Normative Data Set of SWAY Balance Mobile Assessment in Pediatric Athletes.

OBJECTIVE: To examine and describe normative values for an objective, mobile measure of postural stability commonly used in concussion assessments, SWAY Balance (SWAY Medical, Tulsa, Oklahoma). DESIGN: Retrospective analysis of baseline balance assessments in a healthy pediatric population. SETTING: Baseline assessments completed by certified athletic trainers at an outpatient concussion center or sports medicine offices in Philadelphia, PA and surrounding suburban Pennsylvania and New Jersey or during an athletic trainer's baseline assessment of collegiate athletes at a National Collegiate Athletic Association (NCAA) Division-II University in Fort Lauderdale, FL. PARTICIPANTS: Test results of a sample of 466 athletes aged 5 to 18 years were included. INTERVENTIONS: The SWAY Balance test was administered using a mobile device on all participants as part of a standard preseason, baseline evaluation, following the standard evaluation protocol. MAIN OUTCOME MEASURES: Baseline SWAY Balance mobile assessment balance and reaction time scores, age and sex effects, were examined. RESULTS: Normative scores are described, with results stratified into 4 age groups (5-9, 10-12, 13-17, and 18 years old). Balance scores, overall and within each individual stance score, improved with the age of the participants. Sex effects on balance were only seen in single-leg stances, with females outperforming males. Reaction time was found to be faster in males and improved with age, peaking at 13 to 17 years old and slowing in 18-year-olds. CONCLUSIONS: Normative, age-specific SWAY Balance test results provided are of clinical use as references in the concussion assessments of pediatric athletes.

A case matched study examining the reliability of using ImPACT to assess effects of multiple concussions.

BACKGROUND: Approximately 3.8 million sport and recreational concussions occur per year, creating a need for accurate diagnosis and management of concussions. Researchers and clinicians are exploring the potential dose-response cumulative effects of concussive injuries using computerized neuropsychological exams, however, results have been mixed and/or contradictory. This study starts with a large adolescent population and applies strict inclusion criteria to examine how previous mild traumatic brain injuries affect symptom reports and neurocognitive performance on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) computerized tool. METHODS: After applying exclusion criteria and case matching, 204 male and 99 female participants remained. These participants were grouped according to sex and the number of previous self-reported concussions and examined for overall differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. In an effort to further reduce confounding factors due to the varying group sizes, participants were then case matched on age, sex, and body mass index and analyzed for differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. RESULTS: Case matched analysis demonstrated males with concussions experience significantly higher rates of dizziness (p = .027, η2 = .035), fogginess (p = .038, η2 = .032), memory problems (p = .003, η2 = .055), and concentration problems (p = .009, η2 = .046) than males with no reported previous concussions. No significant effects were found for females, although females reporting two concussions demonstrated a slight trend for experiencing higher numbers of symptoms than females reporting no previous concussions. CONCLUSIONS: The results suggest that male adolescent athletes reporting multiple concussions have lingering concussive symptoms well after the last concussive event; however, these symptoms were found to be conflicting and better explained by complainer versus complacent attitudes in the population examined. Our results conflict with a significant portion of the current literature that uses relatively lenient inclusion and exclusion criteria, providing evidence of the importance of strict inclusion and exclusion criteria and examination of confounding factors when assessing the effects of concussions.

Concussion history and knowledge base in competitive equestrian athletes.

BACKGROUND: Head injuries are responsible for the majority of serious equestrian sports injuries and deaths. Because of significant health risks to equestrians, education regarding the prevention of head and brain injuries is essential. HYPOTHESIS: A significant number of riders have experienced a concussion, and few have knowledge of concussion. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 2. METHODS: Ninety-four riders competing, riding, or attending equestrian events at the Palm Beach International Equestrian Center in Wellington, Florida, from January to April 2010 were surveyed. Measures of central tendency were utilized to evaluate response patterns. RESULTS: Almost half of equestrian riders (44%) experienced concussions during their careers. Those riders who suffered a brain injury were likely to return to riding without seeking medical clearance. Almost 40% of riders were never educated regarding concussions, while 15% received education from their trainers. CONCLUSION: Education of riders, parents, and horse trainers is needed to raise awareness of concussions and reduce the likelihood of subsequent injuries.