Collegiate Adapted Athlete Baseline Performance on the Vestibular/Ocular Motor Screening.

CONTEXT: Concussion assessment in adapted and para-sport athletes has continued to evolve with growing considerations in para-sports, but little is known about vestibular/ocular performance assessment in this sample. OBJECTIVE: To examine baseline performance on the Vestibular/Ocular Motor Screening (VOMS) in collegiate adapted athletes. A secondary objective was to investigate the role of sex, history of concussion, and functional classification on baseline measures. DESIGN: Cross-sectional study. SETTING: University adapted athletics facility. PATIENTS OR OTHER PARTICIPANTS: 54 collegiate adapted athletes (age=21.19±2.6 years) from multiple institution's adapted athletics programs across the United States. MAIN OUTCOME MEASURES: Adapted athletes completed a baseline VOMS assessment while at the host university for in-season competition and tournaments. Independent variables were sex, history of concussion and functional classification (1.0-4.5 at 0.5 intervals). VOMS performance consisted of pre-test symptoms (headache, dizziness, nausea, and fogginess) and post-item (e.g., smooth pursuits, saccades) symptom provocation/change from pre-test scores. RESULTS: 50.9% reported 0 symptom provocation on the VOMS, with 72% having no pre-test symptoms. No sex differences were noted on the VOMS (p>0.05); However, adapted athletes with a history of concussion reported greater VOMS provocation on horizontal saccades (p=0.008) than those with no history. Higher functional classifications (2.0-4.5) reported greater provocation on horizontal saccades (p=0.010), horizontal and vertical saccades (p=0.043 and 0.048) vestibular ocular reflex (VOR), and VOR cancellation (p=0.036) than 1.0-1.5 athletes. CONCLUSIONS: Our findings provide context for baseline VOMS performance in collegiate adapted athletes and identifying modifiers at baseline. Special consideration is warranted on vestibular and oculomotor assessment in adapted and para-sport athletes with a history of concussion and higher functional classifications.

Level of Agreement Between Child and Parent Reporting on the Child Sport Concussion Assessment Tool (SCAT5).

CONTEXT: The Child Sport Concussion Assessment Tool, fifth edition (SCAT5), remains the consensus instrument for concussion evaluation in youth athletes. Both child and parent are recommended to complete the athlete background and symptom reporting. OBJECTIVE: To determine the level of agreement between child and parent medical history and symptom reporting and quantify their performance on the Child SCAT5 in male football athletes. DESIGN: Cross-sectional study. SETTING: National Collegiate Athletic Association Division I college football facility. PATIENTS OR OTHER PARTICIPANTS: A total of 157 youth male football athletes (age = 10.7 ± 1.3 years) participating in a university-sanctioned youth football camp and their parent or legal guardian. MAIN OUTCOME MEASURE(S): Youth athletes and their parent completed the athlete background (demographics, diagnosed medical history) and symptom evaluation (symptom items, total number of symptoms, and symptom severity score) of the Child SCAT5 and were instructed not to discuss reporting with each other during testing. Cronbach α tests were conducted to determine the internal consistency, and descriptive statistics determined the level of agreement between medical history, symptom reporting, and baseline performance. RESULTS: The internal consistency of the symptom items was high for both child (Cronbach α = 0.91) and parent (α = 0.92). Agreement on medical history ranged from 67% (learning disability or dyslexia) to 85% (attention-deficit/hyperactivity disorder), with 82% agreement on sustaining a previous concussion. Fourteen youth athletes reported having been hospitalized for a head injury, with zero matched parent confirmations. Individual symptom agreement ranged from 70.7% (gets distracted easily) to 94.9% (going to faint). Agreement was 35% on total number of symptoms and severity. Abnormal scoring ranged from 2% (going to faint) to 25% (headache) for child and 2% (double vision) to 28% (gets distracted easily) for parent reporting. CONCLUSIONS: Fair agreement was shown between children and their parent on medical history and self-reported symptoms on the Child SCAT5 at baseline. When available, child and parent reporting should be used for concussion assessment and clinical decision-making.

