (ie, provider training) and 48 received care after intervention. The primary outcome measure was the Neurobehavioral Symptom Inventory. RESULTS The patients seen before and after the intervention were predominantly male (89.7% and 93.8%, respectively) of military age (mean ± SD, 26.62 ± 6.29 years and 25.08 ± 6.85 years, respectively) and a mean ± SD of 1.92 ± 0.88 days from injury. Compared with patients receiving care before intervention, patients receiving care after intervention had smaller increases in physical activities (difference in mean change; 95% CI, 0.39 to 6.79) and vestibular/balance activities (95% CI, 0.79 to 7.5) during the first week of recovery. Although groups did not differ in symptoms at ≤72 hours of injury (d = 0.22; 95% CI, -2.21 to 8.07), the postintervention group reported fewer symptoms at 1 week (d = 0.61; 95% CI, 0.52 to 10.92). Postintervention patients who completed the 6-month study had improved recovery both at 1 month (d = 1.55; 95% CI, 5.33 to 15.39) and 3 months after injury (d = 1.10; 95% CI, 2.36 to 11.55), but not at 6 months (d = 0.35; 95% CI, 5.34 to 7.59). CONCLUSION Training medical providers on the PRA-CR for management of concussion resulted in expedited recovery of patients.
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Affiliation(s)
- Jason M Bailie
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Rosemay A Remigio-Baker
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Wesley R Cole
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Karen L McCulloch
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Mark L Ettenhofer
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Therese West
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Angelica Ahrens
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Paul Sargent
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Amy Cecchini
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Saafan Malik
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Lynita Mullins
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Keith Stuessi
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Felicia M Qashu
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Emma Gregory
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
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15
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Register-Mihalik JK, Guskiewicz KM, Marshall SW, McCulloch KL, Mihalik JP, Mrazik M, Murphy I, Naidu D, Ranapurwala SI, Schneider K, Gildner P, McCrea M. Methodology and Implementation of a Randomized Controlled Trial (RCT) for Early Post-concussion Rehabilitation: The Active Rehab Study. Front Neurol 2019; 10:1176. [PMID: 31781021 PMCID: PMC6856221 DOI: 10.3389/fneur.2019.01176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Sports-related concussion (SRC) is a complex injury with heterogeneous presentation and management. There are few studies that provide guidance on the most effective and feasible strategies for recovery and return to sports participation. Furthermore, there have been no randomized studies of the feasibility, safety, and efficacy of early rehabilitation strategies across multiple sports and age groups. This international cluster-randomized pragmatic trial evaluates the effectiveness of early multi-dimensional rehabilitation integrated with the current return to sport strategy vs. the current return to sport strategy alone. Methods: The study is a cluster-randomized pragmatic trial enrolling male and female athletes from 28 sites. The sites span three countries, and include multiple sports, levels of play (high school, college, and professional), and levels of contact. The two study arms are Enhanced Graded Exertion (EGE) and Multidimensional Rehabilitation (MDR). The EGE arm follows the current return to sport strategy and the MDR arm integrates early, MDR strategies in the context of the current return to sport strategy. Each arm employs a post-injury protocol that applies to all athletes from that site in the event they sustain a concussion during their study enrollment. Participants are enrolled at pre-season baseline. Assessment timepoints include pre-season baseline, time of injury (concussion), 24–48 h post-injury, asymptomatic, and 1-month post-injury. Symptoms and activity levels are tracked post injury through the return to play process and beyond. Injury and recovery characteristics are obtained for all participants. Primary endpoints include time to medical clearance for full return to sport and time to become asymptomatic. Secondary endpoints include symptom, neurocognitive, mental status, balance, convergence insufficiency, psychological distress, and quality of life trajectories post-injury. Discussion: Outputs from the trial are expected to inform both research and clinical practice in post-concussion rehabilitation across all levels of sport and extend beyond civilian medicine to care for military personnel. Ethics and Dissemination: The study is approved by the data coordinating center Institutional Review Board and registered at clinicaltrials.gov. Dissemination will include peer-reviewed publications, presentation to patients and public groups, as well as dissemination in other healthcare and public venues of interest. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02988596 Trial Funding: National Football League.
