Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 84
Filtrar
1.
J Athl Train ; 2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34709396

RESUMO

CONTEXT: The King-Devick (K-D) is used to identify oculomotor impairment following concussion. However, the diagnostic accuracy of the K-D over time has not been evaluated. OBJECTIVE: (a) Examine the sensitivity and specificity of the K-D test at 0-6 hours of injury, 24-48 hours, asymptomatic, return-to-play, and 6-months following concussion and (b) compare outcomes for differentiating athletes with a concussion from non-concussed across confounding factors (sex, age, contact level, school year, learning disorder, ADHD, concussion history, migraine history, administration mode). DESIGN: Retrospective, cross-sectional design. SETTING: Multisite institutions within the Concussion Assessment, Research, and Education (CARE) Consortium. PATIENTS OR OTHER PARTICIPANTS: 1239 total collegiate athletes without a concussion (age=20.31±1.18, male=52.2%) were compared to 320 athletes with a concussion (age=19.80±1.41, male=51.3%). MAIN OUTCOME MEASURE(S): We calculated K-D time difference (sec) by subtracting baseline from the most recent time. Receiver operator characteristics (ROC) and area under the curve (AUC) analyses were used to determine the diagnostic accuracy across timepoints. We identified cutoff scores and corresponding specificity at 80% and 70% sensitivity levels. We repeated ROC with AUC outcomes by confounding factors. RESULTS: King-Devick predicted positive results at 0-6 hours (AUC=0.724, p<0.001), 24-48 hours (AUC=0.701, p<0.001), return-to-play (AUC=0.640, P<0.001), and 6-months (AUC=0.615, P<0.001), but not at asymptomatic (AUC=0.513, P=0.497). The 0-6 and 24-48-hour timepoints yielded an 80% sensitivity cutoff score of -2.6 and -3.2 seconds (faster) respectively, but 46% and 41% specificity. The K-D test had significantly better AUC when administered on an iPad (AUC=0.800, 95%CI:0.747,0.854) compared to the spiral card system (AUC=0.646, 95%CI:0.600,0.692; p<0.001). CONCLUSIONS: The K-D test has the greatest diagnostic accuracy at 0-6 and 24-48 hours of concussion, but declines across subsequent post-injury timepoints. AUCs did not significantly differentiate between groups for confounding factors. Our negative cutoff scores indicate that practice effects contribute to improved performance, requiring athletes to outperform their baseline.

2.
Med Sci Sports Exerc ; 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34559729

RESUMO

INTRODUCTION: Physical and mental activity post-concussion has received renewed attention to improve concussion management, however most protocols start after several days and do not assess the acute window. Therefore, the purpose of this study was to assess physical and mental activity in the first 48 hours post-concussion on the time to symptom free status and return to play. METHODS: We recruited 78 NCAA Division I athletes (Male: 51.3%, Age: 19.6 ± 1.4 y.o., Height: 173.7 ± 11.5 cm, Weight: 80.1 ± 23.2 kg) who were diagnosed with a sports related concussion. Participants completed a 0 - 5 physical activity (PA) and mental activity (MA) scale daily until fully cleared for return to participation (mean: 15.1 ± 6.9 days). A quadratic model regression assessed PA and MA over the first two days (acute) post-concussion on to time to symptom free and return to play. RESULTS: The overall model was significant for both time to symptom free (r2 = 0.27, p = 0.004) and return to play (r2 = 0.23, p = 0.019). Reported PA was the only significant predictor for time to symptom free (p = 0.002) and RTP (p = 0.006) day. Reported MA was not associated either outcome. CONCLUSION: The primary finding of this study was that mild to moderate PA acutely post-concussion was associated with reduced time to symptom free and return-to-participation as opposed to either lower or higher levels of PA. Conversely, acute MA was not associated with recovery outcomes. These results further elucidate the role of post-concussion physical activity.

