Mobility Clinic Team Composition: Optimizing Care for Individuals with Spinal Cord Injury

INTRODUCTION Specialized interprofessional primary care-based Mobility Clinics represent a significant opportunity to improve spinal cord injury (SCI) care, however, there are no gold standards to inform team composition. This study explored the ideal mix of skill sets and competencies for Mobility Clinics. METHODS Twelve individual interviews were conducted with primary care and rehabilitation clinicians and individuals from professional associations representing nurses, nurse practitioners, social workers, physical therapists, occupational therapists, physicians, physician assistants, and recreation therapists. Participants received briefing notes on the Mobility Clinic care model and roles of each discipline within this model. Questions were asked related to discipline specific scope of practice, ideal team composition to meet consumer needs, and opportunities for expanding and sharing discipline roles. RESULTS Discipline specific role descriptions within the Mobility Clinic were perceived to be comprehensive and accurate; in some cases additional activities were suggested for some disciplines. Suggestions were made for cross discipline sharing of tasks (e.g., some social worker activities can be assumed by occupational therapists, OT or nurse practitioners, NPs). Recommendations for core team members included a physician, nurse, OT, exercise therapist, and a representative from a SCI-specific community service, with linkages to specialists or interprofessional rehabilitation teams for consultation support. Potential roles were described for disciplines not currently represented in this care model (nurse practitioners, physiotherapists, physician assistants, recreation therapists). CONCLUSION As there exists a critical balance of optimizing care and availability of resources, this study informs appropriate Mobility Clinic team composition, adaptable within the context of existing human resources

Understanding the consequences of repetitive subconcussive head impacts in sport : brain changes and dampened motor control are seen after boxing practice

LW was supported by FP7 grant number 602150-2 (CENTER-TBI)Objectives: The potential effects of exposure to repetitive subconcussive head impacts through routine participation in sport are not understood. To investigate the effects of repetitive subconcussive head impacts we studied boxers following customary training (sparring) using transcranial magnetic stimulation (TMS), decomposition electromyographic (EMG) and tests of memory. Methods: Twenty amateur boxers performed three 3-min sparring bouts. Parameters of brain function and motor control were assessed prior to sparring and again immediately, 1 h and 24 h post-sparring. Twenty control participants were assessed following mock-sparring. Results: One hour after sparring boxers showed increased corticomotor inhibition, altered motor unit recruitment strategies, and decreased memory performance relative to controls, with values returning to baseline by the 24 h follow up. Conclusion: Repetitive subconcussive head impacts associated with sparring resulted in acute and transient brain changes similar to those previously reported in soccer heading, providing convergent evidence that sport-related head impacts produce a GABAergic response. These acute changes in brain health are reminiscent of effects seen following brain injury, and suggest a potential mechanism underlying the damaging long-term effects of routine repetitive head impacts in sport.Publisher PDFPeer reviewe

Long-term outcome of partial P450 side-chain cleavage enzyme deficiency in three brothers: the importance of early diagnosis.

Objective: CYP11A1 mutations cause P450 side-chain cleavage (scc) deficiency, a rare form of congenital adrenal hyperplasia with a wide clinical spectrum. We detail the phenotype and evolution in a male sibship identified by HaloPlex targeted capture array. Family study: The youngest of three brothers from a non-consanguineous Scottish family presented with hyperpigmentation at 3.7 years. Investigation showed grossly impaired glucocorticoid function with ACTH elevation, moderately impaired mineralocorticoid function, and normal external genitalia. The older brothers were found to be pigmented also, with glucocorticoid impairment but normal electrolytes. Linkage studies in 2002 showed that all three brothers had inherited the same critical regions of the maternal X chromosome suggesting an X-linked disorder, but analysis of NR0B1 (DAX-1, adrenal hypoplasia) and ABCD1 (adrenoleukodystrophy) were negative. In 2016, next-generation sequencing revealed compound heterozygosity for the rs6161 variant in CYP11A1 (c.940G>A, p.Glu314Lys), together with a severely disruptive frameshift mutation (c.790_802del, K264Lfs*5). The brothers were stable on hydrocortisone and fludrocortisone replacement, testicular volumes (15-20 mL), and serum testosterone levels (24.7, 33.3, and 27.2 nmol/L) were normal, but FSH (41.2 µ/L) was elevated in the proband. The latter had undergone left orchidectomy for suspected malignancy at the age of 25 years and was attending a fertility clinic for oligospermia. Initial histology was reported as showing nodular Leydig cell hyperplasia. However, histological review using CD56 staining confirmed testicular adrenal rest cell tumour (TART). Conclusion: This kinship with partial P450scc deficiency demonstrates the importance of precise diagnosis in primary adrenal insufficiency to ensure appropriate counselling and management, particularly of TART

Evidence for Acute Electrophysiological and Cognitive Changes Following Routine Soccer Heading

