Electromyographic analysis of shoulder-complex muscles performing overhead presses with dumbbell, kettlebell, and bottom-up kettlebell.

INTRODUCTION: Kettlebell exercises, specifically the bottom-up grip, have become increasingly popular in training programs. The purpose of this research was to determine if a bottom-up kettlebell grip favorably alters the electromyography (EMG), activity in the medial deltoid (MD), serratus anterior (SA), and lower trapezius (LT), muscles compared to using a dumbbell or traditional kettlebell grip during overhead shoulder presses. METHODS: Twenty-eight healthy, male, Division III collegiate baseball players (mean age = 19.8 ± 1.28 years) performed five overhead presses of equal weight, 11.34 kg (25 lbs), using a dumbbell (DB), kettlebell w/traditional grip (KB), and kettlebell held with a bottom-up grip (KBU). RESULTS: For the MD, there was significantly greater EMG activity using the DB compared to KBU, but no significant differences between the DB and KB, or KB and KBU. For the SA, greater EMG activity was noted using the KBU compared to KB, and KBU compared to DB, but no differences between KB and DB. For the LT, greater EMG activity was noted using the DB compared to KB, but no differences between DB and KBU, or KB and KBU. CONCLUSION: The KBU press only elicited greater EMG activity in the SA. The DB elicited greater EMG activity in both the MD and LT. Shoulder-complex EMG activity varies with different types of overhead presses using equivalent loads.

Shoulder kinetic during pitching in baseball players with scapular dyskinesis.

INTRODUCTION: Shoulder injuries in baseball players cause excessive shoulder load during pitching and scapular dyskinesis (SD). However, the characteristics of pitching kinetics in the shoulder joint with SD are unclear. This study aimed to investigate the effect of SD on pitching kinetics in the shoulder joint of baseball players. METHOD: Seventy-two college and independent league baseball players participated in the study. The pitching motion was measured using an 18-camera motion-capture system. SD was classified into four types (I-IV) using the scapular dyskinesis test (SDT). The pitching kinetics data were analyzed. RESULTS: The agreement of SD in this study was 56/72 (77.8%). SD were classified into 31 abnormal group (type I-Ⅲ) and 25 control group (type Ⅳ). Three participants with measurement failure during the pitching motion analysis were excluded from the analysis. The abnormal group showed a larger maximum value of the glenohumeral normalized anterior joint force than the control group. CONCLUSIONS: These results suggest that an increase in GH anterior force during pitching causes an excessive increase in external rotation of the GH with an insufficient posterior tilt of the scapula with SD. Therefore, baseball pitching with SD may involve shoulder injuries owing to excessive shoulder load during pitching.

Motor imagery ability in baseball players with throwing yips.

The motor imagery ability is closely related to an individual's motor performance in sports. However, whether motor imagery ability is diminished in athletes with yips, in whom motor performance is impaired, is unclear. Therefore, this cross-sectional study aimed to determine whether general motor imagery ability or vividness of motor imagery specific to throwing motion is impaired in baseball players with throwing yips. The study enrolled 114 college baseball players. They were classified into three groups: 33 players in the yips group, 26 in the recovered group (previously had yips symptoms but had resolved them), and 55 in the control group. They answered the revised version of the vividness of movement imagery questionnaire (VMIQ-2), which assesses general motor imagery ability. Furthermore, they completed a questionnaire that assesses both positive and negative motor imagery vividness specific to baseball throwing. In the former, they responded to their ability to vividly imagine accurately throwing a controlled ball, whereas in the latter, they responded to the vividness of their experience of negative motor imagery associated with baseball throwing, specifically the image of a wild throw. No significant difference in the VMIQ-2 was found among the three groups. While no significant difference in the vividness of positive motor imagery for ball throwing was found in either first-person visual or kinesthetic perspectives among the three groups, the yips group exhibited significantly higher vividness of negative motor imagery than the control group in both perspectives. These results indicate that negative motor imagery specific to baseball throwing may be associated with symptoms of yips. Therefore, interventions addressing psychological aspects, such as anxiety, which are potential causes of the generation of negative motor imagery, may be necessary to alleviate the symptoms of yips.

