Risk Reduction of Concussion in Athletes: Do Neck Size or Neck Strength Make a Difference?

ABSTRACT: Medical provider's ability to detect, diagnose, and treat sport-related concussion (SRC) has greatly improved in recent years. Though more is known about the biomechanical forces involved in concussion, it is still uncertain whether there are preventative measures athletes can take to prevent a SRC from occurring. The objective of this review was to determine if either neck size or neck strength is related to a decreased risk of sustaining a SRC. A literature review was conducted on Google Scholar and Ovid MEDLINE for pertinent articles. Findings indicate that isometric neck strength, but not neck size, has been shown to be a predictor for SRC prevention. Formal neck strengthening programs are feasible and lead to decreased SRC risk. Additionally, there may be greater opportunity to increase neck strength in amateur athletes compared to professional. In conclusion, cervical strengthening programs have been shown to be feasible and beneficial for athletes to decrease their risk of sustaining a SRC, though the optimal duration, intensity, and frequency has yet to be determined.

Treatment and Management of Work-Related Mild Traumatic Brain Injury in Physical Medicine and Rehabilitation.

ABSTRACT: The purpose of this narrative review was to assess work-related mild traumatic brain injury treatment approaches and outcomes. Literature indicates that incidence of work-related mild traumatic brain injury is high. Ability to return to work after injury is variable, with differences identified across industry sector, mechanisms of injury, sex, and timely treatment and referral. Additional challenges exist in the context of secondary gains (e.g., financial) and the potential for symptom exaggeration. Emerging evidence from studies outside the United States demonstrate the benefits of proactive assessment and treatment at the time of injury. These benefits can be further augmented by early referral to multidisciplinary treatment teams led by physical medicine and rehabilitation physicians. Opportunities for ongoing research and development of strategies to improve treatment, management, and more timely return to work for patients with occupational mild traumatic brain injury are discussed. It is concluded that challenges persist in treatment and management of patients with work-related mild traumatic brain injury as they present unique challenges not seen in those with nonwork-related mild traumatic brain injuries. The unique position of physical medicine and rehabilitation and the skills of physiatrists render them poised to lead multidisciplinary treatment teams for these patients and contribute to the development of a new guideline for return to work, with an emphasis on functional recovery.

Perceived discrimination and blood pressure in individuals aging with traumatic brain injury.

Purpose/Objective: Older adults with a history of traumatic brain injury (TBI) remain an understudied population, resulting in a paucity of geriatric-specific guidelines. Given an increased vascular risk among older adults with TBI, we aimed to examine distal predictors of vascular health in this population. Specifically, we sought to compare levels of perceived discrimination in Black and White older adults with a history of complicated mild, moderate, or severe TBI, and to examine the relationship between levels of discrimination and pulse pressure, a measure of vascular health. Research Method/Design: Self-report measures of everyday discrimination (ED) and major experiences of discrimination (MED) were completed by 106 individuals aging with TBI (27 identified as Black, 79 identified as White). Resting blood pressure was collected during the assessment. Results: MED, but not ED, was significantly higher among Black individuals versus White individuals aging with TBI. Greater MED was significantly associated with higher pulse pressure independent of race and antihypertensive medication status. There was a marginally significant race by MED interaction, where the association between MED and pulse pressure was observed in Black individuals but not White individuals. Injury severity was not associated with pulse pressure, nor were there significant severity by discrimination interactions on pulse pressure. Conclusions/Implications: Discrimination, which may arise from multiple sources of bias (e.g., related to race, disability), is associated with vascular burden. These findings suggest that patients' experiences of discrimination should be addressed as a factor that contributes to health and well-being in brain injury rehabilitation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Elimination of dysphagia using ultrasound guidance for botulinum toxin injections in cervical dystonia.

INTRODUCTION: Dysphagia is a common side effect after botulinum toxin injections for cervical dystonia, with an incidence of 10-40%, depending upon the study and dose used. METHODS: Our study consisted of 5 preselected women who met criteria for cervical dystonia and subsequent dysphagia after electromyography (EMG)-guided injections. Injections were performed with ultrasound (US) imaging, and the effects on swallowing were examined. Separately, sternocleidomastoid (SCM) thickness in healthy controls and treated patients was measured. RESULTS: There were 34 episodes of dysphagia over 98 injection sessions using EMG guidance for a cumulative rate of 34.7%. Using US plus EMG guidance, there was 0% dysphagia across 27 injection sessions. SCM thickness was <1.1 cm. CONCLUSION: US combined with EMG guidance eliminated recurrent dysphagia after botulinum toxin treatment, possibly by keeping the injectate within the SCM.

Testing whether male age or high nutrition causes the cessation of reproductive aging in female Drosophila melanogaster populations.

Fecundity seems to stop declining and plateaus at low levels very late in Drosophila melanogaster populations. Here we test whether this apparent cessation of reproductive aging by a population, herein referred to as fecundity plateaus, is robust under various environmental influences: namely, male age and nutrition. The effect of male age on late age fecundity patterns was tested by supplying older females with young males before average population fecundity declined to plateau levels. The second possible environmental influence we tested was nutrition and whether late-life fecundity plateaus arise from a decline in the calories available for reproduction. This hypothesis was tested by comparing average daily female fecundity with both low- and high-lifetime nutrition. Both hypotheses were tested by measuring mid- and late-life fecundity for each cohort under the various environmental influences, and statistically testing whether fecundity stops declining and plateaus at late ages. These experiments demonstrate that mid- and late-life population fecundity patterns are significantly affected by the age of males and nutrition level. However, male age and nutrition level did not affect the existence of late-life fecundity plateaus, which demonstrates the robustness of our earlier findings. These results do not address any issue pertaining to the possible role, if any, of lifelong inter-individual heterogeneity in Drosophila fecundity.