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BACKGROUND: While changes in brain metabolites after injury have been reported, relationships between metabolite changes and head impacts are less characterized. PURPOSE: To investigate alterations in neurochemistry in high school athletes as a function of head impacts, concussion, and the use of a jugular vein compression (JVC) collar. STUDY TYPE: Prospective controlled trial. SUBJECTS: A total of 284 male American football players, divided into JVC collar and noncollar groups; 215 included in final analysis (age = 15.9 ± 1.0 years; 114 in collar group). FIELD STRENGTH/SEQUENCE: 3 Tesla/T1-weighted gradient echo, 1H point resolved spectroscopy, acquired between August and November 2018. ASSESSMENT: Head impacts were quantified using accelerometers. Concussion was diagnosed by medical professionals for each team. Pre- to postseason differences in total N-acetylaspartate (tNAA), total choline (tCho), myo-inositol (myoI), and glutamate + glutamine (Glx), in primary motor cortex (M1) and anterior cingulate cortex (ACC), relative to total creatine (tCr), were determined. STATISTICAL TESTS: Group-wise comparisons were performed using Wilcoxon signed-rank, Friedman's, and Mann-Whitney U tests. Relationships between ∆metabolite/tCr and mean g-force were analyzed using linear regressions accounting for concussion and JVC collar. Significance was set at P ≤ 0.05. RESULTS: In participants without concussion, a significant decrease in tCho/tCr (0.233 ± 1.40 × 10-3 to 0.227 ± 1.47 × 10-7) and increase in Glx/tCr (1.60 ± 8.75 × 10-3 to 1.63 ± 1.08 × 10-2) in ACC were observed pre- to postseason. The relationship between ∆tCho/tCr in M1 and ACC and mean g-force from >80 g to >140 g differed significantly between participants with and without concussion (M1 ß ranged from 3.9 × 10-3 to 2.1 × 10-3; ACC ß ranged from 2.7 × 10-3 to 2.1 × 10-3). Posthoc analyses revealed increased tCho/tCr in M1 was positively associated with mean g-force >100 g (ß = 3.6 × 10-3) and >110 g (ß = 2.9 × 10-3) in participants with concussion. Significant associations between ∆ myoI / tCr $$ \Delta \mathrm{myoI}/\mathrm{tCr} $$ in ACC and mean g-force >110 g (ß = -1.1 × 10-3) and >120 g (ß = -1.1 × 10-3) were observed in the collar group only. DATA CONCLUSION: Diagnosed concussion and the use of a JVC collar result in distinct neurochemical trends after repeated head impacts. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 3.
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CONTEXT: There is a well-established increased risk of lower-extremity (LE) musculoskeletal (MSK) injury following a sport-related concussion (SRC). Neuromuscular training programs improve biomechanics associated with LE MSK injury and reduce LE MSK injury incidence, but their relative effectiveness in athletes with history of SRC is unknown. The purpose of this study was to evaluate LE MSK injury incidence in female adolescent athletes with history of SRC following a neuromuscular training intervention. DESIGN: Prospective case-control. METHODS: Seventy-seven adolescent female athletes aged 12-18 years who participated in soccer, volleyball, or basketball were recruited from a single institutional sports medicine research and performance center to complete a 6-week neuromuscular training program prior to competitive athletic season. Group (Control, History of SRC) comparisons of athlete exposure and relative LE MSK injury risk and rates during the competitive athletic season were assessed. RESULTS: Ten injuries were recorded by 9 athletes. Female athletes who reported history of SRC had increased injury risk (Risk Ratio 3.9, 95% CI, 1.1-13.8, P = .01) and increased injury rate (rate ratio 4.1, 95% CI, 1.1-15.8, P = .03) compared with female athletes without history of SRC. CONCLUSIONS: Female adolescent athletes with history of SRC showed a greater risk of LE MSK injury compared with athletes with no history of SRC. Future work is still needed to understand the underlying mechanisms associated with future LE MSK injury following SRC and interventions that ameliorate elevated injury risk.