Scapular dyskinesis type is associated with glenohumeral joint and scapular kinematic alteration during pitching motion in baseball players.

INTRODUCTION: Scapular dyskinesis (SD) is associated with an increased risk of throwing-related shoulder injury onset, resulting in abnormalities in glenohumeral joint (GH) and scapular motions during pitching. The effects of SD on shoulder motion during pitching remain unknown. This study aimed to investigate kinematic alterations in GH and scapular motions during pitching in baseball players with type I SD. METHODS: Sixty-seven university and independent-league baseball players with and without SD were included. Pitching motion was measured using an optical three-dimensional motion capture system, and a SD test was conducted to evaluate SD. SD was classified into types I-IV. The inter-rater reliability of SD assessment was calculated using kappa coefficients. Three-dimensional GH and scapular kinematics during pitching motion were analyzed. RESULTS: The percentage of agreement representing the inter-rater reliability of SD assessment was 77.6% (52/67; kappa coefficient: 0.72). Overall, 24 and 27 participants were categorized into abnormal (type I SD) and normal group (type IV SD), respectively, with normal scapular motion; one individual with type III SD was excluded. The abnormal group exhibited a significantly increased GH external rotation angle (9°) and decreased scapular posterior tilt angle (6°) during the maximum external rotation period compared with the normal group. CONCLUSIONS: Baseball players in the abnormal group showed increased GH motion and decreased scapular motion during pitching. The SD test for the evaluation of type I SD can help predict excessive GH external rotation and decreased scapular posterior tilt during pitching.

Effects of Tai Chi Softball Exercises on Physical Fitness Level and Cardiovascular Health-Related Factors among Older Females.

Tai Chi softball was voted as one of the most popular health-promoting exercises and can also develop manipulative skill and hand-eye coordination. The purpose of this study was to explore changes in the physical fitness level and cardiovascular health-related factors after the 16-week Tai Chi softball (TCSB) training program among older females. One hundred healthy older females were assessed at the baseline before TCSB training, and then, they conducted intervention experiments. Through the 16-week TCSB intervention training, a control group and a physical exercise group showed significant differences. The physical exercise group significantly reduced body mass index, systolic blood pressure, and diastolic blood pressure from all the results studied. It also reduces total cholesterol, triglycerides, low-density lipoprotein cholesterol ( ∗ p < 0.05), and waist-to-hip ratio ( ∗∗ p < 0.01), whereas handgrip, sit and reach, single leg stance, vital capacity ( ∗ p < 0.05), and high-density lipoprotein cholesterol ( ∗∗ p < 0.01) were significantly increased. TCSB training may improve physical fitness ability and decrease the risk of cardiovascular disease among older females.

Influence of quantified dry cupping on soft tissue compliance in athletes with myofascial pain syndrome.

PURPOSE: This study aimed to develop a quantitative dry cupping system that can monitor negative pressure attenuation and soft tissue pull-up during cupping to quantify soft tissue compliance. METHODS: Baseball players with myofascial pain syndrome were recruited to validate the benefits of cupping therapy. Nine of 40 baseball players on the same team were diagnosed with trapezius myofascial pain syndrome; another nine players from the same team were recruited as controls. All participants received cupping with a negative pressure of 400 mmHg for 15 minutes each time, twice a week, for 4 weeks. Subjective perception was investigated using upper extremity function questionnaires, and soft tissue compliance was quantified objectively by the system. RESULTS: During the 15-minute cupping procedure, pressure attenuation in the normal group was significantly greater than that in the myofascial group (p = 0.017). The soft tissue compliance in the normal group was significantly higher than that in the myofascial group (p = 0.050). Moreover, a 4-week cupping intervention resulted in an obvious increase in soft tissue lift in the myofascial pain group (p = 0.027), although there was no statistical difference in the improvement of soft tissue compliance. Shoulder (p = 0.023) and upper extremity function (p = 0.008) were significantly improved in both groups, but there was no significant difference between the two groups. CONCLUSION: This quantitative cupping monitoring system could immediately assess tissue compliance and facilitate the improvement of soft tissues after cupping therapy. Hence, it can be used in athletes to improve their functional recovery and maintain soft tissues health during the off-season period.