Minimal Detectable Change for the ImPACT Subtests at Baseline.

OBJECTIVE: To establish the minimal detectable change (MDC) of the subtests that comprise the composite scores from remotely administered Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baselines. METHOD: Remote ImPACT baseline data from 172 (male = 45, female = 127) National Collegiate Athletic Association Division I student-athletes from the 2020 and 2021 athletic preseasons were used to calculate the MDC at the 95%, 90%, and 80% confidence intervals (CIs) for all subtest scores used to generate the four core composite scores and the impulse control composite. RESULTS: The MDCs for the verbal memory subtests at the 95% CI were 10.31 for word memory percent correct, 4.68 for symbol match total correct hidden, and 18.25 for three letters percentage correct. Visual memory subtest MDCs were 19.03 for design memory total percent correct and 4.90 for XO total correct memory. Visual motor speed subtest MDCs were 18.89 for XO total correct interference and 5.40 for three letters average counted correctly. Reaction time (RT) MDCs were 0.12 for XO average correct, 0.95 for symbol match average correct RT, and 0.28 for color match average correct. Impulse control MDCs were 5.97 for XO total incorrect and 1.15 for color match total commissions. One-way repeated measures MANOVA, repeated measures ANOVAs, and Wilcoxon signed-ranks test all suggested no significant difference between any subtests across two remote ImPACT baselines. CONCLUSIONS: The ImPACT subtest scores did not significantly change between athletic seasons. Our study suggests the subtests be evaluated in conjunction with the composite scores to provide additional metrics for clinical interpretation.

Grit, Athlete Burnout, and Well-Being in Female Collegiate Student-Athletes.

CONTEXT: Collegiate student-athletes are faced with significant athletic and academic demands, causing a substantial amount of stress, which can lead to athlete burnout. Problematically, little research has been done to find ways to prevent or mitigate the effect of athlete burnout in collegiate student-athletes. Grit is one characteristic that they could use as a coping mechanism to reduce the effects of burnout and to improve overall well-being. OBJECTIVE: To determine if grit had a main or buffering effect on well-being and athlete burnout in female collegiate student-athletes. DESIGN: Cross-sectional study. SETTING: National Collegiate Athletics Association Division I institution. PATIENTS OR OTHER PARTICIPANTS: A total of 174 female collegiate student-athletes. MAIN OUTCOME MEASURE(S): The Grit Scale, Athlete Burnout Questionnaire, and Warwick Edinburgh Mental Well-Being Scale were used to assess grit, athlete burnout, and well-being. RESULTS: Grit was a significant negative predictor for physical and emotional exhaustion (F1,172 = 28.25, P < .001), a reduced sense of accomplishment (F1,172 = 20.40, P < .001), and sport devaluation (F1,172 = 40.32, P < .001). Additionally, grit was a significant positive predictor of well-being (F1,172 = 29.68, P < .001). The moderated regression with grit did not reveal significant results. CONCLUSIONS: We provide new information on considerations for reducing athlete burnout and improving well-being in female collegiate student-athletes. Athletic trainers and sports medicine stakeholders should consider intervention strategies for improving grit to mitigate athlete burnout and diminished well-being while continuing to explore their effectiveness.

Baseline Evaluation of Concussion-Like Symptoms and Modifying Factors in Collegiate Club-Sport Athletes.

