The association between removing and reintroducing man-made jumps in terrain parks and severe alpine skiing and snowboarding injuries.

OBJECTIVES: To explore the effect of removing and reintroducing man-made jumps in terrain parks (TPs), on the proportion of severe injuries among alpine skiers and snowboarders in Québec, Canada. DESIGN: Quasi-experimental study. METHODS: Injuries were identified via injury report forms completed by ski patrollers during seasons 2000-2001 to 2016-2017 in Québec ski areas. Severe injuries were defined based on the type of injury or ambulance evacuation. Logistic regression analysis was used to provide adjusted odds ratios (AOR) for the comparison of the time periods before jump removal (PRE) and after jump reintroduction (POST) with the jump removal interval (INT). RESULTS: Compared with INT, the proportion of severe injuries in PRE was not significantly different (AOR: 1.05; 95% CI: 0.85-1.30), but was higher in POST (AOR: 1.76; 95% CI: 1.24-2.51) for ski areas with jump removal. In ski areas without jump removal, there was no change in PRE (AOR: 0.96; 95% CI: 0.87-1.07) and increased odds of severe injuries in POST (AOR: 1.20; 95% CI: 1.07-1.35). A supplementary analysis suggested that removing jumps from TPs has contributed significantly to a reduction in the proportion of severe injuries. This protective effect appears to decline over time. CONCLUSIONS: These results do not suggest that removing jumps from TPs as an effective long-term injury prevention strategy in skiing and snowboarding. Collecting data on exposure could improve our understanding of how removing, introducing or reintroducing man-made jumps in TPs is associated with the risk of minor and severe injuries in TPs and on regular trails.

Terrain park feature compliance with Québec ski area safety recommendations.

OBJECTIVES: The primary objective of this paper is to examine terrain park (TP) feature compliance with recommendations from a ski area industry guide (are TP features compliant with the guide?) and determine factors that could be associated with TP feature compliance in Québec ski areas (do factors influence TP feature compliance?), Canada. These recommendations on the design, construction and maintenance are provided by the Québec Ski Areas Association Guide. METHODS: A group of two to four trained research assistants visited seven ski areas. They used an evaluation tool to assess the compliance of 59 TP features. The evaluation tool, originally developed to assess the quality of TP features based on the guide, was validated in a previous study. Compliance was calculated by the percentage of compliant measures within a given feature. The potential influence of four factors on compliance (size of the TP, size of the feature, snow conditions and type of feature) were examined using a mixed-effects logistic regression model. RESULTS: The average TP feature compliance percentage was 93% (95% CI 88% to 99%) for boxes, 91% (95% CI 89% to 94%) for rails and 89% (95% CI 86% to 92%) for jumps. The logistic regression showed that none of the four factors examined were associated with TP feature compliance with the guide. CONCLUSION: Our results suggest that TP features are highly compliant with the guide in Québec ski areas.

What are the risk factors for injuries and injury prevention strategies for skiers and snowboarders in terrain parks and half-pipes? A systematic review.

OBJECTIVE: To synthesise the current evidence regarding the risk factors, the injury prevention strategies and the profile of injured skiers and snowboarders in terrain parks (TPs) and half-pipes (HPs). DESIGN: Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. DATA SOURCES: Literature searches from six electronic databases and manual searches were performed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Inclusion criteria were: (1) publication based on original data; (2) injuries sustained in TPs or HPs; (3) recreational skiing or snowboarding injuries; (4) observational or experimental study design with a comparison group. RESULTS: No study explored the risk factors in HPs or the prevention strategies in TPs or HPs. From the literature retrieved, there is strong evidence that skiing or snowboarding in a TP is a risk factor for head, neck, back and severe injuries. Two papers assessed the risk factors for injuries in TPs, mainly demonstrating that features promoting aerial manoeuvres or a large drop to the ground were associated with higher feature-specific injury rates. The profile of injured skiers and snowboarders in TPs described in the literature suggested some evidence of associations between factors including activity, sex, skill level, helmet use, age and TP injuries. SUMMARY/CONCLUSIONS: This systematic review demonstrates the need for studies identifying the risk factors for injuries to skiers and snowboarders and on interventions to reduce the risk of injury in TPs and HPs. Studies addressing the issue of TP design should be considered. PROSPERO REGISTRATION NUMBER: CRD42016045206.

