History of previous concussion and sports-specific skills in youth ice hockey players

Concussions can lead to cognitive or neuromotor impairments which may influence skill performance. Fewstudies have investigated concussion and sports-specific skill performance, particularly in youth. Therefore, thepurpose of this study was to examine previous concussion and components of the Hockey Canada Skills Test, ameasure of ice hockey-specific skill performance, in youth ice hockey players (ages 11-17). A secondarypurpose was todetermine the test-retest reliability of these components. Players completed a detailed baselinequestionnaire on previous concussion history. On-ice measures included forward agility weave,forward/backward speed skate, transition agility, and a 6-repeat endurance skate (all measured in seconds).Multiple linear regression was conducted to examine history of concussion, number of previous concussions,time since most recent concussion, and severity of most recent concussion on on-ice performance. Test-retestreliability was assessed using intraclass correlation coefficients and mean differences with Bland-Altman Limitsof Agreement. In total, 596 participants [525 males and 71 females, representing elite (upper 30% by division ofplay) and non-elite (lower 70%)] were recruited to examine the primary purpose. History of concussion (yes/no)and time since most recent concussion was not associated with any component. Players reporting 2 or moreconcussions were significantly faster than those with no previous concussion on forward agility weave with thepuck. For every additional day to return to play post-concussion, player times were significantly faster onforward agility weave with and without the puck, transition agility without the puck, and backward speed withand without the puck. The intraclass correlation coefficients ranged from 0.50 to 0.92 and the Bland-AltmanLimits of Agreement varied by component. These findings indicate players with and without history ofconcussion have similar on-ice scores, and that the components of the Hockey Canada Skills Test are a reliablemeasure of on-ice performance

Adding confidence to our injury burden estimates: is bootstrapping the solution?

Injury burden is a composite measure of injury incidence and mean severity that can be used to understand the overall impact of injuries and help identify priority areas for injury prevention. Injury burden has been used within rugby union epidemiological studies since the early 2000s, but it is now recognised and recommended within other sports, including the most recent International Olympic Committee consensus statement for the recording and reporting of epidemiological data on injury and illness. Injury burden is normally reported as athlete days absence per 1000 athletehours and is derived from the product of injury incidence (expressed as injuries sustained/1000 athlete-hours) and severity (expressed as the mean severity of injury in days). While the value of injury burden as an output measure from injury surveillance studies is evident, there appears to be some confusion in the literature regarding its calculation. For instance, some authors have used median severity to calculate injury burden rather than mean severity, as discussed in a recent critical review. In addition, there appears to be no clear guidance within the sports medicine literature regarding the most appropriate way to calculate confidence intervals (CIs) for this metric

More Than Just Adolescence: Differences in Fatigue Between Youth With Cerebral Palsy and Typically Developing Peers

Objective To quantify differences in fatigue and disordered sleep between adolescents with cerebral palsy (CP) and their typically developing peers. A secondary aim was to investigate the association between fatigue and disordered sleep in adolescents with CP. Methods A convenience sample of 36 youth with CP aged 10-18 years was matched for age and sex with 36 typically developing peers. The Fatigue Impact and Severity Self-Assessment (FISSA), the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue profile, and the Sleep Disturbance Scale for Children (SDSC) were collected. Results Higher fatigue was reported in participants with CP than in their typically developing peers based on the FISSA total score (mean paired difference=19.06; 99% confidence interval [CI], 6.06-32.1), the FISSA impact subscale (mean paired difference=11.19; 99% CI, 3.96-18.4), and the FISSA Management and Activity Modification subscale (mean paired difference=7.86; 99% CI, 1.1-14.6). There were no differences between groups in the PROMIS fatigue profile (mean paired difference=1.63; 99% CI, -1.57-4.83) or the SDSC total score (mean paired difference=2.71; 99% CI, -2.93-8.35). Conclusion Youth with CP experienced significantly more fatigue than their peers as assessed by a comprehensive measure that considered both general and diagnosis-specific concerns. Sleep did not differ between youth with CP and their typically developing peers. These findings underscore the need to consider the clinical management of fatigue across the lifespan of individuals with CP to prevent the associated deterioration of functional abilities