3.
J Athl Train ; 56(8): 851-859, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34375406

RESUMO

CONTEXT: Preseason testing can be time intensive and cost prohibitive. Therefore, using normative data for postconcussion interpretation in lieu of preseason testing is desirable. OBJECTIVE: To establish the recovery trajectory for clinical reaction time (RTclin) and assess the usefulness of changes from baseline (comparison of postconcussion scores with individual baseline scores) and norm-based cutoff scores (comparison of postconcussion scores with a normative mean) for identifying impairments postconcussion. DESIGN: Case-control study. SETTING: Multisite clinical setting. PATIENTS OR OTHER PARTICIPANTS: An overlapping sample of 99 participants (age = 19.0 ± 1.1 years) evaluated within 6 hours postconcussion, 176 participants (age = 18.9 ± 1.1 years) evaluated at 24 to 48 hours postconcussion, and 214 participants (age = 18.9 ± 1.1 years) evaluated once they were cleared to begin a return-to-play progression were included. Participants with concussion were compared with 942 control participants (age = 19.0 ± 1.0 years) who did not sustain a concussion during the study period but completed preseason baseline testing at 2 points separated by 1 year (years 1 and 2). MAIN OUTCOME MEASURE(S): At each time point, follow-up RTclin (ie, postconcussion or year 2) was compared with the individual year 1 preseason baseline RTclin and normative baseline data (ie, sex and sport specific). Receiver operating characteristic curves were calculated to compare the sensitivity and specificity of RTclin change from baseline and norm-based cutoff scores. RESULTS: Clinical reaction time performance declined within 6 hours (18 milliseconds, 9.2% slower than baseline). The decline persisted at 24 to 48 hours (15 milliseconds, 7.6% slower than baseline), but performance recovered by the time of return-to-play initiation. Within 6 hours, a change from baseline of 16 milliseconds maximized combined sensitivity (52%) and specificity (79%, area under the curve [AUC] = 0.702), whereas a norm-based cutoff score of 19 milliseconds maximized combined sensitivity (46%) and specificity (86%, AUC = 0.700). At 24 to 48 hours, a change from baseline of 2 milliseconds maximized combined sensitivity (64%) and specificity (61%, AUC = 0.666), whereas a norm-based cutoff score of 0 milliseconds maximized combined sensitivity (63%) and specificity (62%, AUC = 0.647). CONCLUSIONS: Norm-based cutoff scores can be used for interpreting RTclin scores postconcussion in collegiate athletes when individual baseline data are not available, although low sensitivity and specificity limit the use of RTclin as a stand-alone test.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Tempo de Reação , Adolescente , Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Volta ao Esporte , Adulto Jovem
4.
Int J Exerc Sci ; 14(1): 149-161, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34055136

RESUMO

Cognitive training (CT) is an effective technique to improve neurological performance, but has not been investigated as a head impact primary prevention strategy. The purpose of this study was to investigate the CT's effectiveness in reducing head impact kinematics in youth ice hockey players. Twenty youth were divided into two groups: a CT and Control group. The CT group performed two 30-minute sessions of IntelliGym CT weekly for 20 weeks and the control group performed two 30-minute sessions weekly evaluating hockey videos. The dependent variables, number of head impacts, cumulative linear acceleration (CLA) and rotational acceleration (CRA) and mean linear and rotation peak acceleration, were compared with repeated measures ANOVAs, with post-hoc for main effect of time for each group, between the first and second half of the season. There were significant interactions for number of head impacts (p = 0.014) and CLA (p = 0.043) and post-hoc testing identified reductions in the second half of the season for the CT, but not control, group. There were no interactions for CRA, mean peak linear acceleration, and mean peak rotational acceleration. These preliminary results suggest CT may be an effective primary prevention strategy to reduce head impacts and cumulative linear acceleration in youth ice hockey players.

5.
Sports Med ; 51(10): 2209-2220, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33881749

RESUMO

OBJECTIVE: To examine how concussion may impair sensory processing for control of upright stance. METHODS: Participants were recruited from a single university into 3 groups: 13 participants (8 women, 21 ± 3 years) between 2 weeks and 6 months post-injury who initiated a return-to-play progression (under physician management) by the time of testing (recent concussion group), 12 participants (7 women, 21 ± 1 years) with a history of concussion (concussion history group, > 1 year post-injury), and 26 participants (8 women, 22 ± 3 years) with no concussion history (control group). We assessed sensory reweighting by simultaneously perturbing participants' visual, vestibular, and proprioceptive systems and computed center of mass gain relative to each modality. The visual stimulus was a sinusoidal translation of the visual scene at 0.2 Hz, the vestibular stimulus was ± 1 mA binaural monopolar galvanic vestibular stimulation (GVS) at 0.36 Hz, the proprioceptive stimulus was Achilles' tendon vibration at 0.28 Hz. RESULTS: The recent concussion (95% confidence interval 0.078-0.115, p = 0.001) and the concussion history (95% confidence interval 0.056-0.094, p = 0.038) groups had higher gains to the vestibular stimulus than the control group (95% confidence interval 0.040-0.066). The recent concussion (95% confidence interval 0.795-1.159, p = 0.002) and the concussion history (95% confidence interval 0.633-1.012, p = 0.018) groups had higher gains to the visual stimulus than the control group (95% confidence interval 0.494-0.752). There were no group differences in gains to the proprioceptive stimulus or in sensory reweighting. CONCLUSION: Following concussion, participants responded more strongly to visual and vestibular stimuli during upright stance, suggesting they may have abnormal dependence on visual and vestibular feedback. These findings may indicate an area for targeted rehabilitation interventions.


