Quantifying Y Balance Test performance with multiple and single inertial sensors

The 42nd Annual International Conferences of the IEEE Engineering in Medicine and Biology Society, Montreal, Canada (held online due to coronavirus outbreak), 20 - 24 July 2020A growing body of evidence has highlighted that inertial sensor data can increase the sensitivity and clinical utility of the Y Balance Test, a commonly used clinical dynamic balance assessment. While early work has demonstrated the value of a single lumbar worn inertial sensor in quantifying dynamic balance control, no research has investigated if alternative (shank) or combined (lumbar and shank) sensor mounting locations may improve the assessments discriminant capabilities. Determining the optimal sensor set-up is crucial to ensuring minimal cost and maximal utility for clinical users The aim of this cross-sectional study was to investigate if single or multiple inertial sensors, mounted on the lumbar spine and/or shank could differentiate young (18-40 years [n = 41]) and middle-aged (40-65 years [n = 42]) adults, based on dynamic balance performance. Random-forest classification highlighted that a single lumbar sensor could classify age-related differences in performance with an accuracy of 79% (sensitivity = 81%; specificity = 78%). The amalgamation of shank and lumbar data did not significantly improve the classification performance (accuracy = 73-77%; sensitivity = 71-76%; specificity = 73-78%). Jerk magnitude root-mean-square consistently demonstrated predictor importance across the three reach directions: posteromedial (rank 1), anterior (rank 3) and posterolateral (rank 6).Science Foundation IrelandInsight Research Centre2020-11-27 JG: Broken PDF replace

Exploring the use of wearables in the management of mild traumatic brain injury

a) Why is the subject of your thesis important? Every year more than 1 million people attend Accident and Emergency with mild traumatic brain injuries (mTBI), many of which arise from Sports Related Concussion (SRC). Despite the high incidence of such injuries, there is still no gold standard method to monitor the wide variety of impairments (cognitive, visual, motor symptom) accompanying mTBI. Accordingly, there is concern about the long-term effects of mTBI if diagnosis is delayed or missed entirely. Current reliance on subjective techniques such as symptoms are non-specific and an unreliable indicator of recovery, making it difficult to know when it is safe for players to return to play (RTP). This highlights the need for testing and validating the accuracy and applicability of objective tools to aid diagnosis, monitoring, and RTP protocols for individuals exposed to mTBI and SRC. b) How have you undertaken the research? I have taken a systematic approach to this problem-based research, starting by understanding the clinical challenges of mTBI from SRC where amateur rugby union is used as an exemplar for investigation throughout the thesis. Both mTBI and SRC is an under-researched area confounded by insufficient medical staff available to recognise SRC and monitor players within low resource (community) based settings. This may place these individuals at an increased risk of having a delayed diagnosis or it being missed entirely. My hypothesis tests if the use of digital technologies may enable affordable mTBI management, ensuring continuity and objective personalised assessment to support traditional approaches. Accordingly, my thesis broadly comprises of a literature examination and preliminary validation and testing, progressing to an in-depth exploration involving larger datasets and concluding with recommendations for clinical practice. c) What are your main research findings? My multidisciplinary approach reveals that focusing on one impairment in mTBI is unlikely to reveal meaningful insight to mTBI/SRC and RTP. Instead, multimodal digital technologies could enable affordable management, ensuring consistency and continuity (e.g., between assessors) while offering objective personalised data to better support traditional approaches. My results provide insight and identify the usefulness of instrumented walking (gait) as a digital (bio) marker for mTBI management. Based on receiver operating characteristics (ROC) and area under the curve (AUC) analyisis free-living step velocity (i.e., walking speed) was the most sensitive (>0.72) at distinguishing healthy from acute SRC and may be useful for continuous monitoring and therefore informing SRC RTP. In a purely computing science context, my findings have uncovered challenges and opportunities for further refinement. For example, there is still room for more ‘no code’ solutions in gait and algorithm analysis. Few clinicians would have the technical skillsets for completing free-living gait analysis. Therefore, validated algorithms within a "drag and drop", click and collect approach is needed to meet the recommend approach of remote, free-living monitoring of habitual behaviours. That is an important next step for the translation of academic research grade devices for broader deployment in clinical practice. d) Why do your research findings matter This thesis generally supports the suggested use of digital technologies as an affordable and objective method to support traditional approaches of assessment in mTBI/SRC. Passive and continuous monitoring solutions such as wearables are becoming ubiquitous in daily life. Moreover, the use of instrumented (lab) and free-living gait may fit that context with evidence of its use as a diagnostic tool. More work is needed to strengthen that claim as well as further investigate its use as a responsive tool. Identifying useful digital biomarkers in pathological cohorts such as mTBI may improve the detection of injuries and better inform safe (personalised) RTP guidelines. Identifying critical stages of recovery more accurately will also reduce the likelihood of premature return to play before full recovery, which is a necessary threshold in offering personalised care and rehabilitation. That is an important next step for the translation of academic research grade devices for broader deployment in clinical practice