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Traumatismos em Atletas , Concussão Encefálica , Extremidade Inferior , Humanos , Feminino , Adolescente , Concussão Encefálica/prevenção & controle , Traumatismos em Atletas/prevenção & controle , Traumatismos em Atletas/epidemiologia , Estudos Prospectivos , Estudos de Casos e Controles , Extremidade Inferior/lesões , Criança , Futebol/lesões , Atletas , Basquetebol/lesões , Voleibol/lesões , Fatores de Risco , IncidênciaRESUMO
OBJECTIVE: Strategies to identify lower extremity musculoskeletal (LEMSK) injury risk have been informed by prospectively identified biomechanical and neuromuscular risk factors. Emergent evidence suggests that cognitive and oculomotor performance may also contribute to LEMSK injury. The purpose of this study was to determine whether prospective cognitive and oculomotor measures identify adolescent athletes who sustain an in-season LEMSK injury. DESIGN: Prospective longitudinal study. SETTINGS: Controlled laboratory and athletic event settings. PARTICIPANTS: Four hundred eighty-eight adolescent male football and female soccer athletes aged 13 to 18 years. ASSESSMENT OF RISK FACTORS: Preseason baseline cognitive and oculomotor performance: Attention Network Task (ANT), cued task switching, King-Devick test, and near point of convergence. MAIN OUTCOME MEASURE: Incidence of LEMSK sprains and strains during a single competitive season. RESULTS: Attention Network Task-orienting network reaction time (RT) was the only cognitive or oculomotor measure significantly associated with LEMSK injury [B = 1.015, 95% confidence interval (CI): 1.01-1.024, P < 0.01]. Every 10 milliseconds increase in orienting network RT was associated with a 15% increased risk for LEMSK injury. Athletes demonstrating an orienting network RT ≥ 32.8 milliseconds had a higher risk for LEMSK injury relative to athletes below the cut-point (relative risk, 2.62; 95% CI, 1.52-4.52; odds ratio, 3.00; 95% CI, 1.63-5.52). CONCLUSIONS: Deficits in visual-spatial components of attention were associated with 2.62 times greater risk for LEMSK injury in adolescent athletes. The present results add evidence to suggest that visual-spatial attentional processing contributes to LEMSK injury and may supplement previously established LEMSK injury risk assessments.
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Traumatismos em Atletas , Traumatismos da Perna , Adolescente , Masculino , Feminino , Humanos , Traumatismos em Atletas/epidemiologia , Estudos Prospectivos , Estudos Longitudinais , Atletas , Extremidade Inferior/lesõesRESUMO
CONTEXT: The etiology of patellofemoral pain has remained elusive, potentially due to an incomplete understanding of how pain, motor control, and kinesiophobia disrupt central nervous system functioning. OBJECTIVE: To directly evaluate brain activity during experimental knee pain and its relationship to kinesiophobia in patients with patellofemoral pain. DESIGN: Cross-sectional. METHODS: Young females clinically diagnosed with patellofemoral pain (n = 14; 14.4 [3.3] y; body mass index = 22.4 [3.8]; height = 1.61 [0.1] m; body mass = 58.4 [12.7] kg). A modified Clarke test (experimental pain condition with noxious induction via patella pressure and quadriceps contraction) was administered to the nondominant knee (to minimize limb dominance confounds) of patients during brain functional magnetic resonance imaging (fMRI) acquisition. Patients also completed a quadriceps contraction without application of external pressure (control contraction). Kinesiophobia was measured using the Tampa Scale of Kinesiophobia. The fMRI analyses assessed brain activation during the modified Clarke test and control contraction and assessed relationships between task-induced brain activity and kinesiophobia. Standard processing for neuroimaging and appropriate cluster-wise statistical thresholds to determine significance were applied to the fMRI data (z > 3.1, P < .05). RESULTS: The fMRI revealed widespread neural activation in the frontal, parietal, and occipital lobes, and cerebellum during the modified Clarke test (all zs > 4.4, all Ps < .04), whereas neural activation was localized primarily to frontal and cerebellar regions during the control contraction test (all zs > 4.4, all Ps < .01). Greater kinesiophobia was positively associated with greater activity in the cerebello-frontal network for the modified Clarke test (all zs > 5.0, all Ps < .01), but no relationships between kinesiophobia and brain activity were observed for the control contraction test (all zs < 3.1, all Ps > .05). CONCLUSIONS: Our novel experimental knee pain condition was associated with alterations in central nociceptive processing. These findings may provide novel complementary pathways for targeted restoration of patient function.
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Síndrome da Dor Patelofemoral , Encéfalo/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Imageamento por Ressonância Magnética , Dor , Síndrome da Dor Patelofemoral/diagnóstico por imagemRESUMO
The purpose of this clinical trial was to examine whether internal jugular vein compression (JVC)-using an externally worn neck collar-modulated the relationships between differential head impact exposure levels and pre- to postseason changes in diffusion tensor imaging (DTI)-derived diffusivity and anisotropy metrics of white matter following a season of American tackle football. Male high-school athletes (n = 284) were prospectively assigned to a non-collar group or a collar group. Magnetic resonance imaging data were collected from participants pre- and postseason and head impact exposure was monitored by accelerometers during every practice and game throughout the competitive season. Athletes' accumulated head impact exposure was systematically thresholded based on the frequency of impacts of progressively higher magnitudes (10 g intervals between 20 to 150 g) and modeled with pre- to postseason changes in DTI measures of white matter as a function of JVC neck collar wear. The findings revealed that the JVC neck collar modulated the relationships between greater high-magnitude head impact exposure (110 to 140 g) and longitudinal changes to white matter, with each group showing associations that varied in directionality. Results also revealed that the JVC neck collar group partially preserved longitudinal changes in DTI metrics. Collectively, these data indicate that a JVC neck collar can provide a mechanistic response to the diffusion and anisotropic properties of brain white matter following the highly diverse exposure to repetitive head impacts in American tackle football. Clinicaltrials.gov: NCT# 04068883.