Introduction  There is growing concern around the effects of concussion and sub-concussive impacts in sport. Routine game-play in soccer involves intentional and repeated head impacts through ball heading. Although heading is frequently cited as a risk to brain health, little data exist regarding the consequences of this activity. This study aims to assess the immediate outcomes of routine football heading using direct and sensitive measures of brain function.  Methods  Nineteen amateur football players (5 females; age 22±3 y) headed machine-projected soccer balls at standardized speeds, modelling routine soccer practice. The primary outcome measure of corticomotor inhibition measured using transcranial magnetic stimulation, was assessed prior to heading and repeated immediately, 24 h, 48 h and 2 weeks post-heading. Secondary outcome measures were cortical excitability, postural control, and cognitive function.  Results  Immediately following heading an increase in corticomotor inhibition was detected; further to these electrophysiological alterations, measurable reduction memory function were also found. These acute changes appear transient, with values normalizing 24 h post-heading.  Discussion  Sub-concussive head impacts routine in soccer heading are associated with immediate, measurable electrophysiological and cognitive impairments. Although these changes in brain function were transient, these effects may signal direct consequences of routine soccer heading on (long-term) brain health which requires further study

Evidence for acute electrophysiological and cognitive changes following routine soccer heading

This work was supported by the National Institute for Health Research (NIHR) Brain Injury Healthcare Technology Cooperative. This work was supported by existing funding awarded to L.W. as part of Framework 7 programme of the European Union (CENTER-TBI, Grant number: 602150-2). The work made use of a TMS coil to which the company Smartfish contributed £1500 for purchase of. T.DiV.'s postgraduate study is support by the research office of Stirling University. W.S. is supported by a NHS Research Scotland Career Researcher Fellowship. D.I.D. and M.I. are members of SINAPSE – see www.sinapse.ac.uk.Introduction There is growing concern around the effects of concussion and sub-concussive impacts in sport. Routine game-play in soccer involves intentional and repeated head impacts through ball heading. Although heading is frequently cited as a risk to brain health, little data exist regarding the consequences of this activity. This study aims to assess the immediate outcomes of routine football heading using direct and sensitive measures of brain function. Methods Nineteen amateur football players (5 females; age 22 ± 3 y) headed machine-projected soccer balls at standardized speeds, modelling routine soccer practice. The primary outcome measure of corticomotor inhibition measured using transcranial magnetic stimulation, was assessed prior to heading and repeated immediately, 24 h, 48 h and 2 weeks post-heading. Secondary outcome measures were cortical excitability, postural control, and cognitive function. Results Immediately following heading an increase in corticomotor inhibition was detected; further to these electrophysiological alterations, measurable reduction memory function were also found. These acute changes appear transient, with values normalizing 24 h post-heading. Discussion Sub-concussive head impacts routine in soccer heading are associated with immediate, measurable electrophysiological and cognitive impairments. Although these changes in brain function were transient, these effects may signal direct consequences of routine soccer heading on (long-term) brain health which requires further study.Publisher PDFPeer reviewe

The use of biofluid markers to evaluate the consequences of sport-related subconcussive head impact exposure : a scoping review

This review was supported by the University of Stirling (no grant number applies). L.W. also received support as part of Framework 7 programme of the European Union (CENTER-TBI, Grant number: 602150–2). S.M. received research support from the Italian Ministry of Health (GR-2013–02354960).Background Amidst growing concern about the safety of sport-related repetitive subconcussive head impacts (RSHI), biofluid markers may provide sensitive, informative, and practical assessment of the effects of RSHI exposure. Objective This scoping review aimed to systematically examine the extent, nature, and quality of available evidence from studies investigating the effects of RSHI on biofluid markers, to identify gaps and to formulate guidelines to inform future research. Methods PRISMA extension for Scoping Reviews guidelines were adhered to. The protocol was pre-registered through publication. MEDLINE, Scopus, SPORTDiscus, CINAHL, PsycINFO, Cochrane Library, OpenGrey, and two clinical trial registries were searched (until March 30, 2022) using descriptors for subconcussive head impacts, biomarkers, and contact sports. Included studies were assessed for risk of bias and quality. Results Seventy-nine research publications were included in the review. Forty-nine studies assessed the acute effects, 23 semi-acute and 26 long-term effects of RSHI exposure. The most studied sports were American football, boxing, and soccer, and the most investigated markers were (in descending order): S100 calcium-binding protein beta (S100B), tau, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), phosphorylated tau (p-tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and hormones. High or moderate bias was found in most studies, and marker-specific conclusions were subject to heterogeneous and limited evidence. Although the evidence is weak, some biofluid markers—such as NfL—appeared to show promise. More markedly, S100B was found to be problematic when evaluating the effects of RSHI in sport. Conclusion Considering the limitations of the evidence base revealed by this first review dedicated to systematically scoping the evidence of biofluid marker levels following RSHI exposure, the field is evidently still in its infancy. As a result, any recommendation and application is premature. Although some markers show promise for the assessment of brain health following RSHI exposure, future large standardized and better-controlled studies are needed to determine biofluid markers’ utility.Publisher PDFPeer reviewe

The Use of Biofluid Markers to Evaluate the Consequences of Sport-Related Subconcussive Head Impact Exposure : A Scoping Review

Funding Information: This review was supported by the University of Stirling (no grant number applies). L.W. also received support as part of Framework 7 programme of the European Union (CENTER-TBI, Grant number: 602150–2). S.M. received research support from the Italian Ministry of Health (GR-2013–02354960).Peer reviewe