Assuntos
Equilíbrio Postural , Universidades , Estudos Transversais , Feminino , Humanos , Postura , Estudantes
6.
Med Sci Sports Exerc ; 53(9): 1895-1902, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33731652

RESUMO

PURPOSE: This study aimed to determine the relationship between age of first exposure (AFE) to repetitive head impacts through contact/collision sports and patient-reported outcomes in community rugby players. METHODS: We recruited community rugby players older than 18 yr with at least 1 yr of contact rugby participation to complete an online survey. Participants completed the Brief Symptom Inventory-18 (BSI-18), Short-Form Health Survey 12 (SF-12), and Satisfaction with Life Scale (SWLS) via Qualtrics. We used generalized linear models to examine the association between AFE (continuous) and patient-reported outcomes by sex, while controlling for cumulative years contact/collision sport history, age, and concussion history (yes/no). In addition, we used Mann-Whitney U tests to compare patient-reported outcomes between AFE <12 and AFE ≥12. RESULTS: A total of 1037 rugby players (31.6 ± 11.3 yr (range, 18-74 yr), 59.1% men) participated in this study. Whether analyzed continuously or dichotomously at age 12 yr, younger AFE was not associated with worse patient-reported outcomes for either men or women. Positive concussion history was a significant predictor of worse BSI-18 subscores, SF-12 subscores, and SWLS in women and worse BSI-18 subscores in men. Cumulative contact/collision sport history was a significant predictor of better BSI-18 Depression and SF-12 (Mental Component Summary) subscores in men only. In men and women, older age was a significant predictor of better BSI-18 Depression, Anxiety, and GSI subscores; better SWLS (in men only); and better SF-12 Mental Component Summary, but worse SF-12 (Physical Component Summary). CONCLUSIONS: Younger AFE to contact/collision sport is not associated with worse patient-reported outcomes in early adult rugby players. Concussion history was predictive of worse patient-reported outcomes.


Assuntos
Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/psicologia , Concussão Encefálica/fisiopatologia , Concussão Encefálica/psicologia , Futebol Americano/lesões , Futebol Americano/psicologia , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Adulto Jovem
7.
J Sport Health Sci ; 10(2): 162-171, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33453430

RESUMO

OBJECTIVE: Since concussion is the most common injury in ice hockey, the objective of the current study was to elucidate risk factors, specific mechanisms, and clinical presentations of concussion in men's and women's ice hockey. METHODS: Ice hockey players from 5 institutions participating in the Concussion Assessment, Research, and Education Consortium were eligible for the current study. Participants who sustained a concussion outside of this sport were excluded. There were 332 (250 males, 82 females) athletes who participated in ice hockey, and 47 (36 males, 11 females) who sustained a concussion. RESULTS: Previous concussion (odds ratio (OR) = 2.00; 95% confidence interval (95% CI): 1.02‒3.91) was associated with increased incident concussion odds, while wearing a mouthguard was protective against incident concussion (OR = 0.43; 95%CI: 0.22‒0.85). Overall, concussion mechanisms did not significantly differ between sexes. There were specific differences in how concussions presented clinically across male and female ice hockey players, however. Females (9.09%) were less likely than males (41.67%) to have a delayed symptom onset (p = 0.045). Additionally, females took significantly longer to reach asymptomatic (p = 0.015) and return-to-play clearance (p = 0.005). Within the first 2 weeks post-concussion, 86.11% of males reached asymptomatic, while only 45.50% of females reached the same phase of recovery. Most males (91.67%) were cleared for return to play within 3 weeks of their concussion, compared to less than half (45.50%) of females. CONCLUSION: The current study proposes possible risk factors, mechanisms, and clinical profiles to be validated in future concussions studies with larger female sample sizes. Understanding specific risk factors, concussion mechanisms, and clinical profiles of concussion in collegiate ice hockey may generate ideas for future concussion prevention or intervention studies.