CONTEXT: Collegiate club-sport athletes participate in a variety of competitive sports and have been understudied in the concussion literature. Baseline performance measures are warranted to better understand assessment and management. OBJECTIVE: To quantify normative values and the effects of modifying factors sex, concussion history, diagnosed attention disabilities (attention-deficit/hyperactivity disorder [ADHD]), and sport type on baseline symptom evaluation among collegiate club-sport athletes. DESIGN: Cross-sectional study. SETTING: Retrospective chart review. PATIENTS OR OTHER PARTICIPANTS: A total of 1034 collegiate club-sport athletes (N = 649 males, 62.7%) from 29 sports at a single institution. MAIN OUTCOME MEASURE(S): Chart reviews were conducted for club-sport athletes who completed athlete background and symptom information on the Sport Concussion Assessment Tool-5th edition as a baseline concussion assessment during a single academic year. Demographics (eg, age, sex, sport), background medical information (eg, concussion history, ADHD), and symptom evaluation, consisting of individual 22-item symptom reports, the total number of symptoms, symptom severity scores, and symptom factors (eg, physical, cognitive, insomnia, and emotional), were analyzed. RESULTS: On baseline symptom reporting, 68% of club-sport athletes were asymptomatic, with mild symptoms described by 3% to 12% and moderate or severe symptoms by ≤4%. Modifier groups differed with a higher total number of symptoms and symptom severity in females (P < .001), individuals reporting a history of concussion (P < .001), and those with ADHD (total number P = .04, symptom severity P = .02). Similar significant findings were noted for females and the history of concussion group on all 4 symptom factors; however, those in collision or contact sports also indicated greater cognitive (P = .03) and insomnia (P = .02) factors. Those with ADHD endorsed more cognitive (P < .001) factors. CONCLUSIONS: Normative symptoms for a collegiate club-sport sample revealed approximately 70% were asymptomatic. Higher total number of symptoms and symptom severity were demonstrated by females and those with a history of concussion. Cognitive-specific symptoms were greater in those diagnosed with ADHD and those who participated in collision or contact sports.

Baseline Computerized Neurocognitive Testing and Oculomotor Measures are not Altered by Hormonal Contraceptive Use.

OBJECTIVE: Neurocognitive testing and oculomotor assessment have been an integral component to provide objective measures for sport-related concussion (SRC) detection and management. Hormonal contraceptive (HC) use is common among collegiate female athletes and may modify baseline SRC performance. The purpose was to examine the effects of HC use on baseline computerized neurocognitive testing (CNT) and oculomotor testing in college-aged individuals. METHOD: A total of 63 participants (22 HC using females, 22 non-HC using females, 19 males) completed a baseline SRC battery consisting of CNT, near point of convergence (NPC), and the King-Devick (KD) test. CNT measures were composite scores of verbal and visual memory, visual motor processing speed and reaction time, impulse control, and cognitive efficiency index (CEI). NPC was measured as the average convergence distance across three trials. KD time was recorded as total time for each of the two trials and best trial marked as baseline. RESULTS: There were no group differences between HC, non-HC, and male control groups on all baseline CNT composite scores (p = .13-.98), impulse control (p = .47), and CEI (p = .49). NPC distance was similar between groups (p = .41), as well as KD time by trial (Trial 1 p = .65; 2 p = .48) and best time (p = .49). CONCLUSIONS: HC use does not appear to influence baseline SRC measures of neurocognition and oculomotor assessment. Clinicians should continue to consider the effects of modifying factors at baseline and post-concussion. Additional research is needed to better understand sex hormone levels and SRC performance measures.

Long-term test-retest reliability of the vestibular/ocular motor screening for concussion in child athletes: A preliminary study.

The Vestibular/Ocular Motor Screening (VOMS) is a sport-related concussion screening tool that assesses vestibular ocular reflex (VOR) and oculomotor symptom provocation. Long-term test-retest reliability of the VOMS over multiple athletic seasons has not yet been established in a pediatric population. Fifty-one child athletes (females = 28, 54.9%) 8-13 years of age, completed a baseline VOMS assessment at two timepoints, 18 months apart. Cronbach's alpha was used to examine the internal consistency at both time points. Two-way mixed intra-class correlation coefficients and Cohen's Kappa statistics were used to evaluate test-retest reliability. High internal consistency existed at both initial (α = 0.91) and follow-up (α = 0.95) for VOMS symptom provocation items. Strong inter-item correlations were noted between vertical VOR (r = ≥0.70) and visual motion sensitivity (VMS) (r = ≥0.70). Fair agreement was produced for convergence (κ = 0.23, vertical VOR (κ = 0.25) and VMS (κ = 0.25), as well as reliability on NPC distance (ICC2,k = 0.31). All other VOMS scores yielded poor agreement between time points. Symptom provocation was the same for 49% of athletes between timepoints, while 31.4% had a decrease in scoring at follow-up. Symptom provocation from VOMS tasks lessened with increasing age and time; therefore, clinicians should consider annual baseline testing to improve accuracy for concussion evaluation and management in pediatrics.