The differences in objective balance outcomes between elite female rugby players with and without a history of lateral ankle sprain

Thesis (MScPhysio)--Stellenbosch University, 2020.ENGLISH SUMMARY : Background: Ankle injuries (in particular ankle sprains) are among the most common musculoskeletal injuries in rugby due to impact. Despite the high physicality of the sport, it has not deterred females from participation. Ankle sprains can be prevented or reduced by a balance training programme. Dynamic balance can be quantified by pressure or force platform systems in balance assessments by measuring displacements of the centre of pressure (COP). Despite the popularity of women‟s rugby, studies in this area are scarce. Objective: The objective of the study was to determine if there are differences in objective balance outcome measures between female rugby players with and without a history of lateral ankle sprains, using COP displacements to quantify their dynamic balance. Methodology: A cross-sectional analytical design was followed in this study. The study was conducted at the High Performance Centre Gymnasium of the Western Province Rugby Football Union (WPRFU), situated at the corner of Voortrekker Road and Duminy Street, Bellville, Cape Town. The study involved 12 participants with a history of lateral ankle sprains and 19 participants without a history of lateral ankle sprains. The Noraxon myoPressureTM (Zebris) pressure plate was utilised to objectively measure dynamic balance using COP parameters, namely Sway Area (SA), COP Speed (COP Sp), and Time-to-Boundary (TTB), using three tasks (catch-and-throw, single-leg balance, and side step). The Mann-Whitney statistical test was used to assess normality of the data. Results: The study population comprised 31 females, 12 with a history of lateral ankle sprains and 19 without a history of lateral ankle sprains. The median age of the ankle sprain group was 21.5 years, similar to the non-ankle sprain group of 21.0 years. Participants of the ankle sprain group presented with statistically significant differences in the outcome Sway Area for the tasks catch-and-throw (p=0.04) and side step (p=0.01). This was similar for the outcome Time-to-Boundary which indicated a statistically significant result for the tasks catch-and-throw (p=0.02) and side step (0=0.01). There was also a statistically significant difference for the outcome COP Speed for the task side step (p=0.01). There were no statistical differences for the task single-leg balance. Conclusion: Our findings showed a significant increase in SA and TTB in the ankle sprain group compared to the non-ankle sprain group for the tasks catch-and-throw and side step. There was also a significant increase in COP Sp in the ankle sprain group compared to the non-ankle sprain group. All other outcomes showed insignificant differences. Our findings add to the evidence base, suggesting that balance can be tested and measured objectively in female rugby players with lateral ankle sprains as a result of balance impairments. In addition, the use of pressure plates in objective balance testing to provide significant data is strengthened and may assist clinicians to identify players whose balance may be impaired following an ankle sprain and who may benefit from a balance training programme. Future studies may explore the effect of a balance intervention programme in female rugby players with and without a history of ankle sprains.AFRIKAANSE OPSOMMING : Agtergrond: Enkelbeserings (in die besonder enkelverstuitings) is een van die mees algemene muskuloskeletale beserings in rugby as gevolg van impak. Die intense fisieke aard van die sport verhinder egter nie die deelname van vrouens nie. Enkelverstuitings kan voorkom of verminder word deur middel van „n balans-opleidingsprogram. Dinamiese balans kan gekwantifiseer word deur middel van druk of krag platform stelsels wat gebruik word vir balans evaluering waar verplasings van die drukmiddelpunt (COP) gemeet word. Ten spyte van die gewildheid van vrouerugby is studies in hierdie studieveld steeds skaars. Doelwit: Die doelwit van die studie was om met behulp van COP verplasings te bepaal of daar verskille is in die resultate van objektiewe balansmeting in vroulike rugbyspelers met en sonder 'n geskiedenis van laterale enkelverstuitings om die spelers se dinamiese balans te kwantifiseer. Metodiek: „n Deursnit ontledingsontwerp is gevolg in hierdie studie. Die studie is uitgevoer by die High Performance Centre Gimnasium van die Westelike Provinsie Rugbyvoetbalunie (WPRFU), geleë op die hoek van Voortrekkerweg en Duminy Street, Bellville, Kaapstad. Die studie het 12 deelnemers ingesluit met „n geskiedenis van laterale enkelverstuitings en 19 deelnemers sonder 'n geskiedenis van laterale enkelverstuitings. Die Noraxon myoPressureTM (Zebris) drukplaat is gebruik om dinamiese balans objektief te meet met behulp van COP parameters, naamlik liggaam Swaai Area (SA), COP Spoed (COP Sp), en Tyd-tot-Grens (TTB), deur die uitvoering van drie take (vang-en-gooi, eenbeen balans en systap). Die Mann-Whitney statistiese toets is gebruik om die normaliteit van die data te evalueer. Resultate: Die studiepopulasie het bestaan uit 31 vroue, waarvan 12 „n geskiedenis van laterale enkelverstuitings gespesifiseer het terwyl die ander 19 aangedui het dat hulle nie „n geskiedenis van laterale enkelverstuitings het nie. Die gemiddelde ouderdom van die enkelverstuitingsgroep was 21.5 jaar, wat ooreenstem met die nie-enkel verstuitingsgroep van 21.0 jaar. Deelnemers van die enkelverstuitingsgroep het statisties beduidende verskille getoon in die Swaai Area uitkoms vir die vang-en-gooi (p=0.04) en systap (p=0.01) take. Die TTB het „n soortgelyke statisties beduidende resultaat getoon vir die vang-en-gooi (p=0.02) en systap (0= 0.01) take. Daar was ook „n statisties beduidende verskil in die COP spoed uitkoms vir die systap (p=0.01) taak. Daar was geen statistiese verskille vir die eenbeen balans taak nie. Gevolgtrekking: Ons bevindinge het getoon dat daar „n beduidende toename is in die liggaam SA en TTB parameters by die enkelverstuitingsgroep in vergelyking met die nie-enkelverstuitingsgroep vir die vang-en-gooi en systap take. Daar was ook „n beduidende toename in COP spoed by die enkelverstuitingsgroep in vergelyking met die nie-enkelverstuitingsgroep. Alle ander resultate dui onbeduidende verskille aan. Ons bevindinge dra by tot die fundamentele bewyse dat balans objektief getoets en gemeet kan word in vroulike rugbyspelers met laterale enkelverstuitings as gevolg van balans gestremdhede. Die gebruik van drukplate met objektiewe balanstoetse om beduidende resultate te lewer word verhoog en kan klinici help om spelers te identifiseer wat gestrem is as gevolg van „n enkelverstuiting en wat bevoordeel kan word deur „n balans opleidingsprogram. Toekomstige studies kan die effek van „n balans intervensieprogram in vroulike rugbyspelers met en sonder 'n geskiedenis van enkelverstuitings ondersoek.Master