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Affiliation(s)
- Johna K Register-Mihalik
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stephen W Marshall
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karen L McCulloch
- Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason P Mihalik
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Martin Mrazik
- Faculty of Education, University of Alberta, Edmonton, AB, Canada.,Canadian Football League, Toronto, ON, Canada
| | - Ian Murphy
- New Zealand Rugby, Wellington, New Zealand
| | - Dhiren Naidu
- Faculty of Education, University of Alberta, Edmonton, AB, Canada.,Canadian Football League, Toronto, ON, Canada
| | - Shabbar I Ranapurwala
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn Schneider
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.,Cummings School of Medicine, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, AB, Canada.,Acute Sport Concussion Clinic, Sport Medicine Centre, University of Calgary, Calgary, AB, Canada
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael McCrea
- Department of Neurosurgery, Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, WI, United States
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16
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Remigio-Baker RA, Bailie JM, Gregory E, Cole WR, McCulloch KL, Cecchini A, Stuessi K, Andrews TR, Qashu F, Mullins L, Sargent P, Ettenhofer ML. Activity Level and Type During Post-acute Stages of Concussion May Play an Important Role in Improving Symptoms Among an Active Duty Military Population. Front Neurol 2019; 10:602. [PMID: 31275223 PMCID: PMC6593059 DOI: 10.3389/fneur.2019.00602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/21/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Previous research demonstrates that early rest and gradual increases in activity after concussion can improve symptoms; however, little is known about the intensity and type of activity during post-acute time periods-specifically months post-injury-that may promote optimal recovery in an active duty service member (SM) population. Objective: The objectives of this study were to investigate how activity level and type at the post-acute stages of concussion (at 1 and 3 month[s] post-injury) impact subsequent symptoms among SMs, and how this relationship might differ by the level of symptoms at the time of injury. Methods: Participants included 39 SMs ages 19-44 years from 3 military installations who were enrolled within 72 h after sustaining a concussion. Linear regression was used to evaluate whether the association between activity level at 1 or 3 month(s) post-injury (as measured by a multi-domain Activity Questionnaire) and subsequent symptoms at 3 and/or 6 months (as measured by the Neurobehavioral Symptom Inventory) varied by the level of symptoms at acute stages of concussion. Partial correlation was used to evaluate relationships that did not differ by acute symptom level. Symptoms at the time of activity assessment (1 or 3 month[s]) were accounted for in all models, as well as activity level at acute stages of concussion. Results: Greater physical and vestibular/balance activity at 1 month were significantly correlated with lower symptoms at 3 months, but not at 6 months post-injury. There were no significant associations found between activity (total or by type) at 3 months and symptoms at 6 months. The association between activity level at either 1 or 3 months and subsequent symptoms at 3 and/or 6 months did not differ by the level of acute symptoms. Conclusion: The intensity and type of activities in which SMs engage at post-acute stages of concussion may impact symptom recovery. Although low levels of activity have been previously shown to be beneficial during the acute stage of injury, higher levels of activity may provide benefit at later stages. These findings provide support for the importance of monitoring and managing activity level beyond the acute stage of concussion.