Assessment of the impact of an exercise program on the physical and functional capacity in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay: An exploratory study.

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neuromuscular disorder caused by the mutation of the SACS gene. Clinical symptoms of this disease include progressive ataxia, spasticity, and peripheral neuropathy. Similar to other neuromuscular disorders, these patients are prone to physical deconditioning which may lead to a loss of functional capacity. This paper aims to evaluate the impact of a training program on the physical fitness and the functional capacity of ARSACS patients. Twelve patients (age: 28.1 ± 8.2 years) participated in this study. They followed an eight-week training program including physical activities, strength-power and aerobic training. Compared to the initial evaluation, measures of physical fitness and functional capacity were significantly improved (p ≤ 0.05) for 11 of the 12 tests. Positive gains were also observed for fall frequency and for upper-limb incoordination. This paper supports the importance of a training program for ARSACS patients in order to improve their quality of life. Through these types of interventions, it may be possible to slow down the progression of the disease and help maintain functional capacity.

Computer-based assessment of upper-limb incoordination in autosomal recessive spastic ataxia of Charlevoix-Saguenay patients: A pilot study.

Ataxia refers to a group of neurological disorders characterized by a lack of coordination during voluntary movements. One of the most commonly used tests to assess upper-limb coordination is the Archimedes spiral test. The purpose of this research is to present an innovative computer-based Archimedes spiral test that can accurately assess coordination. Forty nine individuals (age: 25.2±7.1years) were recruited including thirteen patients diagnosed with Autosomal Recessive Spastic Ataxia of Charlevoix/Saguenay (ARSACS). Participants were instructed to trace a spiral on the touch-screen with the tip of their index finger at a self-paced velocity by following an on-screen spiral template. Mean error and maximum error as well as frequency analysis were calculated to classify healthy and ARSACS participants. While mean and maximum errors provided good results, the highest classification success rate was obtained using frequency analysis, particularly between f=1.2Hz and f=1.7Hz. Interpretation of traditional paper-drawn Archimedes spirals is limited, and several computerized versions have been reported. Herein, we present a custom-made tool that allows discrimination of measures assessing ataxia in ARSACS. This utilizes a proposed frequency method that may have the potential to track the evolution of upper-limb incoordination in patients and therefore help clinicians and scientists to better monitor their patients.

Measurement properties of a new wireless electrogoniometer for quantifying spasticity during the pendulum test in ARSACS patients.

INTRODUCTION: Autosomal recessive spastic ataxia of Charlevoix/Saguenay (ARSACS) is a neuromuscular disorder that induces spasticity in lower limbs. The Wartenberg pendulum test is a classical method of assessing lower limb spasticity based on the dynamics of the pendular leg motion. However, in its original form, this test only provides subjective results and do not allow accurate assessment of spasticity. METHODS: Thirteen ARSACS patients were assessed using a new wireless electrogoniometer to measure spasticity by quantifying oscillation amplitudes and relaxation indices during the Wartenburg pendulum test. The validity of the instrument was evaluated by comparing its measurements to a known precise goniometer whereas discriminant validity was evaluated by comparing healthy participants and ARSACS patients. Reliability was measured using intraclass correlation (ICC) between pendulum test scores obtained at different moments in time. RESULTS: Data from different tests show that the proposed device is accurate (standard error of measurement of 0.0005°), discriminates healthy and ARSACS patients (most variables have p=0.00) and provides repeatable results (significant ICC usually higher than 0.64 and p<0.05). DISCUSSION: The proposed tool allows the clinician to analyze pendulum oscillation amplitudes and ratios and thus, provide an index of spasticity for the patients affected by ARSACS. This is important as the original procedure is only evaluated visually and the progression cannot be detected until the condition changes drastically. Thus, the system proposed meets the requirements of being useful, precise and user-friendly in the evaluation of patients in a research as well as a clinical environment.