R2DRV: study protocol for longitudinal assessment of driving after mild TBI in young drivers.

BACKGROUND: Mild traumatic brain injury (mTBI) and traffic-related injuries are two major public health problems disproportionately affecting young people. Young drivers, whose driving skills are still developing, are particularly vulnerable to impaired driving due to brain injuries. Despite this, there is a paucity of research on how mTBI impacts driving and when it is safe to return to drive after an mTBI. This paper describes the protocol of the study, R2DRV, Longitudinal Assessment of Driving After Mild TBI in Young Drivers, which examines the trajectory of simulated driving performance and self-reported driving behaviors from acutely post-injury to symptom resolution among young drivers with mTBI compared to matched healthy drivers. Additionally, this study investigates the associations of acute post-injury neurocognitive function and cognitive load with driving among young drivers with and without mTBI. METHODS: A total of 200 young drivers (ages 16 to 24) are enrolled from two study sites, including 100 (50 per site) with a physician-confirmed isolated mTBI, along with 100 (50 per site) healthy drivers without a history of TBI matched 1:1 for age, sex, driving experience, and athlete status. The study assesses primary driving outcomes using two approaches: (1) high-fidelity driving simulators to evaluate driving performance across four experimental study conditions at multiple time points (within 96 h of injury and weekly until symptom resolution or 8 weeks post-injury); (2) daily self-report surveys on real-world driving behaviors completed by all participants. DISCUSSION: This study will fill critical knowledge gaps by longitudinally assessing driving performance and behaviors in young drivers with mTBI, as compared to matched healthy drivers, from acutely post-injury to symptom resolution. The research strategy enables evaluating how increased cognitive load may exacerbate the effects of mTBI on driving, and how post-mTBI neurocognitive deficits may impact the driving ability of young drivers. Findings will be shared through scientific conferences, peer-reviewed journals, and media outreach to care providers and the public.

A National Survey on the Relationship of Youth Sport Specialization Behaviors to Self-Reported Anxiety and Depression in Youth Softball Players.

BACKGROUND: There are little to no data on whether any associations exist between sport specialization and mental health in youth softball athletes. HYPOTHESIS: Highly specialized youth softball athletes will have worse self-reported depression and anxiety symptom scores compared with low and moderate specialized athletes. STUDY DESIGN: Cross-sectional survey. LEVEL OF EVIDENCE: Level 4. METHODS: An online cross-sectional survey was distributed in the fall of 2021 to a national sample of female youth softball athletes between the ages of 12 and 18 years. Sport specialization status was determined using a 3-point specialization scale that classifies either low, moderate, or high. The patient health questionnaire-9 (PHQ-9) and the 7-item general anxiety disorder scale (GAD-7) were used to assess self-reported symptoms of depression and anxiety. Comparison also included sports participation and specialization behaviors between specialization groups. RESULTS: A total of 1283 subjects (mean age, 15.1 ± 1.7 years) fully completed the survey. After adjusting for covariates, lower scores were reported on both the PHQ-9 and GAD-7 by highly specialized athletes compared with moderate or low specialization athletes (PHQ-9, high = 8.6 ± 0.4; moderate = 11.2 ± 0.3; low = 10.9 ± 0.5; P < 0.01; GAD-7, high = 6.5 ± 0.4; moderate = 8.6 ± 0.3; low = 8.4 ± 0.4, P < 0.01). Conversely, higher scores were reported on both scales for athletes who received private softball coaching compared with those who did not (PHQ-9, 11.5 ± 0.3 vs 9.0 ± 0.3; P < 0.01; GAD-7, 8.8 ± 0.3 vs 6.9 ± 0.3, P < 0.01). Finally, athletes who reported an arm overuse injury in the previous year reported higher PHQ-9 scores (10.8 ± 0.3 vs 9.8 ± 0.3; P < 0.01). CONCLUSION: While sport specialization, as measured by the validated 3-point scale, was not associated with increased anxiety and depression symptom scores, other aspects of specialization behavior such as private coaching or overuse injury history were associated with worse scores on these scales, indicating potential concern for anxiety and depression. However, although the differences we observed were statistically significant, they did not exceed the minimal clinically important difference values that have been established for the PHQ-9 (5 points) or GAD-7 (4 points). CLINICAL RELEVANCE: This project is a first step toward understanding the sport specialization behaviors and their influence on the mental health of youth softball athletes. Focusing on investigating specialization behaviors further may reveal to be a better indicator of risk of developing anxiety and depression symptoms compared with utilizing the 3-point specialization scale.

Results of a National Survey on Sport Specialization Behavior and Throwing Arm Injury in Youth Softball Players.