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Lesões Encefálicas Traumáticas/prevenção & controle , Bandagens Compressivas , Futebol Americano/lesões , Traumatismos Cranianos Fechados/complicações , Veias Jugulares , Equipamentos de Proteção , Substância Branca/lesões , Esportes Juvenis/lesões , Acelerometria , Adolescente , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/etiologia , Imagem de Tensor de Difusão , Desenho de Equipamento , Traumatismos Cranianos Fechados/epidemiologia , Humanos , Veias Jugulares/fisiopatologia , Masculino , Modelos Neurológicos , Cooperação do Paciente , Estudos Prospectivos , Recidiva , Estados Unidos , Substância Branca/diagnóstico por imagem , Substância Branca/patologiaRESUMO
OBJECTIVE: To evaluate recovery trajectories among youth athletes with a concussion and healthy controls across different domains using a quantitative and multifaceted protocol. STUDY DESIGN: Prospective repeated measures. PARTICIPANTS: Youth athletes diagnosed with a concussion between the ages of 8 and 18 years were evaluated (1) within 10 days after injury, (2) approximately 3 weeks after injury, and (3) after return-to-play clearance. Control participants completed the same protocol. SETTING: Sport concussion clinic. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Participants underwent a multifaceted protocol that assessed symptoms (postconcussion symptom scale [PCSS]), dual-task gait, event-related potentials (ERPs), and eye tracking. RESULTS: Sixty-seven athletes participated: 36 after concussion (age = 14.0 ± 2.6 years; 44% female) and 31 controls (age = 14.6 ± 2.2 years; 39% female). Concussion symptoms were higher for the concussion group compared with controls at the first (PCSS = 31.7 ± 18.8 vs 1.9 ± 2.9; P < 0.001) and second time points (PCSS = 10.8 ± 11.2 vs 1.8 ± 3.6; P = 0.001) but resolved by the final assessment (PCSS = 1.7 ± 3.6 vs 2.0 ± 3.8; P = 0.46). The concussion group walked slower during dual-task gait than controls at all 3 tests including after return-to-play clearance (0.83 ± 0.19 vs 0.95 ± 0.15 m/s; P = 0.049). There were no between-group differences for ERP connectivity or eye tracking. Those with concussions had a decrease in ERP connectivity recovery over the 3 time points, whereas control participants' scores increased (concussion Δ = -8.7 ± 28.0; control Δ = 13.9 ± 32.2; χ2 = 14.1, P = 0.001). CONCLUSIONS: Concussion is associated with altered dual-task gait speeds after resolution of concussion symptoms, but ERP and eye tracking measures did not demonstrate between-group differences across time. Some objective approaches to concussion monitoring may support with identifying deficits after concussion, but further work is required to delineate the role of gait, electrophysiological, and eye tracking methods for clinical decision-making.
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Concussão Encefálica/diagnóstico , Síndrome Pós-Concussão/diagnóstico , Esportes Juvenis/lesões , Adolescente , Concussão Encefálica/fisiopatologia , Criança , Eletroencefalografia , Potenciais Evocados , Movimentos Oculares , Feminino , Análise da Marcha , Humanos , Masculino , Síndrome Pós-Concussão/fisiopatologia , Prognóstico , Estudos Prospectivos , Volta ao Esporte , Fatores de TempoRESUMO
STUDY DESIGN: Prospective longitudinal cohort study. BACKGROUND: Adolescent athletes may be more susceptible to the long-term effects of mild traumatic brain injury (mTBI). A diagnostic and prognostic neuromarker may optimize management and return-to-activity decision-making in athletes who experience mTBI. OBJECTIVE: Measure an event-related potential (ERP) component captured with electroencephalography (EEG), called processing negativity (PN), at baseline and post-injury in adolescents who suffered mTBI and determine their longitudinal response relative to healthy controls. METHODS: Thirty adolescents had EEG recorded during an auditory oddball task at a pre-mTBI baseline session and subsequent post-mTBI sessions. Longitudinal EEG data from patients and healthy controls (n= 77) were obtained from up to four sessions in total and processed using Brain Network Analysis algorithms. RESULTS: The average PN amplitude in healthy controls significantly decreased over sessions 2 and 3; however, it remained steady in the mTBI group's 2nd (post-mTBI) session and decreased only in sessions 3 and 4. Pre- to post-mTBI amplitude changes correlated with the time interval between sessions. CONCLUSION: These results demonstrate that PN amplitude changes may be associated with mTBI exposure and subsequent recovery in adolescent athletes. Further study of PN may lead to it becoming a neuromarker for mTBI prognosis and return-to-activity decision-making in adolescents.