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Affiliation(s)
- Rosemay A. Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, United States
- Venesco LLC, Chantilly, VA, United States
| | - Jason M. Bailie
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, United States
- General Dynamics Health Solutions, Silver Spring, MD, United States
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
| | - Wesley R. Cole
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
- Womack Army Medical Center, Fort Bragg, NC, United States
| | - Karen L. McCulloch
- Venesco LLC, Chantilly, VA, United States
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amy Cecchini
- Womack Army Medical Center, Fort Bragg, NC, United States
| | - Keith Stuessi
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, United States
- General Dynamics Health Solutions, Silver Spring, MD, United States
| | - Taylor R. Andrews
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
- Venesco LLC, Chantilly, VA, United States
- Naval Medical Center San Diego, San Diego, CA, United States
| | - Felicia Qashu
- Division of Program Coordination, Planning and Strategic Initiatives, National Institutes of Health, Bethesda, MD, United States
| | - Lynita Mullins
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
- Womack Army Medical Center, Fort Bragg, NC, United States
| | - Paul Sargent
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, United States
| | - Mark L. Ettenhofer
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
- Naval Medical Center San Diego, San Diego, CA, United States
- American Hospital Services Group LLC, Exton, PA, United States
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17
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Reed N, Silverberg ND, Iaccarino MA, McCrea M, McCulloch KL, Panenka W, Gregory E, Dams-O’Connor K, Iverson GL, Weyer Jamora C, Belanger H, McKinney G, Cogan AM, Provvidenza C. Returning to Activity After a Concussion. Arch Phys Med Rehabil 2019; 100:789-791. [DOI: 10.1016/j.apmr.2018.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
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18
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Ahn S, Prim JH, Alexander ML, McCulloch KL, Fröhlich F. Identifying and Engaging Neuronal Oscillations by Transcranial Alternating Current Stimulation in Patients With Chronic Low Back Pain: A Randomized, Crossover, Double-Blind, Sham-Controlled Pilot Study. J Pain 2018; 20:277.e1-277.e11. [PMID: 30268803 DOI: 10.1016/j.jpain.2018.09.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/23/2018] [Accepted: 09/23/2018] [Indexed: 01/29/2023]
Abstract
Chronic pain is associated with maladaptive reorganization of the central nervous system. Recent studies have suggested that disorganization of large-scale electrical brain activity patterns, such as neuronal network oscillations in the thalamocortical system, plays a key role in the pathophysiology of chronic pain. Yet, little is known about whether and how such network pathologies can be targeted with noninvasive brain stimulation as a nonpharmacological treatment option. We hypothesized that alpha oscillations, a prominent thalamocortical activity pattern in the human brain, are impaired in chronic pain and can be modulated with transcranial alternating current stimulation (tACS). We performed a randomized, crossover, double-blind, sham-controlled study in patients with chronic low back pain (CLBP) to investigate how alpha oscillations relate to pain symptoms for target identification and whether tACS can engage this target and thereby induce pain relief. We used high-density electroencephalography to measure alpha oscillations and found that the oscillation strength in the somatosensory region at baseline before stimulation was negatively correlated with pain symptoms. Stimulation with alpha-tACS compared to sham (placebo) stimulation significantly enhanced alpha oscillations in the somatosensory region. The stimulation-induced increase of alpha oscillations in the somatosensory region was correlated with pain relief. Given these findings of successful target identification and engagement, we propose that modulating alpha oscillations with tACS may represent a target-specific, nonpharmacological treatment approach for CLBP. This trial has been registered in ClinicalTrials.gov (NCT03243084). PERSPECTIVE: This study suggests that a rational design of transcranial alternating current stimulation, which is target identification, engagement, and validation, could be a nonpharmacological treatment approach for patients with CLBP.
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Affiliation(s)
- Sangtae Ahn
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Julianna H Prim
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Morgan L Alexander
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Karen L McCulloch
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Flavio Fröhlich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599; Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599..