Categorizing 10 Sports According to Bone and Soft Tissue Profiles in Adolescents.

PURPOSE: Considering the different loading and training characteristics of the sports practiced during growth, it is important to specify and categorize the bone and soft tissue adaptations in adolescent athletes. This study aimed to categorize 10 different loading sports and a nonsport group and identify the differences in bone density and soft tissues. METHODS: The sample included 625 adolescents (10 to 17 yr of age) of 10 sports (soccer, basketball, volleyball, track and field, judo, karate, kung fu, gymnastics, baseball, and swimming) and a nonsport group. Dual-energy x-ray absorptiometry assessed areal bone mineral density (aBMD), bone mineral apparent density (BMAD), and soft tissues (lean soft tissue and fat mass). The results were adjusted for sex, peak height velocity status, lean soft tissue, fat mass, and weekly training volume. RESULTS: The comparisons among groups showed that soccer had the highest whole-body aBMD (mean ± SEM: 1.082 ± 0.007 g·cm) and lower limb aBMD (1.302 ± 0.010 g·cm). Gymnastics presented the highest upper limb aBMD (0.868 ± 0.012 g·cm) and whole-body BMAD (0.094 ± 0.001 g·cm). Swimming presented the lowest aBMD values in all skeletal sites (except at the upper limbs) and whole-body BMAD. The soft tissue comparisons showed that soccer players had the highest lean soft tissue (43.8 ± 0.7 kg). The lowest fat mass was found in gymnasts (8.04 ± 1.0 kg). CONCLUSION: The present study investigated and categorized for the first time 10 different sports according to bone density and soft tissue profiles. Soccer and gymnastics sport groups were found to have the highest bone density in most body segments, and both sports were among the groups with the lowest fat mass.

Manipulative Therapy Plus Ankle Therapeutic Exercises for Adolescent Baseball Players with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial.

Manipulative therapies and exercises are commonly used for the management of chronic ankle instability (CAI), but there is no evidence regarding the efficacy of high-velocity low-amplitude manipulation (HVLA) in addition to ankle therapeutic exercise to improve CAI in adolescent baseball players (ABP). To compare the effects of HVLA plus ankle therapeutic exercise and ankle therapeutic exercise alone on ankle status, pain intensity, pain pressure threshold (PPT), range of motion (ROM) of the ankle joint, and balance ability in ABP with CAI, a single-blinded randomized controlled trial was conducted. A total of 31 ABP with CAI were randomly allocated to the intervention (n = 16) or control (n = 15) groups. The intervention group received HVLA plus resistance exercise twice a week for 4 weeks, while the control group received resistance exercise alone. Ankle status, pain intensity, PPT, ROM, and balance ability were assessed before and after the intervention. The American Orthopedic Foot and Ankle Society scores showed significant group and time interactions (total, p = 0.002; pain, p < 0.001; alignment, p = 0.001). There were significant group and time interactions in pain intensity (resting pain, p = 0.008; movement pain, p < 0.001). For ROM, there were significant group and time interactions on dorsiflexion (p = 0.006) and eversion (p = 0.026). The unipedal stance of the balance ability showed significant group and time interactions in path length (p = 0.006) and velocity (p = 0.006). Adding HVLA to resistance exercises may be synergistically effective in improving the ankle status, pain intensity, ROM, and balance ability in ABP with CAI.

High-protein supplementation facilitates weight training-induced bone mineralization in baseball players.