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Concussão Encefálica , Adolescente , Eletroencefalografia , Potenciais Evocados , Humanos , Estudos Longitudinais , Estudos ProspectivosRESUMO
PURPOSE: To (1) quantify white matter (WM) alterations in female high school athletes during a soccer season and characterise the potential for normalisation during the off-season rest period, (2) determine the association between WM alterations and exposure to repetitive subconcussive head impacts, and (3) evaluate the efficacy of a jugular vein compression collar to prevent WM alterations associated with head impact exposure. METHODS: Diffusion tensor imaging (DTI) data were prospectively collected from high school female soccer participants (14-18 years) at up to three time points over 9 months. Head impacts were monitored using accelerometers during all practices and games. Participants were assigned to a collar (n=24) or non-collar group (n=22). The Tract-Based Spatial Statistics approach was used in the analysis of within-group longitudinal change and between-group comparisons. RESULTS: DTI analyses revealed significant pre-season to post-season WM changes in the non-collar group in mean diffusivity (2.83%±2.46%), axial diffusivity (2.58%±2.34%) and radial diffusivity (3.52%±2.60%), but there was no significant change in the collar group despite similar head impact exposure. Significant correlation was found between head impact exposure and pre-season to post-season DTI changes in the non-collar group. WM changes in the non-collar group partially resolved at 3 months off-season follow-up. DISCUSSION: Microstructural changes in WM occurred during a season of female high school soccer among athletes who did not wear the collar device. In comparison, there were no changes in players who wore the collar, suggesting a potential prophylactic effect of the collar device in preventing changes associated with repetitive head impacts. In those without collar use, the microstructural changes showed a reversal towards normal over time in the off-season follow-up period.
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Bandagens Compressivas , Traumatismos Craniocerebrais/patologia , Traumatismos Craniocerebrais/prevenção & controle , Veias Jugulares/fisiologia , Futebol/lesões , Substância Branca/patologia , Adolescente , Comportamento Competitivo/fisiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Imagem de Tensor de Difusão , Feminino , Humanos , Estudos Longitudinais , Estudos Prospectivos , Recidiva , Ultrassonografia , Substância Branca/diagnóstico por imagemRESUMO
OBJECTIVE: Youth athletes are believed to be more susceptible to white matter (WM) degradation resulting from head impact exposure relative to high school (HS) athletes; this hypothesis has not been objectively tested. The purpose of this study was to determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season. DESIGN: Prospective cohort. SETTING: One season of YFB (grades 7 and 8) and varsity HS football (grades 10-12). PATIENTS OR OTHER PARTICIPANTS: Twelve YFB (13.08 ± 0.64 years) and 21 HS (17.5 ± 0.78 years) athletes. INTERVENTIONS: Participants completed 2 magnetic resonance imaging sessions: preseason and postseason. Head impact exposure was recorded during practice and games using a helmet-mounted accelerometer. MAIN OUTCOME MEASURES: Tract-based spatial statistics were used to evaluate group differences in preseason to postseason changes in diffusion tensor imaging, including fractional anisotropy and mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). RESULTS: The HS group exhibited significant preseason to postseason reductions in MD, AD, and RD (P < 0.05, corrected) in widespread WM areas. Significant WM reductions for the YFB group were only observed for AD (P < 0.05, corrected), but was more limited in extent compared with HS. CONCLUSIONS: Significant preseason to postseason AD reduction was found in both YFB and HS groups after one season of competitive play. Our results did not confirm recent speculation that younger children are more susceptible to the deleterious effects of repetitive head impacts compared with their older counterparts.
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Comportamento Competitivo/fisiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/patologia , Futebol Americano/lesões , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Adolescente , Fatores Etários , Criança , Imagem de Tensor de Difusão , Humanos , Projetos Piloto , Estudos Prospectivos , Fatores de TempoRESUMO
CONTEXT: Existing anterior cruciate ligament (ACL) injury prevention programs have failed to reverse the high rate of ACL injuries in adolescent female athletes. OBJECTIVE: This investigation attempts to overcome factors that limit efficacy with existing injury prevention programs through the use of a novel, objective, and real-time interactive visual feedback system designed to reduce the biomechanical risk factors associated with ACL injuries. DESIGN: Cross-over study. SETTING: Medical center laboratory. PARTICIPANTS: A total of 20 females (age = 19.7 [1.34] y; height = 1.74 [0.09] m; weight = 72.16 [12.45] kg) participated in this study. METHODS: Participants performed sets of 10 bodyweight squats in each of 8 training blocks (ie, 4 real-time and 4 control blocks) and 3 testing blocks for a total of 110 squats. Feedback conditions were blocked and counterbalanced with half of participants randomly assigned to receive the real-time feedback block first and half receiving the control (sham) feedback first. RESULTS: Heat map analysis revealed that during interaction with the real-time feedback, squat performance measured in terms of key biomechanical parameters was improved compared with performance when participants squatted with the sham stimulus. CONCLUSIONS: This study demonstrates that the interactive feedback system guided participants to significantly improve movement biomechanics during performance of a body weight squat, which is a fundamental exercise for a longer term ACL injury risk reduction intervention. A longer training and testing period is necessary to investigate the efficacy of this feedback approach to effect long-term adaptations in the biomechanical risk profile of athletes.