Examination of clinical sleep difficulties in college student-athletes.

BACKGROUND: Due to the rising concern of inadequate sleep, critical analysis is needed for the presence of sleep problems in diverse populations. Research has shown that college athletes may be one such population at risk for sleep disturbances. Poor sleep may lead to physiological, psychological, and cognitive deficits that can impact college athletes academically and athletically. This investigation was performed to examine the relationship of age, sex, and history of concussion on sleep disturbance in college athletes. METHODS: A total of 191 collegiate athletes between the ages of 18-26 from a single academic NCAA institution in the Rocky Mountain region of the USA, consented to participate in the study. Participants completed a demographic questionnaire and the Athlete Sleep Screening Questionnaire (ASSQ). Results were analyzed using SPSS Version 27. RESULTS: Primary results revealed that female athletes reported higher sleep disturbance scores when compared to males (U=3643.0, P=0.016). Self-reported sleep disturbances when traveling for sport were higher for females (X(1) = 23.800, P<0.001). Males were also less likely to report daytime dysfunction when traveling for sport (X(1) =22.988, P<0.001). Sleep disturbance had a significant association with age (X(1) =4.145, P=0.042), with older participants (20+ years of age) reporting greater sleep disturbance. Concussion history did not associate with sleep disturbance in the present study. CONCLUSIONS: Results suggest that sophomore or older female may be at higher risk for sleep disturbances. Clarifying sex-specific sleep health and understanding the role of age and academic class is crucial to enhance and personalize interventions.

The effects of sleep disturbance and chronotype on baseline vestibular/ ocular motor screening in collegiate athletes.

Background: The vestibular/ocular motor screening (VOMS) is a clinically validated screening tool for concussion management. Multiple factors have been known to influence VOMS performance such as preexisting migraine and mood disorders. Poor sleep is an another important variable that warrants investigation as a modifier on the VOMS that may need to be considered during administration. Aim: This study aims to examine whether self-reported sleep difficulties significantly modify baseline VOMS symptom provocation in collegiate athletes. Methods: A total of 191 collegiate student-athletes completed a pre-season baseline VOMS and the 16-item Athlete Sleep Screening Questionnaire (ASSQ) before the start of their respective sport season. The ASSQ was used to establish sleep health variables consisting of hours of sleep per night, sleep difficulties when traveling for sport, chronotype (e.g., morning or evening person), and a sleep disturbance score (SDS) category of none, mild, and moderate + severe. Results: Those who reported sleep disturbances when traveling for sport on that respective ASSQ item had higher pre-test VOMS symptoms (P < 0.001) and symptom provocation on convergence (P = 0.015), horizontal vestibular ocular reflex (VOR) (P = 0.008), and vertical VOR (P = 0.039). There were worse pre-test symptoms (P = 0.015) and provocation on horizontal VOR (P = 0.046) in the moderate + severe SDS group than no SDS. The moderate + severe SDS group reported worse symptom provocation on the horizontal (P = 0.018) and vertical VOR (P = 0.010), and VMS (P = 0.017). No differences were found on VOMS symptom provocation for hours of sleep or chronotype. Conclusions: These results show agreement with previous symptom and neurocognitive data in that sleep difficulties among collegiate athletes may have an important role in the interpretation of baseline concussion testing. It may be beneficial to utilize sleep assessments with baseline concussion testing when using the VOMS as the clinical concussion measurement modality. Relevance for Patients: The addition of sleep assessment may aid sports medicine practitioners in properly interpreting baseline VOMS scores. Pre-season baseline testing may need to be delayed if athletes report with poor sleep in the acute period prior.

Self-reported prior night's sleep quantity on baseline symptom factors and computerized neurocognitive testing in high school athletes.