The impact of concussion on cardiac autonomic function:a systematic review

<p><i>Primary objective</i>: To evaluate the evidence regarding the effect of concussion on cardiac autonomic function (CAF).</p> <p><i>Inclusion criteria</i>: Original research; available in English; included participants with concussion or mild traumatic brain injury (mTBI) and a comparison group; included measures of heart rate (HR) and/or heart rate variability (HRV) as outcomes. Studies of humans (greater than 6 years old) and animals were included.</p> <p><i>Critical appraisal tools</i>: The Downs and Black (DB) criteria and Structured Effectiveness Quality Evaluation Scale (SEQES).</p> <p><i>Results</i>: Nine full-length articles and four abstracts were identified. There is conflicting evidence regarding CAF at rest following concussion. There is evidence of elevated HR and reduced HRV with low-intensity, steady-state exercise up to 10 days following concussion. There was no significant difference in HRV during isometric handgrip testing or HR while performing cognitive tasks following concussion. The validity of current literature is limited by small sample sizes, lack of female or paediatric participants, methodological heterogeneity and lack of follow-up.</p> <p><i>Conclusions</i>: While there is some evidence to suggest CAF is altered during physical activity following concussion, methodological limitations highlight the need for further research. Understanding the effect of concussion on CAF will contribute to the development of more comprehensive concussion management strategies.</p

Shoulder Check:Investigating Shoulder Injury Rates, Types, Severity, Mechanisms, and Risk Factors in Canadian Youth Ice Hockey

Objective: To describe shoulder-related injury rates, types, severity, mechanisms, and risk factors in youth ice hockey players during games and practices. Study Design: Secondary analysis of data from a 5-year prospective cohort study Safeto-Play (2013-2018). Subjects: Overall, 4419 individual players (representing 6585 player-seasons; 3806 males: 613 females) participated. During this period, 118 primary shoulder-related game injuries and 12 practice injuries were reported. Outcome Measures: Injury surveillance data was collected from 2013-2018 (time-loss or medical attention injuries). Descriptive statistics were calculated, and injury rates with 95% CI were estimated using Poisson regression. An exploratory multivariable mixed-effects Poisson regression model (clustering by team and offset by exposure hours) examined risk factors. Results: The shoulder injury rate was 0.70 injuries/1000 game-hours (95% CI 0.371.33) and 0.07 injuries/1000 practice-hours (95% CI 0.04-0.12). Two-thirds of game injuries (n=79, 69%) resulted in &gt;8 days of time-loss, and more than one-third (n=44, 39%) resulted in &gt;28 days of time-loss. An 82% lower rate of shoulder injury was associated with policy prohibiting body checking compared to leagues allowing body checking [IRR=0.18 (95% CI 0.10-0.32)]. A higher shoulder injury rate was seen for those who reported any injury in the last 12-months compared to those with no history [IRR=2.32 (95% CI 1.57-3.41)]. Conclusions: Most shoulder injuries resulted in more than one week of time-loss. Risk factors for shoulder injury included participation in a body checking league and history of injury in the previous 12 months. Further study of prevention strategies specific to the shoulder may merit further consideration in ice hockey

Shoulder Check:Investigating Shoulder Injury Rates, Types, Severity, Mechanisms, and Risk Factors in Canadian Youth Ice Hockey