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Traumatismos em Atletas/prevenção & controle , Técnicas de Exercício e de Movimento/métodos , Retroalimentação Sensorial , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/prevenção & controle , Fenômenos Biomecânicos , Estudos Cross-Over , Feminino , Humanos , Cinética , Fatores de Risco , Adulto JovemRESUMO
The cumulative effects of repetitive subclinical head impacts during sports may result in chronic white matter (WM) changes and possibly, neurodegenerative sequelae. In this pilot study, we investigated the longitudinal WM changes over the course of two consecutive high-school football seasons and explored the long-term effects of a jugular vein compression collar on these WM alterations. Diffusion tensor imaging data were prospectively collected both pre- and postseason in the two consecutive seasons. Participants were assigned into either collar or noncollar groups. Tract-based spatial statistics (TBSS) approach and region of interest-based approach were used to quantify changes in WM diffusion properties. Despite comparable exposure to repetitive head impacts, significant reductions in mean, axial, and/or radial diffusivity were identified in Season 1 in multiple WM regions in the noncollar group but not in the collar group. After an 8- to 9-month long off-season, these changes observed in the noncollar group partially and significantly reversed but also remained significantly different from the baseline. In Season 2, trend level WM alterations in the noncollar group were found but located in spatially different regions than Season 1. Last, the WM integrity in the collar group remained unchanged throughout the four time points. In conclusion, we quantitatively assessed the WM structural changes and partial reversal over the course of two consecutive high-school football seasons. In addition, the mitigated WM alterations in athletes in the collar group might indicate potential effect of the collar in ameliorating the changes against repetitive head impacts. Hum Brain Mapp 39:491-508, 2018. © 2017 Wiley Periodicals, Inc.
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Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/prevenção & controle , Futebol Americano/lesões , Equipamento de Proteção Individual , Substância Branca/diagnóstico por imagem , Adolescente , Atletas , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/prevenção & controle , Imagem de Tensor de Difusão , Seguimentos , Humanos , Veias Jugulares , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Projetos Piloto , Estudos Prospectivos , Estudantes , Resultado do TratamentoRESUMO
Exposure to explosive blasts places one at risk for traumatic brain injury, especially for special weapons and tactics (SWAT) and military personnel, who may be repeatedly exposed to blasts. In the current study, the effectiveness of a jugular vein compression collar to prevent alterations in resting-state electrocortical activity following a single-SWAT breacher training session was investigated. SWAT team personnel were randomly assigned to wear a compression collar during breacher training and resting state electroencephalography (EEG) was measured within 2 days prior to and two after breacher training. It was hypothesized that significant changes in brain dynamics-indicative of possible underlying neurodegenerative processes-would follow blast exposure for those who did not wear the collar, with ameliorated changes for the collar-wearing group. Using recurrence quantification analysis (RQA) it was found that participants who did not wear the collar displayed longer periods of laminar electrocortical behavior (as indexed by RQA's vertical max line measure) after breacher training. It is proposed that the blast wave exposure for the no-collar group may have reduced the number of pathways, via axonal disruption-for electrical transmission-resulting in the EEG signals becoming trapped in laminar states for longer periods of time. Longer laminar states have been associated with other electrocortical pathologies, such as seizure, and may be important for understanding head trauma and recovery.