Little is known regarding sleep and baseline concussion performance and symptoms in athletes. We explored the effects of self-reported prior night's sleep quantity on baseline symptoms and computerized neurocognitive testing in high school athletes. A retrospective analysis of 958 high school athletes between the ages of 13-19 years was completed on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance. Participants were categorized into two groups based on self-reported prior night's sleep quantity: <8 h (n = 524; 55%) and ≥8 h (n = 434; 45%). Measures consisted of baseline total symptom score, symptom factors (vestibular-somatic, sleep-arousal, affective, and cognitive-sensory), and ImPACT composite scores (verbal and visual memory, visual-motor speed, reaction time, and impulse control). Significant differences were found on all baseline symptom factors (ps < .02) and total symptom scores (p < .001) with greater symptom reporting in the <8 h prior night's sleep group. No group differences were observed between duration and composite scores of verbal memory (p = .49), visual memory (p = .94), visual-motor speed (p = .38), reaction time (p = .50), or impulse control (p = .81). High school athletes who report <8 h of sleep the night prior to baseline concussion testing reported greater symptoms across all symptom factors. Clinicians should consider inadequate sleep the night prior to concussion testing to ensure accurate, valid assessments, especially on symptom reporting scales.

Effects of attention deficit hyperactivity disorder and learning disability on vestibular and ocular baseline concussion assessment in pediatric athletes.

Vestibular and ocular motor assessment has gained popularity as a tool for sport-related concussion among healthcare professionals. With awareness of premorbid risk factors, such as attentional problems, it is imperative to understand their effects at baseline. The purpose of this study was to examine the effects of attention deficit/hyperactivity disorder (ADHD) and diagnosed learning disability (LD) on vestibular and oculomotor baseline concussion assessment in pediatrics. Pediatric athletes between the ages of 8 and 14 years with ADHD/LD (n = 30) and match controls without ADHD/LD (n = 30) completed baseline concussion testing, consisting of symptom provocation on the Vestibular/Ocular Motor Screening (VOMS) and oculomotor performance on near point of convergence (NPC) and King-Devick (K-D) tools. Those diagnosed with ADHD/LD performed worse on baseline saccades (p range = .02-.10), convergence (p = .04), vestibular ocular reflex (VOR) (p = .03) and visual motion sensitivity (VMS) (p = .04) of the VOMS. Base rate analyses revealed that 26% of athletes in the ADHD/LD group had ≥1 and 13.3% had ≥2 VOMS domains over clinical cutoff levels, compared to 3.3% (≥1 domain) and 0 (≥2 domains) of controls. Individuals with ADHD/LD also performed worse on K-D assessment (p = .005). However, no differences were reported on NPC distance (p = .19). These findings suggest worse baseline concussion assessment scores on vestibular/ocular motor assessment domains in pediatric athletes diagnosed with ADHD/LD. Additional research is needed on assessment outcomes to determine if special consideration to those diagnosed with ADHD/LD is warranted.

Racial disparities in parent knowledge of concussion and recognition of signs and symptoms.

INTRODUCTION: Concussion is a type of traumatic brain injury that can be sustained through participation in different sports. It is important that a parent be able to identify common and uncommon symptoms of a concussion to ensure the safety and good health of their child. The purpose of this study was to compare knowledge of concussion scores among White and African American parents and guardians. METHODOLOGY: This cross-sectional study consisted of a single survey of 53 questions that was given to parents/guardians of high school athletes at a preseason parent meeting. Parent and guardian knowledge of concussion was assessed through a series of 45 questions. Participants were asked to correctly identify signs and symptoms of concussion, answer questions regarding the anatomy of a concussion (i.e. a concussion is an injury to the brain), answer true/false questions about general concussion knowledge, select from a list the consequences of multiple concussions and select from a list the consequences of returning to play too soon from a concussion. Knowledge of concussion was calculated by summing correct responses for the 45 knowledge questions. Racial differences were calculated using an ANCOVA, controlling for socioeconomic school type. The statistical significance level was set a priori p ≤ 0.05 for all analyses. RESULTS: Participants of this study consisted of 176 [115 (65.3%) White, 61 (34.7%) African American] parents/guardians of high school athletes. Significant differences in knowledge of concussion scores between White parents/guardians [38.50 ±â€¯4.55 (85.6% correct)], and African American parents/guardians [35.15 ±â€¯4.97, 78.1% correct)] were identified (F(1,172) = 4.82, p = 0.03). CONCLUSION: Knowledge of concussion disparities exist between African American and White parents/guardians. This disparity could cause complications from concussion to surface among children and adolescents participating in sport as their parents/guardians may not be able to correctly identify the signs and symptoms in order to seek proper medical care. Practical Application: Findings from this study highlight quantitative differences in concussion knowledge of parents from different demographics. These findings underline disparities and inequities in access to concussion-health resources that need to be addressed.