Athlete Monitoring in Canadian Football

INTRODUCTION: Sports performance optimization relies heavily on the balance between increasing training load (TL) and appropriate recovery. In high performance settings, the crucial role that athlete monitoring plays in this intricate balancing act is widely recognized. PURPOSE: Due to the violent and unique demands of Canadian football, minimal research and few practical monitoring tools are available for coaches and practitioners. The thesis aim therefore, is to provide a body of research that begins to address athlete monitoring challenges in Canadian football. CHAPTER III: Study 1 was designed to validate the Session-Ratings of Perceived Exertion (sRPE) method of quantifying internal TL in football players. Statistically significant correlations for all individual players between sRPE and two criterion heart rate-based measures were found. Results confirm that sRPE is a highly practical and valid tool for Canadian football application. CHAPTER IV: Despite frequent use in other sports, the high injury occurrence in football often prevents consistent neuromuscular fatigue (NMF) monitoring using a maximal countermovement jump (CMJ). Further, little direct evidence exists supporting the relationship between athlete CMJ performance and NMF. Study 2 addressed these issues by assessing the acute-fatiguing effects of a game simulation (G-Sim) on postural sway (PS), CMJ performance and lab-based NMF measures in football players. Congruency between all measures post G-Sim suggests that submaximal PS monitoring has the potential to supplement CMJ in NMF tracking of football players hampered by minor injuries. CHAPTER V: Recognizing that acute-fatiguing effects may misrepresent fatigue across extended training periods, study 3 applied previous methodology (study 1 & 2) to evaluate PS as a valid NMF indicator over a competitive 11-week season. Significant associations between both CMJ and PS performance with weekly Global TL fluctuations provided evidence of NMF assessments valid across a football season. There was no evidence of differences in NMF status between starters and non-starters of the weekly game. CONCLUSION: Thesis findings confirm the validity and practicality of sRPE and the NMF monitoring tools of CMJ and PS across a competitive football season. This initial work provides a spring-board for future research as it has broadened our knowledge of athlete responses to- and monitoring in- Canadian football