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Lesões Encefálicas/cirurgia , Traumatismos Craniocerebrais/prevenção & controle , Veias Jugulares/cirurgia , Pressão , Armas , Adulto , Idoso , Encéfalo/patologia , Lesões Encefálicas/prevenção & controle , Lesões Encefálicas Traumáticas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To investigate the association between dual-task gait performance and brain network activation (BNA) using an electroencephalography (EEG)-based Go/No-Go paradigm among children and adolescents with concussion. METHODS: Participants with a concussion completed a visual Go/No-Go task with collection of electroencephalogram brain activity. Data were treated with BNA analysis, which involves an algorithmic approach to EEG-ERP activation quantification. Participants also completed a dual-task gait assessment. The relationship between dual-task gait speed and BNA was assessed using multiple linear regression models. RESULTS: Participants (n = 20, 13.9 ± 2.3 years of age, 50% female) were tested at a mean of 7.0 ± 2.5 days post-concussion and were symptomatic at the time of testing (post-concussion symptom scale = 40.4 ± 21.9). Slower dual-task average gait speed (mean = 82.2 ± 21.0 cm/s) was significantly associated with lower relative time BNA scores (mean = 39.6 ± 25.8) during the No-Go task (ß = 0.599, 95% CI = 0.214, 0.985, p = 0.005, R2 = 0.405), while controlling for the effect of age and gender. CONCLUSION: Among children and adolescents with a concussion, slower dual-task gait speed was independently associated with lower BNA relative time scores during a visual Go/No-Go task. The relationship between abnormal gait behaviour and brain activation deficits may be reflective of disruption to multiple functional abilities after concussion.
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Concussão Encefálica/complicações , Concussão Encefálica/patologia , Encéfalo/fisiopatologia , Transtornos Neurológicos da Marcha/etiologia , Inibição Psicológica , Adolescente , Adulto , Algoritmos , Criança , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estimulação Luminosa , Caminhada/fisiologiaRESUMO
OBJECTIVE: By the end of 2013, the United States had an estimated 278 000 female lacrosse players, with half of those participating at the youth level. The effects of the sport's rapid growth on injury rates have yet to be determined. The purpose of this clinical review is to synthesize the available published data on injuries that have occurred in the sport of women's lacrosse. Of particular interest was the risk of injury based on the level of play and position. DATA SOURCES: A comprehensive literature search was performed in PubMed, High Wire Press, SPORTDiscus, Google Scholar, and Ovid using the keywords "Lacrosse Injuries," "Epidemiology Lacrosse Injuries," "Lacrosse Injury," "Lacrosse," and "Injury." STUDY SELECTION: The electronic search included material published during or after 1950. In addition, all bibliographies of electronically found sources were cross-referenced to identify any additional publications that were not produced in the electronic searches. DATA EXTRACTION: All articles with data on women's injury rates were categorized by overall injury rates, rates by session (competition vs practice), nature of injury, location, type, severity, and player position. DATA SYNTHESIS: Injury rates increase with age: from youth leagues to high school and finally to the collegiate level. Rates of injury varied from 0.03 to 3.9 injuries/100 athletes. Women's game injury rates are consistently higher than practice injury rates (ranging from 0.2 to 7.1 vs 0.01 to 3.3). Injuries occur most frequently from stick-to-player or player-to-ball contact, rather than player-to-player contact. Women sustain a higher percentage of head and facial injuries relative to male lacrosse players. The most common types of injuries for women are concussions, sprains, contusions, and lacerations. More than half of all injuries are in the mild category resulting in players missing practice and games for 1 to 7 days. Offensive players had the most injuries, followed by defensive players and then midfielders, with goalies having the fewest number of injuries. CONCLUSIONS: In women's lacrosse, the rules and equipment used are substantially different than for the men's game. Face and hand injuries are more prevalent for women when compared with men, and ankle injuries are most prevalent in female youth. Medical professionals who treat lacrosse players can benefit from an improved understanding of the types and rates of the injuries they are likely to encounter. Improved awareness of lacrosse-specific injuries can assist these professionals to be more prepared to treat these athletes, which may lead to improved care and outcomes.
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Traumatismos em Atletas/epidemiologia , Esportes com Raquete/lesões , Atletas , Traumatismos em Atletas/classificação , Traumatismos em Atletas/prevenção & controle , Feminino , Humanos , Prevalência , Fatores de Risco , Instituições Acadêmicas , Estados Unidos , UniversidadesRESUMO
CONTEXT: A limiting factor for reducing anterior cruciate ligament injury risk is ensuring that the movement adaptions made during the prevention program transfer to sport-specific activity. Virtual reality provides a mechanism to assess transferability, and neuroimaging provides a means to assay the neural processes allowing for such skill transfer. OBJECTIVE: To determine the neural mechanisms for injury risk-reducing biomechanics transfer to sport after anterior cruciate ligament injury prevention training. DESIGN: Cohort study. SETTING: Research laboratory. PARTICIPANTS: Four healthy high school soccer athletes. INTERVENTIONS: Participants completed augmented neuromuscular training utilizing real-time visual feedback. An unloaded knee extension task and a loaded leg press task were completed with neuroimaging before and after training. A virtual reality soccer-specific landing task was also competed following training to assess transfer of movement mechanics. MAIN OUTCOME MEASURES: Landing mechanics during the virtual reality soccer task and blood oxygen level-dependent signal change during neuroimaging. RESULTS: Increased motor planning, sensory and visual region activity during unloaded knee extension and decreased motor cortex activity during loaded leg press were highly correlated with improvements in landing mechanics (decreased hip adduction and knee rotation). CONCLUSION: Changes in brain activity may underlie adaptation and transfer of injury risk-reducing movement mechanics to sport activity. Clinicians may be able to target these specific brain processes with adjunctive therapy to facilitate intervention improvements transferring to sport.