BACKGROUND: There are few data on throwing arm and shoulder injury in youth softball athletes, and no data on the influence of sport specialization on injury in softball. HYPOTHESIS: We hypothesized that highly specialized athletes, and pitchers in particular, demonstrating various sport specialization behaviors would be more likely to report an upper extremity overuse injury in the previous 12 months. STUDY DESIGN: Cross-sectional survey. LEVEL OF EVIDENCE: Level 4. METHODS: An online, anonymous, cross-sectional survey was distributed to a national sample of female youth softball players between the ages of 12 and 18 years in fall 2021. Topics included were indicators of sport specialization and self-reported injuries to the throwing arm. RESULTS: A total of 1309 participants (mean age, 15.1 ± 1.7 years) completed the survey; 19.4% (N = 254) scored as highly specialized, 69.7% (N = 912) as moderately specialized, and 10.9% (N = 143) with low specialization. Of all participants, 27.3% (N = 357) pitched in the previous year. A minority of all players (43.7%; N = 572) reported arm injury in the previous 12 months, with 45.9% of pitchers (N = 164) reporting the same. Multivariate regression showed increased adjusted odds ratio (aOR) of injury history for athletes playing >30 games per year (aOR, 1.74; 95% CI, 1.26-2.40), participating on a club team (aOR, 3.36; 95% CI,1.85-6.07), and in pitchers participating on club teams (aOR, 2.97; 95% CI, 1.18-7.45). Decreased aOR of injury was noted in those participating in >8 months of softball per year (aOR, 0.25; 95% CI, 0.12-0.51) and in pitchers who were moderately specialized (aOR, 0.39; 95% CI, 0.17-0.92) and playing >8 months per year (aOR, 0.33; 95% CI, 0.11-0.96). CONCLUSION: This sample provides a large proportion of athletes classified as high or moderately specialized in youth softball (89%). A large proportion (43.7%) of subjects reported arm injury in the past year, and insight into injury risk is provided. The results present conflicting data on the risk versus protective effect of specialization in youth softball athletes. CLINICAL RELEVANCE: This project is a first step toward understanding sport specialization behavior and its influence on injury in youth softball.

Physical demands and physiological strain of American football referees while officiating.

OBJECTIVES: Certain occupations are associated with greater risk of triggering a sudden cardiac event because of high levels of physical exertion and extreme thermal environments in which they occur. The extent to which sports officials--particularly high school (HS) American football referees--experience these conditions is unknown. Forty-six male HS officials (72% White/Caucasian; age = 48 ± 12 years, body mass index = 31.7 ± 6.6 kg·m-2) were studied to quantify the physiological strain and physical demands of officiating. METHODS: Referee demographics (e.g., experience, habitual exercise), pre-game urine specific gravity (USG), thermal (peak core temperature [Tcore]) and cardiovascular (average heart rate [HR]) strain, kinematic activity (e.g., total distance, speed, mechanical intensity), and environmental conditions were measured during 10 regular season varsity HS football games (≈2.5 h each) in the Southeastern United States (average wet bulb globe temperature and relative humidity: 18.9 ± 6.0 °C and 78.2% ± 12.1%). Analyses included descriptive statistics, bivariate correlations, and linear regression. RESULTS: Referees covered 5.2 ± 1.2 km per game, eliciting average HR and peak Tcore of 71.5% ± 8.0% HRmax and 38.3 ± 0.5 °C, respectively; 38% began games dehydrated (USG = 1.026 ± 0.004). Multiple regression analyses revealed that obesity (ß = 0.34), not participating in regular exercise (ß = -0.36), and officiating at lower mechanical intensity (ß = -0.33) predicted greater cardiovascular strain (all p ≤ 0.03). White/Caucasian race/ethnicity (ß = 0.59), younger age (ß = -0.46), and obesity (ß = 0.28) predicted greater thermal strain (all p ≤ 0.01). CONCLUSION: HS football referees experienced elevated levels of physiological strain while officiating, with individual factors modulating the magnitude of strain. Strategies aimed at reducing obesity, increasing exercise participation, and improving cardiovascular health should be emphasized to mitigate strain and prevent cardiac events.

Nonsurgical Management of Heterotopic Ossification in a Runner.

A 51-year-old man was referred to physical therapy with right calf and anterior lateral lower-leg pain that had begun 3 weeks prior. Radiographs ordered by his physician identified calcific changes within the mid-posterior lower leg. Computed tomography was ordered to further characterize the lesion and identified heterotopic ossification in the right soleus. The patient refrained from running for 3 weeks and had complete resolution of pain. Following 5 weeks of physical therapy, the patient was able to increase his distance and remain pain free. J Orthop Sports Phys Ther 2019;49(9):676. doi:10.2519/jospt.2019.8491.

Midterm Follow-up of Divergent Peg Glenoid Components in Total Shoulder Arthroplasty.

Glenoid component aseptic loosening is the most common source of total shoulder arthroplasty (TSA) revision. Divergent pegged glenoids may improve fixation. Thirty-four patients underwent divergent peg TSA. Data were reviewed for component loosening. Failure was defined as the need for revision after loosening. The last postoperative radiographs were graded on a Lazarus glenoid lucency scale. Mean follow-up was 5.6 years ± 2.44 (range, 2-10 years). Radiolucency around one or fewer pegs was noted in 14/20 patients. Six glenoids had complete radiolucency around two pegs; one shoulder had gross loosening. No secondary surgery was performed. Improvements were seen in active elevation and internal rotation. The mean Shoulder Pain and Disability Index (SPADI) score decreased by 48.1 points (p = .039). Shoulder elevation, internal rotation, and SPADI scores significantly improved at final follow-up. No patients underwent revision for glenoid loosening. There were, however, a significant number of patients with radiolucency around two pegs. (Journal of Surgical Orthopaedic Advances 27(1):6-9, 2018).

Vision testing is additive to the sideline assessment of sports-related concussion.

We examined the King-Devick (K-D) test, a vision-based test of rapid number naming, as a complement to components of the Sport Concussion Assessment Tool, 3rd edition (SCAT3) for diagnosis of concussion. Baseline and postconcussion data for the University of Florida men's football, women's soccer, and women's lacrosse teams were collected, including the K-D test, Standardized Assessment of Concussion (SAC), and Balance Error Scoring System (BESS). Among 30 athletes with first concussion during their athletic season (n = 217 total), differences from baseline to postinjury showed worsening of K-D time scores in 79%, while SAC showed a ≥2-point worsening in 52%. Combining K-D and SAC captured abnormalities in 89%; adding the BESS identified 100% of concussions. Adding a vision-based test may enhance the detection of athletes with concussion.