The acute effect of heading on neurovascular coupling, optic nerve sheath diameter and memory recall in women footballers

Purpose: Retired male footballers are at 3.5 times greater risk of neurodegenerative disease, with repeated heading suggested to contribute to the increased risk. Currently, no such cohort data exist in women players. However, the women’s game is growing, so studies are needed to understand whether heading acutely alters outcomes potentially linked to neurodegenerative disease in this group. Alterations in neurovascular coupling (NVC) may precede the cognitive impairment associated with neurological disease, and evidence suggests that NVC is acutely altered following heading in men. Increased intracranial pressure (ICP) is linked with unfavourable patient outcomes following mild traumatic brain injury. This study assessed whether exposure to a realistic number of football headers acutely influenced NVC, ICP and cognitive function in women footballers. Methods: 19 women footballers completed a heading trial consisting of 6 headers at 40 ± 5 km/h, evenly spaced across an hour, and a time-matched seated control trial. Trials were performed on separate days, spaced a least 7 days apart. The posterior cerebral artery blood velocity response to a visual search task was measured via transcranial Doppler ultrasonography and used to quantify NVC. ICP was evaluated by measuring the optic nerve sheath diameter (ONSD). Finally, cognitive performance was determined using a modified version of the international shopping list test. Each outcome was assessed before and after the heading and control trials. Results: No significant time by trial interaction was present for any metric of NVC (P>0.14, ηp2<0.16), ONSD (P= 0.65, ηp2 = 0.01) or cognitive function (P = 0.053, ηp2 = 0.19). Conclusion: Our data suggests that NVC, ICP and cognitive function is not altered following six headers in women footballers. Future studies should examine how these outcomes are effected by repeated exposure across a season and career

Epidemiology of Injury in English Women's Super league Football: A Cohort Study

INTRODUCTION: The epidemiology of injury in male professional football has been well documented (Ekstrand, Hägglund, & Waldén, 2011) and used as a basis to understand injury trends for a number of years. The prevalence and incidence of injuries occurring in womens super league football is unknown. The aim of this study is to estimate the prevalence and incidence of injury in an English Super League Women’s Football squad. METHODS: Following ethical approval from Leeds Beckett University, players (n = 25) signed to a Women’s Super League Football club provided written informed consent to complete a self-administered injury survey. Measures of exposure, injury and performance over a 12-month period was gathered. Participants were classified as injured if they reported a football injury that required medical attention or withdrawal from participation for one day or more. Injuries were categorised as either traumatic or overuse and whether the injury was a new injury and/or re-injury of the same anatomical site RESULTS: 43 injuries, including re-injury were reported by the 25 participants providing a clinical incidence of 1.72 injuries per player. Total incidence of injury was 10.8/1000 h (95% CI: 7.5 to 14.03). Participants were at higher risk of injury during a match compared with training (32.4 (95% CI: 15.6 to 48.4) vs 8.0 (95% CI: 5.0 to 10.85)/1000 hours, p 28 days) of which there were three non-contact anterior cruciate ligament (ACL) injuries. The epidemiological incidence proportion was 0.80 (95% CI: 0.64 to 0.95) and the average probability that any player on this team will sustain at least one injury was 80.0% (95% CI: 64.3% to 95.6%) CONCLUSION: This is the first report capturing exposure and injury incidence by anatomical site from a cohort of English players and is comparable to that found in Europe (6.3/1000 h (95% CI 5.4 to 7.36) Larruskain et al 2017). The number of ACL injuries highlights a potential injury burden for a squad of this size. Multi-site prospective investigations into the incidence and prevalence of injury in women’s football are require

THE EFFECTS OF MILD TRAUMATIC BRAIN INJURY HISTORY AND MILITARY CAREER STAGE ON FUNCTIONAL BALANCE PERFORMANCE

Concussion is a prevalent injury in the United States Military. The potential long-term effects of these injuries can be detrimental to a career that requires optimal physical ability. A variety of balance tests exist and are utilized before and after concussion, but the use of dynamic assessments like the Y-Balance Test may provide a more functional measurement. The purpose of this study was to determine the effect of concussion history on Y-Balance task performance and whether it was influenced by military career stage. The Y-Balance Test was utilized in assessment of dynamic balance and the Fusionetics Movement Efficiency (ME) Test provided information on the participants’ movement quality. Y-Balance and Fusionetics ME Test scores were collected in male Service members by trained investigators at UNC-Chapel Hill from 2013-2021. Statistical analyses determined that there was no significant relationship between the independent variables (concussion history and military career stage) and Y-Balance composite scores.Master of Art