Assuntos
Adaptação Fisiológica , Encéfalo/fisiologia , Movimento , Lesões do Ligamento Cruzado Anterior/prevenção & controle , Atletas , Fenômenos Biomecânicos , Estudos de Coortes , Feminino , Humanos , Córtex Motor/fisiologia , Neuroimagem , Plasticidade Neuronal , Oxigênio/sangue , Condicionamento Físico Humano , Futebol , Esportes , Realidade VirtualRESUMO
OBJECTIVE: The aim of the current review was to systematically identify, evaluate and synthesise trials that examine concussion prevention via equipment, educational programmes and training programmes. DATA SOURCES: PubMed and EBSCO host (CINAHL, MEDLINE, SPORTDiscus). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The electronic databases PubMed and EBSCO were searched using the phrases: concussion prevention equipment, concussion prevention training and concussion prevention education. Included studies utilised a prospective study design to evaluate the preventative effect of: (1) equipment, (2) training or (3) educational programmes on the incidence of concussions in comparison to a control group. DATA EXTRACTION: Demographic data and intervention methods were recorded. Intervention and control group concussion rates and superficial head injury rates were extracted and combined using random-effects relative risk meta-analysis. RESULTS: 14 studies evaluated interventions of novel protective equipment. One prospective investigation evaluated an educational programme. The relative risk of concussion for participants enrolled in the interventional arms of trials was not significantly different from that in standard practice arms (RR=0.78, 95% CI 0.55 to 1.11, χ2=1.8, p=0.17; I2=85.3%, 95% CI 71.5% to 90.8%). The relative risk of concussion for participants wearing protective equipment (ie, headgear, full face shields) relative to their counterparts wearing standard or no equipment, calculated from seven available reports, showed no effect of intervention (RR=0.82, 95% CI 0.56 to 1.20, χ2=1.06, p=0.30; I2=86.7%, 95% CI 73.3% to 91.8%). The relative risk of superficial head injury for participants wearing protective equipment relative to their counterparts, calculated from three reports, showed a significant risk reduction (RR=0.41, 95% CI 0.31 to 0.56, χ2=34.13, p<0.0001; I2=53.1%, 95% CI 0% to 85.2%). CONCLUSIONS: Prospective controlled studies indicate that certain protective equipment may prevent superficial head injury, but these items are suboptimal for concussion prevention in sport.
Assuntos
Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Dispositivos de Proteção da Cabeça , Humanos , Comportamento de Redução do Risco , EsportesRESUMO
OBJECTIVE: The aim of this study was to determine key components in neuromuscular training that optimise ACL injury reduction in female athletes using meta-regression analyses. DESIGN: Systematic review and meta-regression. DATA SOURCES: The literature search was performed in PubMed and EBSCO. ELIGIBILITY CRITERIA: Inclusion criteria for the current analysis were: (1) documented the number of ACL injuries, (2) employed a neuromuscular training intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective control study design and (5) recruited female athletes as participants. Two independent reviewers extracted studies which met the inclusion criteria. Methodological quality of included study and strength of recommendation were evaluated. Number of ACL injuries and participants in control and intervention groups, age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and status of verbal feedback were extracted. RESULTS: The meta-regression analyses identified age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback as significant predictors of ACL injury reduction (p=0.01 in fixed-effects model, p=0.03 in random-effects model). Inclusion of 1 of the 4 components in neuromuscular training could reduce ACL injury risk by 17.2-17.7% in female athletes. No significant heterogeneity and publication bias effects were detected. Strength of recommendation was rated as A (recommendation based on consistent and good-quality patient-oriented study evidence). CONCLUSIONS: Age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback are predictors that influence the optimisation of prophylactic effects of neuromuscular training and the resultant ACL injury reduction in female athletes.