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Weightman MM, McCulloch KL, Radomski MV, Finkelstein M, Cecchini AS, Davidson LF, Heaton KJ, Smith LB, Scherer MR. Further Development of the Assessment of Military Multitasking Performance: Iterative Reliability Testing. PLoS One 2017; 12:e0169104. [PMID: 28056045 PMCID: PMC5215871 DOI: 10.1371/journal.pone.0169104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022] Open
Abstract
The Assessment of Military Multitasking Performance (AMMP) is a battery of functional dual-tasks and multitasks based on military activities that target known sensorimotor, cognitive, and exertional vulnerabilities after concussion/mild traumatic brain injury (mTBI). The AMMP was developed to help address known limitations in post concussive return to duty assessment and decision making. Once validated, the AMMP is intended for use in combination with other metrics to inform duty-readiness decisions in Active Duty Service Members following concussion. This study used an iterative process of repeated interrater reliability testing and feasibility feedback to drive modifications to the 9 tasks of the original AMMP which resulted in a final version of 6 tasks with metrics that demonstrated clinically acceptable ICCs of > 0.92 (range of 0.92–1.0) for the 3 dual tasks and > 0.87 (range 0.87–1.0) for the metrics of the 3 multitasks. Three metrics involved in recording subject errors across 2 tasks did not achieve ICCs above 0.85 set apriori for multitasks (0.64) and above 0.90 set for dual-tasks (0.77 and 0.86) and were not used for further analysis. This iterative process involved 3 phases of testing with between 13 and 26 subjects, ages 18–42 years, tested in each phase from a combined cohort of healthy controls and Service Members with mTBI. Study findings support continued validation of this assessment tool to provide rehabilitation clinicians further return to duty assessment methods robust to ceiling effects with strong face validity to injured Warriors and their leaders.
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Affiliation(s)
- Margaret M. Weightman
- Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Karen L. McCulloch
- Division of Physical Therapy, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mary V. Radomski
- Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America
| | - Marsha Finkelstein
- Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America
| | - Amy S. Cecchini
- Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America
- Defense and Veterans Brain Injury Center, Fort Bragg, North Carolina, United States of America
| | - Leslie F. Davidson
- Department of Clinical Research and Leadership, George Washington School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Kristin J. Heaton
- United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States of America
- Boston University School of Public Health, Department of Environmental Health, Boston, Massachusetts, United States of America
| | - Laurel B. Smith
- United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States of America
| | - Matthew R. Scherer
- Clinical and Rehabilitative Medicine Research Program, Medical Research Materiel Command, Ft Detrick, Maryland, United States of America
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Gregory E, West TA, Cole WR, Bailie JM, McCulloch KL, Ettenhofer ML, Cecchini A, Qashu FM. Use of a multi-level mixed methods approach to study the effectiveness of a primary care progressive return to activity protocol after acute mild traumatic brain injury/concussion in the military. Contemp Clin Trials 2016; 52:95-100. [PMID: 27836507 DOI: 10.1016/j.cct.2016.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
The large number of U.S. service members diagnosed with concussion/mild traumatic brain injury each year underscores the necessity for clear and effective clinical guidance for managing concussion. Relevant research continues to emerge supporting a gradual return to pre-injury activity levels without aggravating symptoms; however, available guidance does not provide detailed standards for this return to activity process. To fill this gap, the Defense and Veterans Brain Injury Center released a recommendation for primary care providers detailing a step-wise return to unrestricted activity during the acute phase of concussion. This guidance was developed in collaboration with an interdisciplinary group of clinical, military, and academic subject matter experts using an evidence-based approach. Systematic evaluation of the guidance is critical to ensure positive patient outcomes, to discover barriers to implementation by providers, and to identify ways to improve the recommendation. Here we describe a multi-level, mixed-methods approach to evaluate the recommendation incorporating outcomes from both patients and providers. Procedures were developed to implement the study within complex but ecologically-valid settings at multiple military treatment facilities and operational medical units. Special consideration was given to anticipated challenges such as the frequent movement of military personnel, selection of appropriate design and measures, study implementation at multiple sites, and involvement of multiple service branches (Army, Navy, and Marine Corps). We conclude by emphasizing the need to consider contemporary approaches for evaluating the effectiveness of clinical guidance.