Assuntos
Concussão Encefálica/etiologia , Hóquei/lesões , Doenças Assintomáticas , Concussão Encefálica/epidemiologia , Intervalos de Confiança , Feminino , Hóquei/estatística & dados numéricos , Humanos , Masculino , Protetores Bucais , Razão de Chances , Estudos Prospectivos , Volta ao Esporte/estatística & dados numéricos , Fatores de Risco , Assunção de Riscos , Fatores Sexuais , Estudantes , Universidades , Adulto Jovem
9.
Sports Med ; 51(5): 1087-1105, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33428120

RESUMO

BACKGROUND: Symptom resolution is a key marker in determining fitness for return to activity following concussion, but in some cases, distinguishing persistent symptoms due to concussion versus symptoms related to other factors can be challenging. OBJECTIVE: To determine base rates of postconcussional syndrome (PCS) diagnostic categorization in healthy cadets and student athletes with no recent concussion. METHODS: 13,009 cadets and 21,006 student athletes completed baseline preseason testing. After inclusion/exclusion criteria were applied, the final sample included 12,039 cadets [9123 men (75.8%); 2916 women (24.2%)] and 18,548 student athletes [10,192 men (54.9%); 8356 women (45.1%)]. Participants completed the Sport Concussion Assessment Tool-3rd Edition (SCAT3) symptom evaluation as part of baseline preseason testing. The PCS diagnostic categorization was classified by the International Classification of Diseases, 10th Revision (ICD-10) symptom criteria for PCS. RESULTS: In the absence of recent concussion, subgroups of cadets (17.8% of men; 27.6% of women) and student athletes (11.4% of men; 20.0% of women) reported a cluster of symptoms that would meet the ICD-10 symptom criteria for PCS. Participants with insufficient sleep and/or preexisting conditions (e.g., mental health problems), freshmen cadets, and cadets at the U.S. Coast Guard Academy and at the U.S. Air Force Academy (freshmen were tested during basic cadet training) were more likely to report a cluster of symptoms that would meet the ICD-10 symptom criteria for PCS. CONCLUSION: The ICD-10 symptom criteria for PCS can be mimicked by preexisting conditions, insufficient sleep, and/or stress. Findings support person-specific assessment and management of symptoms following concussion.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Síndrome Pós-Concussão , Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Feminino , Humanos , Masculino , Estudantes
10.
J Sci Med Sport ; 24(3): 247-257, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32948449

RESUMO

OBJECTIVES: The purpose of our study was to investigate the association between repetitive head impact (RHI) exposure and postural control. DESIGN: Systematic review. METHODS: PubMed, Embase and PsycInfo were searched using a self-developed search term including the keywords balance OR postural control AND repetitive OR sub-concussive head impacts. Twenty-one studies excluding non-peer reviewed studies, secondary studies, cross-sectional studies, animal studies, and studies investigating concussion were included for further analyses. We rated Level of Evidence and quality using the Centre for Evidence-Based Medicine tool, the Quality Assessment for the Systematic Review of Effectiveness, and the Sub-concussion Specific Tool. RESULTS: All included studies were grouped into Category I and II studies. Category I included trials investigating the effects of controlled soccer heading on postural control (n=8) and Category II studies were cohort studies investigating on-the-field changes between preseason and postseason assessments on postural control measures (n=13). Findings were heterogeneous, with a tendency towards no effects of RHI on clinical postural control measures. Most laboratory studies in Category I used instrumented assessments whereas on-the-field studies in Category II used both instrumented and non-instrumented assessments. CONCLUSIONS: Due to heterogeneous findings, future studies aiming to investigate the effects of RHI on different athlete populations are needed on other participant cohorts. Furthermore, the combination of objective clinical balance measures may be a promising approach to accurately measure how, and to what degree, postural control may be affected by RHI.