Assuntos
Lesões do Ligamento Cruzado Anterior/prevenção & controle , Traumatismos em Atletas/prevenção & controle , Traumatismos do Joelho/prevenção & controle , Atletas , Exercício Físico , Feminino , Humanos , Condicionamento Físico Humano , Análise de Regressão , Fatores de RiscoRESUMO
BACKGROUND: Historical approaches to protect the brain from outside the skull (eg, helmets and mouthpieces) have been ineffective in reducing internal injury to the brain that arises from energy absorption during sports-related collisions. We aimed to evaluate the effects of a neck collar, which applies gentle bilateral jugular vein compression, resulting in cerebral venous engorgement to reduce head impact energy absorption during collision. Specifically, we investigated the effect of collar wearing during head impact exposure on brain microstructure integrity following a competitive high school American football season. METHODS: A prospective longitudinal controlled trial was employed to evaluate the effects of collar wearing (n=32) relative to controls (CTRL; n=30) during one competitive football season (age: 17.04±0.67â years). Impact exposure was collected using helmet sensors and white matter (WM) integrity was quantified based on diffusion tensor imaging (DTI) serving as the primary outcome. RESULTS: With similar overall g-forces and total head impact exposure experienced in the two study groups during the season (p>0.05), significant preseason to postseason changes in mean diffusivity, axial diffusivity and radial diffusivity in the WM integrity were noted in the CTRL group (corrected p<0.05) but not in the collar group (p>0.05). The CTRL group demonstrated significantly larger preseason to postseason DTI change in multiple WM regions compared with the collar group (corrected p<0.05). DISCUSSION: Reduced WM diffusivity alteration was noted in participants wearing a neck collar after a season of competitive football. Collar wearing may have provided a protective effect against brain microstructural changes after repetitive head impacts. TRIAL REGISTRATION NUMBER: NCT02696200.
Assuntos
Traumatismos em Atletas/prevenção & controle , Traumatismos Craniocerebrais/prevenção & controle , Futebol Americano/lesões , Veias Jugulares , Equipamentos de Proteção , Acelerometria , Adolescente , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Imagem de Tensor de Difusão , Cabeça , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pescoço/diagnóstico por imagem , Neuroimagem , Estudos Prospectivos , UltrassomRESUMO
PURPOSE: The purpose of this investigation was to estimate and document the reliability and validity of the Anterior Knee Pain Scale (AKPS) and to estimate its relative prediction accuracy of anterior knee pain in young females. METHODS: Data from a prospective, epidemiologic study to diagnose patellofemoral knee pain among female athletes (n = 499) using the Anterior Knee Pain Scale (AKPS). Data were treated in 4 phases (descriptive phase, reliability phase, scale refinement phase) and a final validation stage that was focused on an effort to test and document the validation of the AKPS short form and perform head-to-head comparisons of the 6-item short form with the original, 13-item form. RESULTS: The AKPS was reduced from 13 items (αCoeff = 0.77, σSEM = 0.004) to 6 items (αCoeff = 0.78, σSEM = 0.004). Point-biserial correlations with patellofemoral pain diagnosis were comparable: r [498] = 0.70 (R(2) = 0.49, short form) and r [498] = 0.71 (R(2) = 0.51, long form), as was sensitivity: 84% (short form) and 80% (long form), and specificity: 89% (short form) and 90% (long form; AUC = 0.94 both). CONCLUSION: The current analyses indicate that a subset of measures from the AKPS is responsive to patellofemoral pain symptoms and may support screening for related diagnoses. A simpler and quicker scale optimized for diagnostic accuracy could reduce the demand on patients, clinicians and research teams focused on the identification and management of patellofemoral pain. LEVEL OF EVIDENCE: III.
Assuntos
Medição da Dor , Síndrome da Dor Patelofemoral/diagnóstico , Adolescente , Criança , Feminino , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: To determine if sport specialization increases the risk of anterior knee pain in adolescent female athletes. DESIGN: Retrospective cohort epidemiology study. METHODS: Female basketball, soccer, and volleyball players (N = 546) were recruited from a single county public school district in Kentucky consisting of 5 middle schools and 4 high schools. A total of 357 multisport and 189 single-sport (66 basketball, 57 soccer, and 66 volleyball) athlete subjects were included due to their diagnosis of patellofemoral pain (PFP) on physical exam. Testing consisted of a standardized history and physician-administered physical examination to determine the presence of PFP. This study compared self-reported multisport athletes with sport-specialized athletes participating in only 1 sport. The sports-participation data were normalized by sport season, with each sport accounting for 1 season of exposure. Incidence rate ratios and 95% confidence intervals (CI) were calculated and used to determine significant differences between athletes who specialized in sport in early youth and multisport athletes. RESULTS: Specialization in a single sport increased the relative risk of PFP incidence 1.5-fold (95% CI 1.0-2.2, P = .038) for cumulative PFP diagnoses. Specific diagnoses such as Sinding Larsen Johansson/ patellar tendinopathy (95% CI 1.5-10.1, P = .005) and Osgood Schlatter disease (95% CI 1.5-10.1, P = .005) demonstrated a 4-fold greater relative risk in single-sport compared with multisport athletes. Incidence of other specific PFP diagnoses such as fat pad, plica, trauma, pes anserine bursitis, and iliotibial-band tendonitis was not different between single-sport and multisport participants (P > .05). CONCLUSION: Early sport specialization in female adolescents is associated with increased risk of anterior knee-pain disorders including PFP, Osgood Schlatter, Sinding Larsen-Johansson compared with multisport athletes.