Preliminary study on an added vestibular-ocular reflex visual conflict task for postural control.

BACKGROUND: Using the modified-Clinical Test of Sensory Integration and Balance (m-CTSIB), clinicians can assess sensory feedback systems of the visual, vestibular, and somatosensory systems on postural control. However, with growing vestibulo-ocular reflex (VOR) assessment, the addition of a VOR task, for sensory feedback on postural control has yet to be investigated. AIM: The aim of the study was to examine the preliminary effect of an added VOR visual conflict task during postural control conditions of the m-CTSIB at baseline and re-test reliability. METHODS: Seventeen healthy college-aged individuals completed a baseline m-CTSIB with an added VOR visual conflict condition consisting of a lateral headshake and follow-up assessment occurring 72-h after baseline. Measures consisted of m-CTSIB sway scores on individual conditions of eyes open and eyes closed tasks on firm and foam surfaces. A series of Wilcoxon matched-pairs signed-rank tests were conducted to determine the differences between the VOR condition and the m-CTSIB conditions. A Spearman Rank Order correlation was used to examine the retest reliability. RESULTS: The VOR visual conflict task condition produced worse sway index scores than eyes-open firm and foam (p<0.001), but better scores than eyes-closed foam (P=0.01) conditions at baseline. VOR tasks on their respective firm (rs=0.81) and foam surface (rs=0.83) were strongly correlated at 72-h retest. CONCLUSIONS: The addition of a VOR visual conflict task condition differed from the other conditions of the m-CTSIB, further targeting the vestibular-ocular system from the vestibular-spinal system during postural control. Incorporating a VOR task during postural stability may create greater postural control deficits in individuals with vestibular-ocular dysfunction. Test-retest correlations at 72-h were clinically acceptable. RELEVANCE FOR PATIENTS: Addition of a VOR task as visual conflict condition of the m-CTSIB may assist in additional sensory system feedback for concussion assessment.

Exploring Baseline Concussion-Assessment Performance in Adapted Wheelchair Sport Athletes.

CONTEXT: With growing awareness of and advocacy for including individuals with disabilities in sport, implementation of concussion-assessment and -management strategies is warranted. Limited research is available on concussion assessment in adapted wheelchair sport athletes. OBJECTIVE: To examine baseline symptom reporting, computerized neurocognitive testing, and a modified balance scoring system in adapted athletes. A secondary objective was to provide preliminary normative data for this population. DESIGN: Cross-sectional study. SETTING: University athletic training room and computer laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-one athletes (age = 22.1 ± 3.0 years) from 1 institution's collegiate adapted athletics program. MAIN OUTCOME MEASURE(S): Athletes completed baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the Wheelchair Error Scoring System (WESS) before the start of their respective seasons. Symptom reporting variables consisted of total symptoms, symptom severity scores, and baseline symptom factors (eg, vestibular-somatic, sleep arousal, cognitive-sensory, and affective). We analyzed ImPACT composite scores of verbal memory, visual memory, visual motor processing speed, and reaction time and impulse control to determine neurocognitive function. Balance performance was quantified using the WESS condition and overall errors. RESULTS: Compared with normative reference values, 17 (81%) of adapted athletes reported greater symptoms and 20 (95%) performed at or below average on at least 1 neurocognitive composite score. Mean errors on the WESS were 3.14 ± 2.9, with 81% committing ≥1 error. Sex differences were not present for symptoms, neurocognitive testing, or balance measures. CONCLUSIONS: Our findings provide context for baseline performance in adapted athletes and help to further develop the WESS as an assessment of balance in these athletes.