Assuntos
Concussão Encefálica/complicações , Equilíbrio Postural , Transtornos das Sensações/etiologia , Futebol/lesões , Adolescente , Atletas , Criança , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos das Sensações/diagnóstico , Fatores Sexuais , Futebol/estatística & dados numéricos , Estudantes , Fatores de Tempo , Adulto Jovem
11.
J Sci Med Sport ; 24(4): 368-372, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33176983

RESUMO

OBJECTIVES: To determine (1) the association between lifetime diagnosed concussion and lower extremity musculoskeletal injury (LE-MSI) among community rugby union players and (2) the sex specific risk of LE-MSI given concussion history among males and females. DESIGN: Retrospective survey. METHODS: 1037 (59.0% male, (612/1037), age: 31.6 ±â€¯11.3 years) rugby players (10.1 ±â€¯8.1 years played) completed an online survey to ascertain injury history. A chi-squared test of association was performed between concussion and LE-MSI; significant outcomes were followed-up with an odds ratio. A binary logistic regression with any LE-MSI (yes/no) as the outcome and concussion (yes/no) and sex (male/female) as predictors was performed to determine if there was a sex by concussion interaction. RESULTS: There was an overall significant association between concussion and any LE-MSI(χ(1) = 13.055, p < 0.001, OR = 2.30 [95%CI: 1.45, 3.65]). Both male (OR = 2.21) and females (OR = 2.49) had significant associations for concussion and LE-MSI, but there were no differences between sex for risk of LE-MSI (R2 = 0.024, p = 0.999). CONCLUSIONS: Community rugby players with a history of concussion are >2× more likely to also experience an LE-MSI than those without a history of concussion. There were no differences in the odds of LE-MSI between males and females with a history of diagnosed concussion. In line with current World Rugby injury prevention programs, future research should aim to reduce LE-MSI incidence to maximize player safety and wellness through targeted injury prevention and teams should utilize a conservative return to play protocols following concussion.


Assuntos
Traumatismos em Atletas/epidemiologia , Concussão Encefálica/diagnóstico , Futebol Americano/lesões , Extremidade Inferior/lesões , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
12.
Brain Imaging Behav ; 15(2): 576-584, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32720179

RESUMO

Sport-related brain injury is very common, and the potential long-term effects include a wide range of neurological and psychiatric symptoms, and potentially neurodegeneration. Around the globe, researchers are conducting neuroimaging studies on primarily homogenous samples of athletes. However, neuroimaging studies are expensive and time consuming, and thus current findings from studies of sport-related brain injury are often limited by small sample sizes. Further, current studies apply a variety of neuroimaging techniques and analysis tools which limit comparability among studies. The ENIGMA Sports Injury working group aims to provide a platform for data sharing and collaborative data analysis thereby leveraging existing data and expertise. By harmonizing data from a large number of studies from around the globe, we will work towards reproducibility of previously published findings and towards addressing important research questions with regard to diagnosis, prognosis, and efficacy of treatment for sport-related brain injury. Moreover, the ENIGMA Sports Injury working group is committed to providing recommendations for future prospective data acquisition to enhance data quality and scientific rigor.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Lesões Encefálicas , Traumatismos em Atletas/diagnóstico por imagem , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/epidemiologia , Concussão Encefálica/etiologia , Humanos , Imageamento por Ressonância Magnética , Reprodutibilidade dos Testes
13.
Clin J Sport Med ; 31(3): 266-272, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30550416

RESUMO

OBJECTIVE: To determine the acute effects of repetitive soccer heading on postural control. DESIGN: Prospective study; participants were divided into 2 groups: a soccer heading group and a control group. SETTING: Biomechanics laboratory. PARTICIPANTS: One hundred sixty participants, including youth (age = 13.0 ± 0.8 years), high school (age = 17.2 ± 1.0 years), and collegiate (age = 20.2 ± 1.3 years) male and female soccer players, participated in this study. INTERVENTIONS: Participants in the soccer heading group performed 12 soccer headers (initial velocity = 11.2 m/s). Postural control testing was performed both before (PRE) and immediately after (POST) the purposeful soccer headers. Control participants performed postural control testing PRE and POST a 15-minute wait period. During postural control testing, participants were asked to stand on the MobileMat (Tekscan Inc, Boston, Massachusetts) for two 2-minute intervals with their hands on their hips and their feet together with one eyes-open and one eyes-closed trial. MAIN OUTCOME MEASURES: Using the center-of-pressure data, 95% area, sway velocity, and ApEn were calculated. Multilevel linear models were used to analyze the effects of age, sex, group, condition, and concussion history simultaneously. RESULTS: Participants in the soccer heading group had significantly higher sway velocity POST than participants in the control group after controlling for age, sex, concussion history, condition, and PRE (t = -3.002; P = 0.003; 95% confidence interval, -0.482 to -0.100). There were no significant differences from PRE to POST for 95% area, M/L ApEn, and A/P ApEn. CONCLUSIONS: Repetitive soccer heading does not affect most postural control measures, even among youth athletes. However, sway velocity increased after heading relative to control participants independent of age, sex, and concussion history.