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Affiliation(s)
- Emma Gregory
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; General Dynamics Health Solutions, 8601 Georgia Ave Ste. 900, Silver Spring, MD 20910, United States.
| | - Therese A West
- US Army Medical Research and Materiel Command, Combat Casualty Care Research Program, 722 Doughten Street, Fort Detrick, MD 21792, United States
| | - Wesley R Cole
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; General Dynamics Health Solutions, 8601 Georgia Ave Ste. 900, Silver Spring, MD 20910, United States; Womack Army Medical Center, MCXC-TBI 2817 Reilly Road, Fort Bragg, NC 28310, United States
| | - Jason M Bailie
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; General Dynamics Health Solutions, 8601 Georgia Ave Ste. 900, Silver Spring, MD 20910, United States; Naval Hospital Camp Pendleton, 33 Area, Camp Margarita, Mental Health Building 33305, Camp Pendleton, CA 92055, United States
| | - Karen L McCulloch
- University of North Carolina Chapel Hill, 321 S. Columbia Street, Bondurant Hall Ste 3024, Chapel Hill, NC 27599, United States; Venesco LLC, 14801 Murdock Street Suite 125, Chantilly, VA 20151, United States
| | - Mark L Ettenhofer
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; Naval Medical Center San Diego, Department of Physical Medicine and Rehabilitation, 34730 Bob Wilson Dr. Ste #201 Bldg 3, San Diego, CA. 92134, United States; American Hospital Services Group LLC, 1 E. Uwchlan Ave, Suite 407, Exton, PA 19341, United States
| | - Amy Cecchini
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; Venesco LLC, 14801 Murdock Street Suite 125, Chantilly, VA 20151, United States
| | - Felicia M Qashu
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States
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Smith LB, Radomski MV, Davidson LF, Finkelstein M, Weightman MM, McCulloch KL, Scherer MR. Development and preliminary reliability of a multitasking assessment for executive functioning after concussion. Am J Occup Ther 2016; 68:439-43. [PMID: 25005507 DOI: 10.5014/ajot.2014.012393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES. Executive functioning deficits may result from concussion. The Charge of Quarters (CQ) Duty Task is a multitask assessment designed to assess executive functioning in servicemembers after concussion. In this article, we discuss the rationale and process used in the development of the CQ Duty Task and present pilot data from the preliminary evaluation of interrater reliability (IRR). METHOD. Three evaluators observed as 12 healthy participants performed the CQ Duty Task and measured performance using various metrics. Intraclass correlation coefficient (ICC) quantified IRR. RESULTS. The ICC for task completion was .94. ICCs for other assessment metrics were variable. CONCLUSION. Preliminary IRR data for the CQ Duty Task are encouraging, but further investigation is needed to improve IRR in some domains. Lessons learned in the development of the CQ Duty Task could benefit future test development efforts with populations other than the military.