Objective: To describe shoulder-related injury rates, types, severity, mechanisms, and risk factors in youth ice hockey players during games and practices. Study Design: Secondary analysis of data from a 5-year prospective cohort study Safeto-Play (2013-2018). Subjects: Overall, 4419 individual players (representing 6585 player-seasons; 3806 males: 613 females) participated. During this period, 118 primary shoulder-related game injuries and 12 practice injuries were reported. Outcome Measures: Injury surveillance data was collected from 2013-2018 (time-loss or medical attention injuries). Descriptive statistics were calculated, and injury rates with 95% CI were estimated using Poisson regression. An exploratory multivariable mixed-effects Poisson regression model (clustering by team and offset by exposure hours) examined risk factors. Results: The shoulder injury rate was 0.70 injuries/1000 game-hours (95% CI 0.371.33) and 0.07 injuries/1000 practice-hours (95% CI 0.04-0.12). Two-thirds of game injuries (n=79, 69%) resulted in &gt;8 days of time-loss, and more than one-third (n=44, 39%) resulted in &gt;28 days of time-loss. An 82% lower rate of shoulder injury was associated with policy prohibiting body checking compared to leagues allowing body checking [IRR=0.18 (95% CI 0.10-0.32)]. A higher shoulder injury rate was seen for those who reported any injury in the last 12-months compared to those with no history [IRR=2.32 (95% CI 1.57-3.41)]. Conclusions: Most shoulder injuries resulted in more than one week of time-loss. Risk factors for shoulder injury included participation in a body checking league and history of injury in the previous 12 months. Further study of prevention strategies specific to the shoulder may merit further consideration in ice hockey

Higher Rates of Head Contacts, Body Checking, and Suspected Injuries in Ringette Than Female Ice Hockey:Time to Ring in Opportunities for Prevention

Objective: Ringette is a popular team ice sport in Canada, primarily played by females. Bodychecking is prohibited at all levels of play. This study used video-analysis to evaluate physical contact (PC), head contact (HC), and suspected injury and concussion incidence rates (IR) in youth ringette. Study Design: Cross-sectional. Subjects: Youth ringette players from the 2021-2022 season playing in the U16 (ages 14-15) or U19 (ages 16-18) age groups (A or AA levels). Games were filmed from regular season, provincials, and nationals (AA only). Observation Technique: Game video-recordings were analyzed using Dartfish video-analysis software. Validated criteria were used to assess trunk PC intensity (levels 1-3=lower-intensity PC, levels 4-5=higher-intensity bodychecking), HC type (HC1=direct player-to-player, HC2=indirect), suspected injury (concussion, non-concussion), and penalty enforcement. Outcome Measures: Multivariable Poisson regression analyses (adjusted for cluster by teamgame, offset by game-minutes) were used to estimate PC, HC, and suspected injury and concussion IRs. Incidence rate ratios (IRR) were used to compare IR across age groups, levels of play, and game types. Proportions of bodychecks and HC1s penalized were reported. Results: Seventy-eight team-games were included (U16 n=40, U19 n=38; A n=30, AA n=48; regular season n=30, provincials n=32, nationals n=16). The overall bodychecking IR was 17.34/100 team-minutes (95% CI:14.80-20.33), HC 19.09/100 team-minutes (95% CI:16.7421.78), suspected injury 1.53/100 team-minutes (95% CI:1.13-2.09), and suspected concussion 0.74/100 team-minutes (95% CI:0.48-1.13). Only 29% (95% CI:24.97-32.59) of bodychecks and 7% (95% CI:4.76-9.70) of HC1s were penalized. No differences were found in bodychecking, HCs, or suspected injury and concussion IRs between age groups or levels of play. Bodychecking IRs were 64% (IRR=1.64; 95% CI:1.13-2.39) higher in provincials and 24% (IRR=1.24; 95% CI:1.02-1.50) higher in nationals than regular season games. A 31% (IRR=0.69; 95% CI:0.49-0.97) lower rate of HCs was reported in national games compared to provincial games. Bodychecking was the most common mechanism for concussion (70%) and nonconcussion injuries (67%), with concussions most often associated with HC2s (62.5%). Conclusions: Bodychecking and HC1 IRs were high among youth ringette players, despite rules prohibiting them. Future research should target prevention strategies aimed to reduce HC1s and bodychecking to reduce injury and concussion IRs in youth ringette