Test-Retest Reliability of a Computerized Concussion Test: CNS Vital Signs

Neurocognitive testing is an important concussion evaluation tool, but for neurocognitive tests to be useful, their psychometric properties must be well established. Test-retest reliability of computerized neurocognitive tests can influence their clinical utility. The reliability for a commonly used computerized neurocognitive test, CNS Vital Signs, is not well established. The purpose of this study was to examine test-retest reliability and reliable change indices for CNS Vital Signs in a healthy, physically active college population

No acute changes in postural control after soccer heading

Background: Soccer heading has been proposed as a potential cause of cerebral dysfunction

Safe-Play Knowledge, Aggression, and Head-Impact Biomechanics in Adolescent Ice Hockey Players

Addressing safe-play knowledge and player aggression could potentially improve ice hockey sport safety

Athletes’ age, sex and years of education moderate the acute neuropsychological impact of sports-related concussion: A meta-analysis

The objective of this study is to determine which pre-existing athlete characteristics, if any, are associated with greater deficits in functioning following sports-related concussion, after controlling for factors previously shown to moderate this effect (e.g., time since injury). Ninety-one independent samples of concussion were included in a fixed+systematic effects meta-analysis (n = 3,801 concussed athletes; 5,631 controls). Moderating variables were assessed using analogue-to-ANOVA and meta-regression analyses. Post-injury assessments first conducted 1-10 days following sports-related concussion revealed significant neuropsychological dysfunction, postural instability and post-concussion symptom reporting (d = -0.54, -1.10, and -1.14, respectively). During this interval, females (d = -0.87), adolescent athletes competing in high school competitions (d = -0.60), and those with 10 years of education (d = -1.32) demonstrated larger post-concussion neuropsychological deficits than males (d = -0.42), adults (d = -0.25), athletes competing at other levels of competition (d = -0.43 to -0.41), or those with 16 years of education (d = -0.15), respectively. However, these sub-groups' differential impairment/recovery beyond 10 days could not be reliably quantified from available literature. Pre-existing athlete characteristics, particularly age, sex and education, were demonstrated to be significant modifiers of neuropsychological outcomes within 10 days of a sports-related concussion. Implications for return-to-play decision-making and future research directions are discussed

Gender differences in the incidence and prevalence of patellofemoral pain syndrome: Epidemiology of patellofemoral pain

The purpose of this investigation was to determine the association between gender and the prevalence and incidence of patellofemoral pain syndrome (PFPS). One thousand five hundred and twenty-five participants from the United States Naval Academy (USNA) were followed for up to 2.5 years for the development of PFPS. Physicians and certified athletic trainers documented the cases of PFPS. PFPS was defined as retropatellar pain during at least two of the following activities: ascending/descending stairs, hopping/jogging, prolonged sitting, kneeling, and squatting, negative findings on examination of knee ligament, menisci, bursa, and synovial plica, and pain on palpation of either the patellar facets or femoral condyles. Poisson and logistic regressions were performed to determine the association between gender and the incidence and prevalence of PFPS, respectively. The incidence rate for PFPS was 22/1000 person-years. Females were 2.23 times (95% CI: 1.19, 4.20) more likely to develop PFPS compared with males. While not statistically significant, the prevalence of PFPS at study enrollment tended to be higher in females (15%) than in males (12%) (P50.09). Females at the USNA are significantly more likely to develop PFPS than males. Additionally, at the time of admission to the academy, the prevalence of PFPS was not significantly different between genders

Standard regression-based methods for measuring recovery after sport-related concussion

Clinical decision making about an athlete's return to competition after concussion is hampered by a lack of systematic methods to measure recovery. We applied standard regression-based methods to statistically measure individual rates of impairment at several time points after concussion in college football players. Postconcussive symptoms, cognitive functioning, and balance were assessed in 94 players with concussion (based on American Academy of Neurology Criteria) and 56 noninjured controls during preseason baseline testing, and immediately, 3 hr, and 1, 2, 3, 5, and 7 days postinjury. Ninety-five percent of injured players exhibited acute concussion symptoms and impairment on cognitive or balance testing immediately after injury, which diminished to 4% who reported elevated symptoms on postinjury day 7. In addition, a small but clinically significant percentage of players who reported being symptom free by day 2 continued to be classified as impaired on the basis of objective balance and cognitive testing. These data suggest that neuropsychological testing may be of incremental utility to subjective symptom checklists in identifying the residual effects of sport-related concussion. The implementation of neuropsychological testing to detect subtle cognitive impairment is most useful once postconcussive symptoms have resolved. This management model is also supported by practical and other methodological considerations

The Concussion Recognition Tool 5th Edition (CRT5): Background and rationale

The Concussion Recognition Tool 5 (CRT5) is the most recent revision of the Pocket Sport Concussion Assessment Tool 2 that was initially introduced by the Concussion in Sport Group in 2005. The CRT5 is designed to assist non-medically trained individuals to recognise the signs and symptoms of possible sport-related concussion and provides guidance for removing an athlete from play/sport and to seek medical attention. This paper presents the development of the CRT5 and highlights the differences between the CRT5 and prior versions of the instrument

Approximate entropy detects the effect of a secondary cognitive task on postural control in healthy young adults: a methodological report

<p>Abstract</p> <p>Background</p> <p>Biomechanical measures of postural stability, while generally useful in neuroscience and physical rehabilitation research, may be limited in their ability to detect more subtle influences of attention on postural control. Approximate entropy (ApEn), a regularity statistic from nonlinear dynamics, recently has demonstrated relatively good measurement precision and shown promise for detecting subtle change in postural control after cerebral concussion. Our purpose was to further explore the responsiveness of ApEn by using it to evaluate the immediate, short-term effect of secondary cognitive task performance on postural control in healthy, young adults.</p> <p>Methods</p> <p>Thirty healthy, young adults performed a modified version of the Sensory Organization Test featuring single (posture only) and dual (posture plus cognitive) task trials. ApEn values, root mean square (RMS) displacement, and equilibrium scores (ES) were calculated from anterior-posterior (AP) and medial-lateral (ML) center of pressure (COP) component time series. For each sensory condition, we compared the ability of the postural control parameters to detect an effect of cognitive task performance.</p> <p>Results</p> <p>COP AP time series generally became more random (higher ApEn value) during dual task performance, resulting in a main effect of cognitive task (p = 0.004). In contrast, there was no significant effect of cognitive task for ApEn values of COP ML time series, RMS displacement (AP or ML) or ES.</p> <p>Conclusion</p> <p>During dual task performance, ApEn revealed a change in the randomness of COP oscillations that occurred in a variety of sensory conditions, independent of changes in the amplitude of COP oscillations. The finding expands current support for the potential of ApEn to detect subtle changes in postural control. Implications for future studies of attention in neuroscience and physical rehabilitation are discussed.</p