Effects of exercise on symptoms, vestibular/ocular motor screening and postural stability in a college-aged sample.

AIM: To examine the effects of maximal exercise on symptoms, vestibular/ocular motor screening (VOMS) and postural stability. METHODOLOGY: A total of 17 college-aged individuals completed a symptom scale, VOMS and the modified Clinical Test for Sensory Interaction and Balance (m-CTSIB), followed by a graded maximal exercise treadmill test. Assessments were repeated post exercise, 20 and 40 min post-exercise. RESULTS: Significant increases in total symptoms, symptom severity scores and m-CTSIB scores from baseline to immediate post exercise were reported. Following 20-min recovery, improvements were noted on symptoms, visual motion sensitivity on VOMS and m-CTSIB. CONCLUSION: Symptoms and postural stability are influenced by exercise and following 20 min of rest, returned to baseline, indicating that a period of 20 min following a suspected concussion may be needed to negate exercise effects.

Long-term test-retest evaluation of the King-Devick test in youth soccer athletes.

Despite the clinical utility of baseline comparisons during concussion assessments, little evidence exists on long-term test-retest reliability of baseline tests in youth athletes. In addition, sex differences in baseline performance are inconsistent in youth athletes, warranting further research. The purpose was to examine sex differences, prevalence of false-positive scores, and long-term test-retest reliability of the King-Devick (KD) test. Healthy youth athletes (23 males, 28 females) completed the KD test prior to the Spring 2016 and Fall 2017 seasons. Two-way random-effects intraclass correlation coefficients (ICCs) were utilized to determine test-retest reliability. A mixed between-within ANOVA with post-hoc t-tests were used to identify the interaction between sex and season, and frequencies were used to determine abnormal test score prevalence. The KD test demonstrated good test-retest reliability (0.77[95% CI, 0.43-0.89]), with 11.8% of youth athletes having clinically meaningful improvements between Season 1 to Season 2. There was a significant sex*season interaction (F(1,49) = 4.67, p = .04), with significantly greater improvements between seasons in male youth athletes compared to female youth athletes. However, 33-35% of youth athletes displayed abnormal test scores in Season 2 relative to Season 1. The KD test demonstrated good reliability and only a small percentage had clinically meaningful changes, however a high prevalence of false-positive scores were observed in this sample.

Sex differences and normative data for the m-CTSIB and sensory integration on baseline concussion assessment in collegiate athletes.

Primary objective: To investigate sex differences on baseline m-CTSIB and sensory integration function between male and female collegiate athletes and develop preliminary normative data for this population.Methods and procedures: Baseline data were retrospectively analyzed for 591 National Collegiate Athletic Association (NCAA) athletes between 2015 and 2018 on the modified Clinical Test for Sensory Interaction and Balance (m-CTSIB). A series of Mann-Whitney U tests were conducted to determine sex differences on m-CTSIB and individual sensory integration performance.Main outcomes and results: Female athletes performed significantly better than male athletes on baseline m-CTSIB composite scores (p < .001). Females also performed better on the eyes open-firm surface (p < .001), eyes closed-firm surface (p = .001), eyes open-foam surface (p < .001), and eyes closed-foam surface (p = .001) tasks as compared to male athletes.Conclusions: Male and female athletes exhibit differences on baseline m-CTSIB and sensory integration test performance. The m-CTSIB normative data are presented for the total sample and by sex. These normative data provide a frame of reference for interpreting m-CTSIB performance in collegiate athletes as part of concussion assessment.

Preseason to Postseason Changes on the BTrackS Force Plate in a Sample of College Athletes.