14.
J Athl Train ; 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33351902

RESUMO

CONTEXT: Pre-season testing is often used to establish baseline scores for post-concussion interpretation. However, pre-season testing can be time-intensive and cost-prohibitive, in which case normative data may be used for post-injury interpretation. OBJECTIVE: To compare change from baseline and normative-based cutoff scores in interpreting clinical reaction time (RTclin) following concussion. DESIGN: Prospective case-control study. SETTING: Multi-site study with testing completed in university athletic training rooms. PATIENTS OR OTHER PARTICIPANTS: An overlapping sample of 99 participants (age=19.0±1.1 years) evaluated within 6 hours post injury, 176 participants (age 18.9±1.1 years) evaluated 24-48 hours post injury, and 214 participants (18.9±1.1 years) evaluated at the time they were cleared to begin a return-to-play progression. Concussion participants were compared to 942 control participants (age=19.0±1.0 years) who did not sustain a concussion during the study period but completed preseason baseline testing one year apart. MAIN OUTCOME MEASURES: At each time point, follow-up RTclin (i.e., post injury or year 2) was compared to individualized year 1 preseason baseline RTclin and to normative baseline data (i.e., sex- and sport-specific). Receiver operating characteristic curves were used to compare sensitivity and specificity of RTclin change from baseline and normative-based cutoff scores. RESULTS: Within 6h, change from baseline of 16ms maximized combined sensitivity (52%) and specificity (78%, AUC=0.702), while normative-based cutoff scores of 19ms maximized combined sensitivity (45%) and specificity (86%, AUC=0.700). At 24-48h, change from baseline of 2ms maximized combined sensitivity (64%) and specificity (61%, AUC=0.666), while normative-based cutoff scores of 0ms maximized combined sensitivity (63%) and specificity (62%, AUC=0.647). CONCLUSIONS: Normative-based cutoff scores can be used for interpreting RTclin scores following concussion when individualized baseline data is not available, although low sensitivity and specificity may limit clinical use as a stand-alone test.

15.
Med Sci Sports Exerc ; 52(11): 2279-2285, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33064402

RESUMO

PURPOSE: The purpose was to examine gait characteristics between collegiate athletes who did and did not sustain a lower-extremity musculoskeletal (LEMSK) injury in the year after concussion. METHODS: Thirty-four NCAA collegiate athletes with diagnosed concussions were divided into two groups based on if they did (n = 16) or did not (n = 18) sustain a LEMSK in the year after concussion. Participants completed baseline testing before the start of the season and again at return to play postconcussion. Injuries were tracked using an electronic medical database. Participants were instrumented with three APDM Opal triaxial accelerometers and performed five single-task (ST) and five dual-task (DT) gait trials. Participants traversed a 10-meter walkway, turned around a specified endpoint, and returned to the original line. During DT, participants simultaneously walked and answered mini-mental style questions. A linear mixed-effects model assessed interactions and/or main effects between groups for gait speed, double support time, cadence, stride length, and cognitive accuracy. RESULTS: The LEMSK group walked slower (ST, 1.15 ± 0.10 m·s; DT, 1.01 ± 0.10 m·s) than the uninjured group (ST, 1.23 ± 0.11 m·s; DT, 1.10 ± 0.11 m·s) during both ST (P = 0.04) and DT (P = 0.03). The injury group spent longer in double support (ST, 20.19% ± 2.34%; DT, 21.92% ± 2.13%) than the uninjured group (ST, 18.16% ± 2.60%; DT, 20.00% ± 2.32%) during both ST (P = 0.02) and DT (P = 0.02). The injury group had a significantly lower cognitive accuracy (89.56% ± 6.48%) than the uninjured group (95.40% ± 7.08%) across time points (P = 0.02). CONCLUSIONS: There were significant differences in gait characteristics and cognitive accuracy between those who did and did not sustain a LEMSK injury after concussion. The LEMSK group demonstrated a conservative gait strategy both before and after their concussive injury.