OBJECTIVES: The aim of this study was to determine whether weight training combined with high-protein intake enhances total and regional bone mineral density (BMD) in athletes. METHODS: BMD of 27 Division 1 collegiate baseball players 18 to 22 y of age (N = 13, 2 dropouts) received either 14% protein or isocaloric 44% protein supplements and were assessed by dual-energy x-ray absorptiometry before and after a 12-wk weight training program (challenging upper and lower body). RESULTS: Baseline data showed unequivocally greater humerus BMD in the dominant arm than their contralateral non-dominant arm (∼20 %) among all baseball players. Humerus BMD of the non-dominant arm was enhanced by 2.7% after weight training for both low- and high-protein groups (main effect, P = 0.008), concurrent with an unexpected small decrease in total body BMD (main effect, P = 0.014). Humerus BMD of the dominant arm with greater baseline value than the non-dominant arm was not increased unless high protein was supplemented (+2.7 %; P < 0.05). CONCLUSION: Bones with relatively higher BMD show blunt adaptation against training, which can be relieved by high-protein supplementation. Total BMD of athletes cannot be further elevated by weight training.

Availability of a sports dietitian may lead to improved performance and recovery of NCAA division I baseball athletes.

BACKGROUND: The purpose was to survey dietary habits (DH) and nutrient timing (NT) practices of baseball student-athletes (mean ± SD; 20.7 ± 1.4 yr.) from three NCAA Division I institutions, and examine the effect of a sports dietitian (SD) in regard to nutrition practices. METHODS: Descriptive statistics and Pearson X2 analyses were run. Responses on 10 DH and 5 NT items differed (p ≤ 0.10) between athletes who sought dietary planning from a SD (n = 36) versus those who consulted a strength and conditioning coach (SCC, n = 42). RESULTS: In regard to DH items, the SD group found it easier to eat before activity (92% vs. 71%, p = 0.03), did not consume fast food (31% vs. 14%, p = 0.02), caffeinated beverages (57% vs. 46%, p = 0.02), or soda (56% vs. 37%, p = 0.10), prepared their own meals more often (86% vs. 73%, p = 0.07), and took daily multi-vitamins (56% vs. 32%, p = 0.02). The SCC group ate more at burger locations (21% vs. 6%, p = 0.02). In regard to NT items, the SD group ate breakfast before training/lifting sessions (67% vs. 37%, p = 0.02), and had post-workout nutrition options provided (61% vs. 27%, p = 0.01). The SCC group reported pre-competition meals of fast food (58% vs. 45%, p = 0.01), and sport coaches who were less aware of healthy food options (39% vs. 65%, p = 0.05). CONCLUSIONS: The SD is as a valuable asset to an intercollegiate athletics program. In the current study, athletes from the SD group consumed less high calorie/low nutrient dense items, ate before exercise, and consumed healthier options post-exercise. The presence of a SD was linked to provision of healthier food options during team trips. The evidence-based eating strategies and dietary plan provided by a SD may lead to improved performance and recovery.

Acute effects of self-myofascial release and stretching in overhead athletes with GIRD.

OBJECTIVE: To examine the acute effects of self-myofascial release (SMR), static stretching (SS), and the combination of self-myofascial release and static stretching (SMR + SS) on glenohumeral internal rotation range of motion (GH IR ROM) in overhead athletes with glenohumeral internal rotation deficit (GIRD). PARTICIPANTS: Twelve asymptomatic adult male amateur softball position players exhibiting GIRD. RESULTS: All three methods significantly improved GH IR ROM. Post hoc testing revealed that SS alone and SMR + SS improved GH IR ROM significantly more than SMR alone. However, there were no significant differences in GH IR ROM between SS alone and SMR + SS. CONCLUSIONS: If an athlete has a limited time to perform a warm-up (e.g., 3-4 min), SS alone is recommended to improve GH IR ROM. However, if the athlete has more time available to warm up (e.g., 7-8 min), combining SMR + SS may result in a greater increase in GH IR ROM.

