Comparison of Concussion Sideline Screening Measures Across Varying Exertion Levels Within Simulated Games.

CONTEXT: Currently, there is no gold standard to evaluate the effect of varying game-like exertion states on Sport Concussion Assessment Tool 3rd Edition (SCAT-3) outcomes. Baseline assessments may occur before, during, or after physical activity, while postinjury evaluations predominantly occur following physical activity. Thus, clinicians may be comparing postinjury evaluations completed following exertion to baseline evaluations completed following varying levels of rest or exertion, which may not be a valid method for clinical decision making. OBJECTIVE: To determine the effect of various physical exertion levels on sideline concussion assessment outcomes and reliability. DESIGN: Within-subjects, repeated measures. SETTING: Field. PARTICIPANTS: Physically active participants (N = 36) who regularly participate in basketball activity. INTERVENTION: Subjects participated in 2 simulated basketball games, completing a symptom checklist, Standardized Assessment of Concussion, and Balance Error Scoring System before game play, during halftime, and at the completion of each simulated game. Pulse rate was assessed as a proxy of physical exertion. MAIN OUTCOME MEASURES: Total symptom, Standardized Assessment of Concussion, and Balance Error Scoring System scores. RESULTS: Physical exertion did not significantly predict symptom, Standardized Assessment of Concussion, or Balance Error Scoring System scores, although a trend toward higher symptom scores was observed for females (ß = 0.03, P = .09). All assessments had poor to moderate reliability across sessions (.15 < interclass correlation coefficient [2,1] < .60). CONCLUSION: Low- to moderate-intensity physical activity did not have a significant effect on clinical concussion sideline assessments; however, the low test-retest reliability observed prevents strong conclusions on these relationships. The poor overall reliability does not allow for clear recommendations for what state of baseline physical exertion (ie, rested or exerted) provides optimal data to make postinjury clinical decisions, although baseline concussion assessments completed at rest have the most valid and conservative normative values for injury comparison.

Acute Effects of Posture Shirts on Rounded-Shoulder and Forward-Head Posture in College Students.

CONTEXT: Rounded-shoulder and forward-head posture can be contributing factors to shoulder pain. Corrective techniques such as manual therapy and exercise have been shown to improve these altered postures, but there is little evidence that corrective garments such as posture shirts can alter posture. OBJECTIVES: To determine the acute effects of corrective postureshirt use on rounded-shoulder and forward-head posture in asymptomatic college students. DESIGN: Repeated-measures intervention study with counterbalanced conditions. SETTING: Research laboratory. PARTICIPANTS: 24 members of the general student body of a university, 18-25 y old, with a forward shoulder angle (FSA) >52° and no history of upper-extremity surgery, scoliosis, active shoulder pain, or shoulder pain in the previous 3 mo that restricted participation for 3 consecutive days. INTERVENTIONS: Photographic posture assessment under a control condition, under a sham or treatment condition (counterbalanced), under another control condition, and treatment or sham. MAIN OUTCOME MEASURES: FSA and forward head angle (FHA) calculated from a lateral photograph. RESULTS: FSA decreased relative to the control condition while participants wore the sham shirt (P = .029) but not the corrective posture shirt (P = 1.00). FHA was unchanged between groups (P = .371). CONCLUSIONS: Application of a corrective posture shirt did not acutely alter FSA or FHA, while application of a sham shirt may decrease FSA at rest.

Concussion-Related Decision-Making by Certified Athletic Trainers: Implications for Concussion Prevention and Care.