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Affiliation(s)
- Laurel B Smith
- Laurel B. Smith, MS, OTR/L, is Captain, U.S. Army, and Research Occupational Therapist, U.S. Army Research Institute of Environmental Medicine, 15 Kansas Street, Natick, MA 01760;
| | - Mary Vining Radomski
- Mary Vining Radomski, PhD, OTR/L, is Clinical Scientist, Courage Kenny Research Center, Minneapolis, MN
| | - Leslie Freeman Davidson
- Leslie Freeman Davidson, PhD, OTR/L, is Director and Associate Professor of Occupational Therapy, Shenandoah University, Winchester, VA
| | - Marsha Finkelstein
- Marsha Finkelstein, MS, is Senior Scientific Advisor, Courage Kenny Research Center, Minneapolis, MN
| | - Margaret M Weightman
- Margaret M. Weightman, PhD, PT, is Clinical Scientist/Physical Therapist, Courage Kenny Research Center, Minneapolis, MN
| | - Karen L McCulloch
- Karen L. McCulloch, PhD, PT, NCS, is Professor, Division of Physical Therapy, University of North Carolina at Chapel Hill
| | - Matthew R Scherer
- Matthew R. Scherer, PhD, PT, is NCS Major, U.S. Army, and Chief of Physical Therapy, Andrew Rader U.S. Army Health Clinic, Fort Myer, VA
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Abstract
PURPOSE To obtain a better understanding of the issues that influence hip protector use among community-dwelling older adults. METHODS The study used a longitudinal, crossover design. A convenience sample of 32 participants used four different brands of hip protectors, each for a 1-week period. Data were collected by weekly telephone interviews and a mailed questionnaire administered at baseline and follow-up. Participant perceptions regarding hip protectors were assessed using both open-ended questions and Likert-type items. RESULTS The most common concerns about hip protectors mentioned in response to open-ended questions involved: discomfort, poor fit, inconvenience and unfavourable effects on appearance. Participants spontaneously mentioned at least one of these barriers in over 70% of the interviews. In contrast, participants spontaneously mentioned the protective benefits offered by hip protectors in only 16% of the interviews. The intention to continue using a particular hip protector after the study ended was associated with the number of hours the hip protector was worn during the study (p<0.01). After controlling for other variables, beliefs concerning the amount of protection that a hip protector provided was positively associated with the number of hours the hip protector was worn during the study (p<0.05) and the intention to continue using the hip protector after the study (p<0.01). CONCLUSION Study findings suggest that the use of hip protectors by community-dwelling older adults is influenced by beliefs about both barriers to use and the amount of protection provided.
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Affiliation(s)
- Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7360, USA.
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McCulloch KL, Freburger JK, Giuliani CA, Busby-White-head J. ACTIVITY-SPECIFIC BALANCE CONFIDENCE SCALE SCORES IN OLDER ADULTS. J Geriatr Phys Ther 2001. [DOI: 10.1519/00139143-200124010-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kopp B, Kunkel A, Flor H, Platz T, Rose U, Mauritz KH, Gresser K, McCulloch KL, Taub E. The Arm Motor Ability Test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living. Arch Phys Med Rehabil 1997; 78:615-20. [PMID: 9196469 DOI: 10.1016/s0003-9993(97)90427-5] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To continue and expand determination of the reliability, validity, and sensitivity to change of the Arm Motor Ability Test (AMAT), an instrument for assessing deficits in activities of daily living (ADL). DESIGN The AMAT was administered twice to patients, with an interest interval of either 1 or 2 weeks, by one of two examiners assigned to patients in counterbalanced order. Patients' interest intervals and scores on the arm portion of the Motricity Index was unknown to the raters. SETTING A referral inpatient neurological rehabilitation center. PATIENTS Thirty-three subacute stroke inpatients with moderate to mild upper extremity motor deficit: median Motricity-Index-Arm score = 89, median chronicity = 43d, median age = 66yr; 12 were women. MAIN OUTCOME MEASURE AND RESULTS The AMAT was developed in 1987, and interrater reliabilities at that time were found to range from .95 to .99. The present values for interrater reliability (2 scales) from videotaped test performance were: kappas = .68 to .77. Spearman correlations = .97 to .99. For performance time, interscorer reliability from videotaped test performance was .99. Homogeneities for the three AMAT measures for the total sample (Cronbach's alpha and split-half reliability) were .93 to .99. The test-retest reliabilities for the total sample were .93 to .99. The correlations to the Motricity-Index-Arm score were .45 to .61. The AMAT detected the difference in change occurring as a result of the passage of 1 versus 2 weeks in these subacute inpatients, presumably as a result of intensive therapy and/or spontaneous recovery, confirming the results of an earlier intervention study. CONCLUSION The AMAT is an instrument with high interrater reliability, internal consistency, and sensitivity to change, as well as having satisfactory concurrent validity.
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Affiliation(s)
- B Kopp
- Department of Psychology, Humboldt-University, Berlin, Germany
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