Assuntos
Traumatismos em Atletas/etiologia , Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/complicações , Marcha/fisiologia , Extremidade Inferior/lesões , Adolescente , Adulto , Feminino , Humanos , Masculino , Análise e Desempenho de Tarefas , Adulto Jovem
16.
Neurology ; 95(21): e2935-e2944, 2020 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-32907967

RESUMO

OBJECTIVE: To examine the association between estimated age at first exposure (eAFE) to American football and clinical measures throughout recovery following concussion. METHODS: Participants were recruited across 30 colleges and universities as part of the National Collegiate Athletic Association (NCAA)-Department of Defense Concussion Assessment, Research and Education Consortium. There were 294 NCAA American football players (age 19 ± 1 years) evaluated 24-48 hours following concussion with valid baseline data and 327 (age 19 ± 1 years) evaluated at the time they were asymptomatic with valid baseline data. Participants sustained a medically diagnosed concussion between baseline testing and postconcussion assessments. Outcome measures included the number of days until asymptomatic, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) composite scores, Balance Error Scoring System (BESS) total score, and Brief Symptom Inventory 18 (BSI-18) subscores. The eAFE was defined as participant's age at the time of assessment minus self-reported number of years playing football. RESULTS: In unadjusted regression models, younger eAFE was associated with lower (worse) ImPACT Visual Motor Speed (R 2 = 0.031, p = 0.012) at 24-48 hours following injury and lower (better) BSI-18 Somatization subscores (R 2 = 0.014, p = 0.038) when the athletes were asymptomatic. The effect sizes were very small. The eAFE was not associated with the number of days until asymptomatic, other ImPACT composite scores, BESS total score, or other BSI-18 subscores. CONCLUSION: Earlier eAFE to American football was not associated with longer symptom recovery, worse balance, worse cognitive performance, or greater psychological distress following concussion. In these NCAA football players, longer duration of exposure to football during childhood and adolescence appears to be unrelated to clinical recovery following concussion.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Futebol Americano/lesões , Adolescente , Adulto , Distribuição por Idade , Atletas , Traumatismos em Atletas/complicações , Concussão Encefálica/diagnóstico , Humanos , Masculino , Testes Neuropsicológicos , Estudantes , Estados Unidos , Universidades , Adulto Jovem
17.
Clin J Sport Med ; 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32852299

RESUMO

OBJECTIVE: To determine the length of time after concussion that impaired tandem gait performance is observed. DESIGN: Clinical measurement, prospective longitudinal. SETTING: NCAA collegiate athletic facility. PARTICIPANTS: Eighty-eight concussed NCAA Division I student-athletes and 30 healthy controls. INDEPENDENT VARIABLES: Group (concussion/control) and time (Baseline, Acute, Asymptomatic, and RTP). MAIN OUTCOME MEASURES: Participants completed 4 single-task and dual-task tandem gait trials. The concussion group completed tests at the following time points: preseason (Baseline), within 48 hours after concussion (Acute), on the day symptoms were no longer reported (Asymptomatic), and when cleared to return to sports (RTP). Controls completed the same protocol at similar intervals. The dual-task trials involved minimental style cognitive questions answered simultaneously during tandem gait. We analyzed the best time of the 4 trials, comparing groups with a linear mixed model. RESULTS: Acutely after concussion, the concussion group performed single-task tandem gait slower (worse) than controls (concussion: 11.36 ± 2.43 seconds, controls: 9.07 ± 1.78 seconds, P < 0.001). The concussion group remained significantly slower than controls (9.95 ± 2.21 vs 8.89 ± 1.65 seconds, P = 0.03) at Asymptomatic day but not RTP. There were significant group (P < 0.001) and time (P < 0.001) effects for dual-task tandem gait. The groups were not significantly different at baseline for single-task (P = 0.95) or dual-task (P = 0.22) tandem gait. CONCLUSIONS: Our results indicate that tandem gait performance is significantly impaired acutely after concussion, compared with both preseason measures and controls. Postural control impairments were not present when the student-athletes were cleared for RTP. This information can assist clinicians when assessing postural control and determining recovery after a concussive injury.