Concussions are a common sport-related injury that require appropriate initial care. Athletic trainers, often a primary source of healthcare for student-athletes, are key individuals involved in initial concussion diagnostic and management decisions. Challenges exist within the athletic environment that may hinder the consistency, efficacy, and/or effectiveness of concussion-related decision-making by athletic trainers, thereby impacting secondary concussion prevention and patient health. The purpose of this study was to identify factors that impact the intentions of athletic trainers to make appropriate concussion-related decisions under various circumstances. Overall, 1029 participants completed a survey examining educational precursors (quantity and quality of healthcare communication educational focus), demographic precursors (age, gender, educational degree, and employment setting), theory-based mediators (attitudes, perceived norms, and personal agency), and external mediators (knowledge, salience, and communication/collaboration practices) on appropriate concussion-related decision-making intentions. Data were analyzed using a two-step structural equation modeling approach. Quality of healthcare communication educational focus indirectly impacted appropriate concussion-related decision-making intentions via perceived behavioral control and communication/collaboration practices. Additionally, several factors impacted intentions to make appropriate concussion-related decisions directly including employment setting, self-efficacy, and general attitudes towards decision-making and concussions. Concussion prevention is aided by the initial and appropriate action taken by a healthcare professional to reduce immediate consequences; however, this action may be influenced by stakeholder relationships. These influential factors of decision-making may place athletes at further injury risk and negatively impact overall athlete health. As such, a sound theoretical framework incorporating the complexity of factors that may influence decision-making is needed.

Comparison of 3 Airway Access Techniques During Suspected Spine Injury Management in American Football.

OBJECTIVE: To determine how head movement and time to access airway were affected by 3 emergency airway access techniques used in American football. DESIGN: Prospective counterbalanced design. SETTING: University research laboratory. PARTICIPANTS: Eighteen certified athletic trainers (ATCs) and 18 noncertified students (NCSs). INTERVENTIONS: Each participant performed 1 trial of each of the 3 after airway access techniques: quick release mechanism (QRM), cordless screwdriver (CSD), and pocket mask insertion (PMI). MAIN OUTCOME MEASURES: Time to task completion in seconds, head movement in each plane (sagittal, frontal, and transverse), maximum head movement in each plane, helmet movement in each plane, and maximum helmet movement in each plane. RESULTS: We observed a significant difference between all 3 techniques with respect to time required to achieve airway access (F2,68 = 263.88; P < 0.001). The PMI allowed for the quickest access followed by the QRM and CSD techniques, respectively. The PMI technique also resulted in significantly less head movement (F2,68 = 9.06; P = 0.001) and less maximum head movement (F2,68 = 13.84; P < 0.001) in the frontal plane compared with the QRM and CSD techniques. CONCLUSIONS: The PMI technique should be used to gain rapid airway access when managing a football athlete experiencing respiratory arrest in the presence of a suspected cervical spine injury. In the event the athlete does not present with respiratory arrest, the facemask may be removed carefully with a pocket mask ready. Medical professionals must be familiar with differences in equipment and the effects these may have on the management of the spine-injured athlete.

Comparison of 3 airway access techniques during suspected spine injury management in American football.

OBJECTIVE: To determine how head movement and time to access airway were affected by 3 emergency airway access techniques used in American football. DESIGN: Prospective counterbalanced design. SETTING: University research laboratory. PARTICIPANTS: Eighteen certified athletic trainers (ATCs) and 18 noncertified students (NCSs). INTERVENTIONS: Each participant performed 1 trial of each of the 3 after airway access techniques: quick release mechanism (QRM), cordless screwdriver (CSD), and pocket mask insertion (PMI). MAIN OUTCOME MEASURES: Time to task completion in seconds, head movement in each plane (sagittal, frontal, and transverse), maximum head movement in each plane, helmet movement in each plane, and maximum helmet movement in each plane. RESULTS: We observed a significant difference between all 3 techniques with respect to time required to achieve airway access (F(2,68) = 263.88; P < 0.001). The PMI allowed for the quickest access followed by the QRM and CSD techniques, respectively. The PMI technique also resulted in significantly less head movement (F(2,68) = 9.06; P = 0.001) and less maximum head movement (F(2,68) = 13.84; P < 0.001) in the frontal plane compared with the QRM and CSD techniques. CONCLUSIONS: The PMI technique should be used to gain rapid airway access when managing a football athlete experiencing respiratory arrest in the presence of a suspected cervical spine injury. In the event the athlete does not present with respiratory arrest, the facemask may be removed carefully with a pocket mask ready. Medical professionals must be familiar with differences in equipment and the effects these may have on the management of the spine-injured athlete.