CONTEXT: Balance testing is a vital component in the evaluation and management of sport-related concussion. Few studies have examined the use of objective, low-cost, force-plate balance systems and changes in balance after a competitive season. OBJECTIVE: To examine the extent of preseason versus postseason static balance changes using the Balance Tracking System (BTrackS) force plate in college athletes. DESIGN: Pretest, posttest design. SETTING: Athletic training facility. PARTICIPANTS: A total of 47 healthy, Division-I student-athletes (33 males and 14 females; age 18.4 [0.5] y, height 71.8 [10.8] cm, weight 85.6 [21.7] kg) participated in this study. MAIN OUTCOME MEASURES: Total center of pressure path length was measured preseason and postseason using the BTrackS force plate. A Wilcoxon signed-rank test was conducted to examine preseason and postseason changes. SEM and minimal detectable change were also calculated. RESULTS: There was a significant difference in center of pressure path length differed between preseason (24.6 [6.8] cm) and postseason (22.7 [5.4] cm) intervals (P = .03), with an SEM of 3.8 cm and minimal detectable change of 10.5 cm. CONCLUSIONS: Significant improvements occurred for center of pressure path length after a competitive season, when assessed using the BTrackS in a sample of college athletes. Further research is warranted to determine the effectiveness of the BTrackS as a reliable, low-cost alternative to force-plate balance systems. In addition, clinicians may need to update baseline balance assessments more frequently to account for improvements.

Sex Differences on Vestibular and Ocular Motor Assessment in Youth Athletes.

CONTEXT: The Vestibular/Ocular Motor Screening (VOMS) is a newly developed measure that evaluates vestibular and ocular motor symptom provocation after sport-related concussion. The effects of sex on baseline VOMS scores in youth athletes have not been established. OBJECTIVE: To examine sex differences on baseline VOMS assessment among youth athletes. RESULTS: No sex differences were demonstrated between male and female youth athletes on individual VOMS items (P range = .07-.98). Female sex was not associated with increased odds for VOMS scores over clinical-cutoff levels (range: odds ratio = 0.64; 95% confidence interval = 0.35, 1.15; P = .13; odds ratio = 0.91; 95% confidence interval = 0.48, 1.71; P = .77). CONCLUSIONS: No sex differences were present on baseline VOMS scores in youth athletes, nor was sex a risk factor for an abnormal VOMS score. These findings highlight the need for continual baseline and postconcussion assessments using multifaceted assessment strategies.

Premorbid migraine history as a risk factor for vestibular and oculomotor baseline concussion assessment in pediatric athletes.

OBJECTIVEMigraine history has recently been identified as a risk factor for concussion and recovery. The authors performed a cross-sectional study examining baseline outcome measures on newly developed and implemented concussion assessment tools in pediatrics. The purpose of this study was to examine the effects of premorbid, diagnosed migraine headaches as a risk factor on vestibular and oculomotor baseline assessment in pediatric athletes.METHODSPediatric athletes between the ages of 8 and 14 years with a diagnosed history of migraine headache (n = 28) and matched controls without a history of diagnosed migraine headache (n = 28) were administered a baseline concussion assessment battery, consisting of the Vestibular/Ocular Motor Screening (VOMS), near point of convergence (NPC), and the King-Devick (K-D) tests. Between-groups comparisons were performed for vestibular symptoms and provocation scores on the VOMS (smooth pursuit, saccades, convergence, vestibular/ocular reflex, visual motion sensitivity), NPC (average distance), and K-D (time).RESULTSIndividuals diagnosed with migraine headaches reported greater VOMS smooth pursuit scores (p = 0.02), convergence scores (p = 0.04), vestibular ocular reflex scores (p value range 0.002-0.04), and visual motion sensitivity scores (p = 0.009). Differences were also observed on K-D oculomotor performance with worse times in those diagnosed with migraine headache (p = 0.02). No differences were reported on NPC distance (p = 0.06) or headache symptom reporting (p = 0.07) prior to the VOMS assessment.CONCLUSIONSPediatric athletes diagnosed with migraine headaches reported higher baseline symptom provocation scores on the VOMS. Athletes with migraine headaches also performed worse on the K-D test, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated concussion assessment outcomes at baseline. Special consideration may be warranted for post-concussion assessment in athletes with migraine headaches.