18.
J Clin Transl Res ; 5(4): 178-185, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32637719

RESUMO

Background: Emerging evidence suggests neurophysiological deficits, such as visual motor coordination (VMC), may persist beyond clinical concussion recovery. Instrumented measurement of upper-limb VMC is critical for neurological evaluation post-concussion and may identify persistent deficits further elucidating persistent neurophysiological impairments not detected by the current clinical assessment battery. Aim: The aim of the study was to determine if a VMC test identifies persistent deficits in concussed collegiate student-athletes who have returned to baseline on clinical concussion assessments. Methods: Thirteen recently concussed intercollegiate student-athletes (male: 7, 18.9±0.7 years, 175.5±12.4 cm, 75.5±23.2 kg), and 13 matched control student-athletes (male: 7, 19.3±1.1 years, 173.5±11.9 cm, 75.8±19.9 kg) completed two testing sessions (T1: <48 h after clinical recovery; T2: 30 days post-concussion) on a visual motor exam. The outcome measures were A* Average score (average number of lights hit on A* exam), simple visual reaction time (SVRT)-RT, and movement time (SVRT-MT) on the Dynavision D2. The dependent variables were compared with a 2 (group) × 2 (time) repeated measures ANOVAs. Results: There was no group interaction in A* average score (F(1,24)=0.036, P=0.849), SVRT-RT (F(1,22)=0.319, P=0.575), and SVRT-MT (F(1,22)=1.179, P=0.188). There was a main effect for time on A* average score (T1: 76.3±10.4 hits; T2: 82.7±11.2 hits; F(1,24)=38.1, P≤0.001) and SVRT-RT (T1: 0.31±0.04; T2: 0.29±0.04 s; F(1,22)=4.9, P=0.039). There was no main effect for SVRT-MT. There were no group differences at either time point. Conclusions: Among recently concussed collegiate student-athletes, no persistent deficits were identified in VMC beyond clinical recovery when assessed by Dynavision D2. This VMC exam may not provide a useful means of tracking recovery following concussion likely due to a substantial practice effect. Relevance for patients: While post-concussion neurophysiological deficits persist beyond clinical recovery, the laboratory based VMC assessment herein did not identify deficits at critical post-concussion time points. Therefore, other clinically translatable VMC assessments should be further investigated.

19.
J Clin Transl Res ; 5(4): 148-154, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32671279

RESUMO

The use of virtual reality (VR) technology continues to grow in the areas of clinical assessment and rehabilitation. Both researchers and health-care providers are exploring ways to incorporate VR in clinical practice as an emerging technology. VR postural control and neuropsychological testing represent a promising next step in sport-related concussion (SRC) management. This article reviews the current literature on VR applications for SRC assessment. Relevance for Patients: VR-based postural control assessments suggest that visual motion is destabilizing following SRC, perhaps indicating persistent perceptual-motion disintegration when clinical postural control tests suggest complete recovery. VR can also provide functional neuropsychological assessments using real-life scenarios or virtual environments, which may be more sensitive than traditional pencil-and-paper or computerized neuropsychological assessments.

20.
Arch Phys Med Rehabil ; 101(8): 1347-1354, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32343972

RESUMO

OBJECTIVE: To identify the effect of acute and multiple concussions on gait initiation performance. DESIGN: Cohort study. SETTING: University research center. PARTICIPANTS: A population-based sample of participants (N=45) divided into 3 groups: No Prior Concussion, ≥3 Prior Concussions, and Acute Concussion. The Acute Concussion participants were assessed within 24 hours of their concussion. Participants were matched based on (1) sport, (2) position, and (3) anthropometric measures. INTERVENTIONS: Participants were tested on a single occasion and performed 5 trials of gait initiation on 4 force plates. The No Prior Concussion and ≥3 Prior Concussions groups were tested out of their primary athletic season. MAIN OUTCOME MEASURES: The dependent variables were the posterior and lateral displacement and velocity of the center of pressure (COP) during the anticipatory postural adjustment phase and initial step kinematics (step length and step velocity). Comparisons between groups used a 1-way analysis of variance with Tukey post hoc when significant effects were identified and effect sizes were calculated. RESULTS: There were significant effects for group for all 6 outcome measures with large effect sizes. Post hoc tests identified differences between Acute Concussion and No Prior Concussion groups for all measures. The ≥3 Prior Concussions group and No Prior Concussion group were different for COP posterior displacement (4.91±1.09 and 4.91±1.09cm, respectively, P=.032, d=0.91) and velocity (0.18±0.06 and 0.27±0.08m/s, respectively, P=.002, d=1.27). CONCLUSION: There was continuum of performance identified whereby the Acute Concussion participants performed worse and the No Prior Concussion participants performed the best. The ≥3 Prior Concussions generally fell between these 2 groups, but only statistical significance on COP posterior displacement and velocity. These results suggest there may be subtle neurophysiological deficits present in collegiate student-athletes with ≥3 Prior Concussions group, and further investigation over the lifespan is warranted.


Assuntos
Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Marcha , Equilíbrio Postural , Doença Aguda , Adolescente , Fenômenos Biomecânicos , Estudos de Coortes , Feminino , Humanos , Masculino , Recidiva , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...