Effect of ice hockey helmet fit on cervical spine motion during an emergency log roll procedure.

OBJECTIVE: To investigate cervical spine motion during a log roll technique in ice hockey players under different helmet fit conditions. DESIGN: Prospective counterbalanced design. SETTING: University research laboratory. PARTICIPANTS: Eighteen club ice hockey players were recruited to participate in this study. ASSESSMENT OF RISK FACTORS: A standard emergency log roll was performed 3 times under each of 3 different helmet fit conditions: properly fit, improperly (competition) fit, and helmet-removed. MAIN OUTCOME MEASUREMENTS: Frontal, sagittal, and transverse plane cervical spine motion were used as outcome measures. RESULTS: Significantly less sagittal and transverse plane motion occurred during the helmet-removed condition. No differences in frontal plane motion among the 3 conditions were observed. CONCLUSIONS: Presence of helmet (whether properly fit or not) resulted in increased of sagittal and transverse plane movement. This suggests that when an ice hockey helmet is stabilized, the head within it is not. We recommend the helmet and face shield be removed before performing an emergency prone log roll.

Delivering Chest Compressions and Ventilations With and Without Men's Lacrosse Equipment.

CONTEXT: Current management recommendations for equipment-laden athletes in sudden cardiac arrest regarding whether to remove protective sports equipment before delivering cardiopulmonary resuscitation are unclear. OBJECTIVE: To determine the effect of men's lacrosse equipment on chest compression and ventilation quality on patient simulators. DESIGN: Cross-sectional study. SETTING: Controlled laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-six licensed athletic trainers (18 women, 8 men; age = 25 ± 7 years; experience = 2.1 ± 1.6 years). INTERVENTION(S): In a single 2-hour session, participants were block randomized to 3 equipment conditions for compressions and 6 conditions for ventilations on human patient simulators. MAIN OUTCOME MEASURE(S): Data for chest compressions (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of optimal compressions) and ventilations (ventilation rate, mean ventilation volume, and percentage of ventilations delivering optimal volume) were analyzed within participants across equipment conditions. RESULTS: Keeping the shoulder pads in place reduced mean compression depth (all P values < .001, effect size = 0.835) and lowered the percentages of both correctly released compressions ( P = .02, effect size = 0.579) and optimal-depth compressions (all P values < .003, effect size = 0.900). For both the bag-valve and pocket masks, keeping the chinstrap in place reduced mean ventilation volume (all P values < .001, effect size = 1.323) and lowered the percentage of optimal-volume ventilations (all P values < .006, effect size = 1.038). Regardless of equipment, using a bag-valve versus a pocket mask increased the ventilation rate (all P values < .003, effect size = 0.575), the percentage of optimal ventilations (all P values < .002, effect size = 0.671), and the mean volume ( P = .002, effect size = 0.598) across all equipment conditions. CONCLUSIONS: For a men's lacrosse athlete who requires cardiopulmonary resuscitation, the shoulder pads should be lifted or removed to deliver chest compressions. The facemask and chinstrap, or the entire helmet, should be removed to deliver ventilations, preferably with a bag-valve mask.

Head Impact Biomechanics in Women's College Soccer.