Ultrasound study of elbow ulnar collateral ligament changes in collegiate baseball players: A pilot study.

OBJECTIVE: To assess changes in elbow ulnar collateral ligament length in college baseball pitchers over the course of a single season. DESIGN: Cohort Feasibility Study. METHODS: Diagnostic ultrasound was used to assess both the dominant and non-dominant medial elbow joint space in four pitchers and five fielders and compared to in-game pitching data. Shoulder, elbow, wrist, hip, knee, and ankle range of motion measurements were also taken. RESULTS: Mean trends for both the pitching and fielding groups showed no increases in dominant arm medial elbow joint space. Range of motion (ROM) increases were seen in both groups, and neither ultrasound nor ROM changes correlated to number of pitches thrown. CONCLUSION: It is feasible that shoulder and hip range of motion changes directly affect stresses at the elbow in baseball pitching (Wilk et al., 2014) (Sauers et al., 2014). Further research is needed to investigate whether UCL injuries are related to increased laxity of the ligament.

Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits.

BACKGROUND: Baseball players displaying deficits in shoulder range of motion (ROM) are at increased risk of arm injury. Currently, there is a lack of consensus regarding the best available treatment options to restore shoulder ROM. HYPOTHESIS: Instrumented manual therapy with self-stretching will result in clinically significant deficit reductions when compared with self-stretching alone. STUDY DESIGN: Controlled laboratory study. METHODS: Shoulder ROM and humeral torsion were assessed in 60 active baseball players (mean age, 19 ± 2 years) with ROM deficits (nondominant - dominant, ≥15°). Athletes were randomly assigned to receive a single treatment of instrumented manual therapy plus self-stretching (n = 30) or self-stretching only (n = 30). Deficits in internal rotation, horizontal adduction, and total arc of motion were compared between groups immediately before and after a single treatment session. Treatment effectiveness was determined by mean comparison data, and a number-needed-to-treat (NNT) analysis was used for assessing the presence of ROM risk factors. RESULTS: Prior to intervention, players displayed significant ( P < 0.001) dominant-sided deficits in internal rotation (-26°), total arc of motion (-18°), and horizontal adduction (-17°). After the intervention, both groups displayed significant improvements in ROM, with the instrumented manual therapy plus self-stretching group displaying greater increases in internal rotation (+5°, P = 0.010), total arc of motion (+6°, P = 0.010), and horizontal adduction (+7°, P = 0.004) compared with self-stretching alone. For horizontal adduction deficits, the added use of instrumented manual therapy with self-stretching decreased the NNT to 2.2 (95% CI, 2.1-2.4; P = 0.010). CONCLUSION: Instrumented manual therapy with self-stretching significantly reduces ROM risk factors in baseball players with motion deficits when compared with stretching alone. CLINICAL RELEVANCE: The added benefits of manual therapy may help to reduce ROM deficits in clinical scenarios where stretching alone is ineffective.

Use of the Spencer Technique on Collegiate Baseball Players: Effect on Physical Performance and Self-Report Measures.