INTRODUCTION: There are limited nonlaboratory soccer head impact biomechanics data. This is surprising given soccer's global popularity. Epidemiological data suggest that female college soccer players are at a greater concussion injury risk than their male counterparts. Therefore, the purposes of our study were to quantify head impact frequency and magnitude during women's soccer practices and games in the National Collegiate Athletic Association and to characterize these data across event type, playing position, year on the team, and segment of game (first and second halves). METHODS: Head impact biomechanics were collected from female college soccer players (n = 22; mean ± SD age = 19.1 ± 0.1 yr, height = 168.0 ± 3.5 cm, mass = 63.7 ± 6.0 kg). We employed a helmetless head impact measurement device (X2 Biosystems xPatch) before each competition and practice across a single season. Peak linear and rotational accelerations were categorized based on impact magnitude and subsequently analyzed using appropriate nonparametric analyses. RESULTS: Overall, women's college soccer players experience approximately seven impacts per 90 min of game play. The overwhelming majority (~90%) of all head impacts were categorized into our mildest linear acceleration impact classification (10g-20g). Interestingly, a higher percentage of practice impacts in the 20g-40g range compared with games (11% vs 7%) was observed. CONCLUSION: Head impact biomechanics studies have provided valuable insights into understanding collision sports and for informing evidence-based rule and policy changes. These have included changing the football kickoff, ice hockey body checking ages, and head-to-head hits in both sports. Given soccer's global popularity, and the growing public concern for the potential long-term neurological implications of collision and contact sports, studying soccer has the potential to impact many athletes and the sports medicine professionals caring for them.

Helmet fit and cervical spine motion in collegiate men's lacrosse athletes secured to a spine board.

CONTEXT: Proper management of cervical spine injuries in men's lacrosse players depends in part upon the ability of the helmet to immobilize the head. OBJECTIVE: To determine if properly and improperly fitted lacrosse helmets provide adequate stabilization of the head in the spine-boarded athlete. DESIGN: Crossover study. SETTING: Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS: Eighteen healthy collegiate men's lacrosse players. INTERVENTION(S): Participants were asked to move their heads through 3 planes of motion after being secured to a spine board under 3 helmet conditions. MAIN OUTCOME MEASURE(S): Change in range of motion in the cervical spine was calculated for the sagittal, frontal, and transverse planes for both head-to-thorax and helmet-to-thorax range of motion in all 3 helmet conditions (properly fitted, improperly fitted, and no helmet). RESULTS: Head-to-thorax range of motion with the properly fitted and improperly fitted helmets was greater than in the no-helmet condition (P < .0001). In the sagittal plane, range of motion was greater with the improperly fitted helmet than with the properly fitted helmet. No difference was observed in helmet-to-thorax range of motion between properly and improperly fitted helmet conditions. Head-to-thorax range of motion was greater than helmet-to-thorax range of motion in all 3 planes (P < .0001). CONCLUSIONS: Cervical spine motion was minimized the most in the no-helmet condition, indicating that in lacrosse players, unlike football players, the helmet may need to be removed before stabilization.

Management of cervical spine injuries in athletes.

OBJECTIVE: Although the incidence of catastrophic cervical spine injury in sport has been significantly reduced over the past 3 decades, the injury warrants continued attention because of the altered quality of life that often accompanies such an injury. The purpose of our literature review was to provide athletic trainers with an understanding of the mechanisms, anatomical structures, and complications often associated with sport-related cervical spine injury. We also present the most current recommendations for management and treatment of these potentially catastrophic injuries. DATA SOURCES: A review of the most pertinent literature between 1970 and 2005 was conducted using MEDLINE and the search terms spinal cord injury, cervical spine injury, neurosurgical trauma, cervical spinal stenosis, and catastrophic spine injury. DATA SYNTHESIS: Flexion of the head places the cervical spine into a straight line and prevents the neck musculature from assisting in force absorption. This mechanism is the primary cause of cervical fracture, dislocation, and quadriplegia. The most serious of the syndromes described in the literature involves a complete spinal cord injury with transverse myelopathy. This injury typically results in total loss of spinal function below the level of the lesion. CONCLUSIONS/RECOMMENDATIONS: Spinal trauma may result in a variety of clinical syndromes, according to the type and severity of the impact and bony displacement, as well as subsequent secondary insults such as hemorrhage, ischemia, and edema. Athletic trainers should be prepared to promptly recognize these potentially catastrophic injuries and follow the recommendations of the Inter-Association Task Force for the Appropriate Care of the Spine Injured Athlete in managing such injuries.