CONTEXT: Repeated overhead throwing in baseball players alters range of motion (ROM), contributing to shoulder injury. The Spencer technique has been used, anecdotally, to reduce the effects of throwing-induced limitations in ROM. OBJECTIVE: To quantify the effects of a single administration of the Spencer technique on the ROM and performance of collegiate baseball pitchers. METHODS: Pitchers from the Seton Hill University men's baseball team were randomly assigned to 2 treatment groups: Spencer technique or sham therapy. The first week consisted of baseline outcome measurements (1 week before treatment), including ROM (flexion, extension, abduction, adduction, internal rotation, and external rotation) of the dominant throwing arm, 10 maximum velocity throws, and self-reported performance using the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES). The second week consisted of pretreatment ROM measurement, followed by a single treatment and repeated measurement of all outcomes. RESULTS: Of 16 players, 15 met inclusion criteria. An effect of training on ROM between weeks 1 and 2 for all players consisted of significantly decreased internal rotation (P=.02) and increased external rotation (P=.04). A differential effect of treatment was found on the mean difference in internal rotation after treatment, compared with the mean difference before treatment on the same day (P=.01). Additionally, a trend toward statistical significance for abduction (P=.08) was noted. Analyses reveal that these effects were caused by significant increases in the internal rotation and abduction for the Spencer group only (P=.02). All other analyses of ROM, as well as performance measured by maximum velocity throws and the KJOC-SES, revealed no differential effect of treatment. CONCLUSION: The results of this study support the use of the Spencer technique in counteracting the potentially negative effects of repeated throwing on internal rotation. However, a single administration did not affect functional ability in this study. Future studies of longer duration and including differing levels of play, injury status, and playing position will be needed to further evaluate the full potential of the Spencer technique in athletes who engage in repeated overhead arm movements.

Descriptive Epidemiology of Symptomatic Femoroacetabular Impingement in Young Athlete: Single Center Study / 대한고관절학회지

PURPOSE: The purpose of this study was to determine the prevalence of symptomatic femoroacetabular impingement (FAI) in athletic patients. MATERIALS AND METHODS: From July 2003 to May 2013, 388 patients (422 hips) who underwent arthroscopic surgery for FAI were evaluated demographic characteristics. The patients' age, gender, diagnosis, and type of sports were analyzed using medical records and radiography. RESULTS: Among 422 hips in 388 patients, 156 hips were involved with sports. Among the 156 hips, 86, 43, and 27 hips were categorized as cam, pincer, and mixed type, respectively. Types of sports were soccer, baseball and taekwondo which showed 44, 36 and 35 hips, respectively. Also, cases related to sports according to age were 63 hips for twenties and 12 hips for teenagers in which the two showed highest association to FAI. The kinds of sports that showed high association were 28 hips of soccer and 20 cases of martial arts such as taekwondo and judo for twenties and 9 hips of martial arts for teenagers which was the highest. CONCLUSION: FAI usually occurs in young adults and is highly related to sports activity. Most of the FAI type related to sports activity was cam type, and soccer and martial arts such as taekwondo were the most common cause of it.

Effects of Three Recovery Protocols on Range of Motion, Heart Rate, Rating of Perceived Exertion, and Blood Lactate in Baseball Pitchers During a Simulated Game.

Baseball pitching has been described as an anaerobic activity from a bioenergetics standpoint with short bouts of recovery. Depending on the physical conditioning and muscle fiber composition of the pitcher as well as the number of pitches thrown per inning and per game, there is the possibility of pitchers fatiguing during a game, which could lead to a decrease in pitching performance. Therefore, the purpose of this study was to evaluate the effects of 3 recovery protocols: passive recovery, active recovery (AR), and electrical muscle stimulation (EMS) on range of motion (ROM), heart rate (HR), rating of perceived exertion (RPE), and blood lactate concentration in baseball pitchers during a simulated game. Twenty-one Division I intercollegiate baseball pitchers (age = 20.4 ± 1.4 years; height = 185.9 ± 8.4 cm; weight = 86.5 ± 8.9 kg; percent body fat = 11.2 ± 2.6) volunteered to pitch 3 simulated 5-inning games, with a maximum of 70 fastballs thrown per game while wearing an HR monitor. Range of motion was measured pre, post, and 24 hours postpitching for shoulder internal and external rotation at 90° and elbow flexion and extension. Heart rate was recorded after each pitch and after every 30 seconds of the 6-minute recovery period. Rating of perceived exertion was recorded after the last pitch of each inning and after completing each 6-minute recovery period. Immediately after throwing the last pitch of each inning, postpitching blood lactate concentration (PPLa-) was measured. At the end of the 6-minute recovery period, before the next inning started, postrecovery blood lactate concentration (PRLa-) was measured. Pitchers were instructed to throw each pitch at or above 95% of their best-pitched fastball. This was enforced to ensure that each pitcher was throwing close to maximal effort for all 3 simulated games. All data presented represent group mean values. Results revealed that the method of recovery protocol did not significantly influence ROM (p > 0.05); however, it did significantly influence blood lactate concentration (p < 0.001), HR (p < 0.001), and RPE (p = 0.01). Blood lactate concentration significantly decreased from postpitching to postrecovery in the EMS recovery condition (p < 0.001), but did not change for either the active (p = 0.04) or the passive (p = 0.684) recovery conditions. Rating of perceived exertion decreased from the postpitching to postrecovery in both the passive and EMS recovery methods (p < 0.001), but did not decrease for AR (p = 0.067). Heart rate decreased for all conditions from postpitching to postrecovery (p < 0.001). The use of EMS was the most effective method at reducing blood lactate concentration after 6 minutes of recovery during a simulated game (controlled setting). Although EMS significantly reduced blood lactate concentrations after recovery, blood lactate concentrations after pitching in the simulated games were never high enough to cause skeletal muscle fatigue and decrease pitching velocity. If a pitcher were to throw more than 14 pitches per inning, throw more total pitches than normal per game, and have blood lactate concentrations increase higher than in the simulated games in this study, the EMS recovery protocol may be beneficial to pitching performance by aiding recovery. This could potentially reduce some injuries associated with skeletal muscle fatigue during pitching, may allow a pitcher throw more pitches per game, and may reduce the number of days between pitching appearances.

Transient ipsilateral mydriasis during correction of left blowout fracture.

Mydriasis, either bilateral or unilateral, seldom occurs during reconstruction of periorbital fracture. Anisocoria, a unilateral mydriasis, requires more urgent assessment than bilateral mydriasis does. Pharmacologic agents, local anesthetic infiltration, as well as direct or indirect oculomotor nerve damage are possible causes of unilateral mydriasis. Few cases have been reported about intraoperative temporary ipsilateral mydriasis during correction of blowout fracture. We have experienced an unusual case of anisocoria and report the case with literature reviews.

Developing a Performance Brain Training™ approach for baseball: a process analysis with descriptive data.

Neurofeedback may be useful for improving sports performance but few studies have examined this potential. Here we present data of five development players from a major league baseball team. The aims were to evaluate the feasibility of conducting sessions within a professional organization, assess changes in quantitative electroencephalograph (QEEG), NeuroPerformance Profile™, and report qualitative self-report data before and after brain training. The EEG was recorded with 19 electrodes for 20 min of baseline conditions and approximately 21 min of a continuous performance test. The fast Fourier transform analysis provided average cross-spectral matrices for bands delta (1-3.5 Hz), theta (4-7.5 Hz), alpha (8-12 Hz), low beta (13-16 Hz), beta 1 (13-21 Hz), beta 2 (22-32 Hz), and gamma (32-45 Hz) from the pre and post intervention evaluations in the baseline condition of eyes open. The continuous performance test metrics included the errors of omission, errors of commission, response time and response time variability. The 9 scales of the NeuroPerformance Profile™ were examined. The QEEG data, CPT data and NeuroPerformance Profile™ data were all compared between the pre and post 15 sessions of brain training using a within subject paired t test design corrected for multiple comparisons using false discovery rate method. Following brain training, comparative QEEG, CPT and NeuroPerformance Profile™ analyses illustrated significant differences. The QEEG findings of all participants illustrated significant changes within the training parameters but also across other frequency bands and electrode sites. Overall, the positive findings in both objective and subjective measures suggest further inquiry into the utility of brain training for performance enhancement with the specific application of sport is warranted. Particularly QEEG and CPT gains were noted in the areas that correspond to client self-report data demonstrating improvement in attention, decreased intrusive thought patterns and improvements in sleep patterns.