Evaluating the "threshold Theory": Can Head Impact Indicators Help?

Purpose This study aimed to determine the clinical utility of biomechanical head impact indicators by measuring the sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-) of multiple thresholds. Methods Head impact biomechanics (n = 283,348) from 185 football players in one Division I program were collected. A multidisciplinary clinical team independently made concussion diagnoses (n = 24). We dichotomized each impact using diagnosis (yes = 24, no = 283,324) and across a range of plausible impact indicator thresholds (10g increments beginning with a resultant linear head acceleration of 50g and ending with 120g). Results Some thresholds had adequate sensitivity, specificity, and PV-. All thresholds had low PV+, with the best recorded PV+ less than 0.4% when accounting for all head impacts sustained by our sample. Even when conservatively adjusting the frequency of diagnosed concussions by a factor of 5 to account for unreported/undiagnosed injuries, the PV+ of head impact indicators at any threshold was no greater than 1.94%. Conclusions Although specificity and PV- appear high, the low PV+ would generate many unnecessary evaluations if these indicators were the sole diagnostic criteria. The clinical diagnostic value of head impact indicators is considerably questioned by these data. Notwithstanding, valid sensor technologies continue to offer objective data that have been used to improve player safety and reduce injury risk

Functional balance assessment in recreational college-aged individuals with a concussion history

Objectives: Despite evidence for increased musculoskeletal injury after concussion recovery, there is a lack of dynamic balance assessments that could inform management and research into this increased injury risk post-concussion. Our purpose was to identify tandem gait dynamic balance deficits in recreational athletes with a concussion history within the past 18-months compared to matched controls. Design: Cross-sectional, laboratory study. Methods: Fifteen participants with a concussion history (age: 19.7 ± 0.9 years; 9 females; median time since concussion 126 days, range 28–432 days), and 15 matched controls (19.7 ± 1.6 years; 9 females) with no recent concussion history participated. We measured center-of-pressure (COP) outcomes (velocity, path length, speed, dual-task cost) under 4 tandem gait conditions: (1) tandem gait, (2) tandem gait, eyes closed, (3) tandem gait, eyes open, cognitive distraction, and (4) tandem gait, eyes closed, cognitive distraction. Results: The concussion history group demonstrated slower tandem gait velocity compared to the control group (4.0 cm/s difference), thus velocity was used as a covariate when analyzing COP path length and speed. The concussion history group (23.5%) demonstrated greater COP speed dual-task cost than the control group (16.3%) during the eyes closed dual-task condition. No other comparisons were statistically significant. Conclusions: There may be subtle dynamic balance differences during tandem gait that are detectable after return-to-activity following concussion, but the clinical significance of these findings is unclear. Longitudinal investigations should identify acute movement deficits in varying visual and cognitive scenarios after concussion in comparison with recovery on traditional concussion assessment tools while also recording musculoskeletal injury outcomes

Reaction Time and Joint Kinematics During Functional Movement in Recently Concussed Individuals

Objective: To compare movement reaction time and joint kinematics between athletes with recent concussion and matched control recreational athletes during 3 functional tasks. Design: Cross-sectional. Setting: Laboratory. Participants: College-aged recreational athletes (N=30) comprising 2 groups (15 participants each): (1) recent concussion group (median time since concussion, 126d; range, 28–432d) and (2) age- and sex-matched control group with no recent concussions. Interventions: We investigated movement reaction time and joint kinematics during 3 tasks: (1) jump landing, (2) anticipated cut, and (3) unanticipated cut. Main Outcome Measures: Reaction time and reaction time cost (jump landing reaction time–cut reaction time/jump landing reaction time×100%), along with trunk, hip, and knee joint angles in the sagittal and frontal planes at initial ground contact. Results: There were no reaction time between-group differences, but the control group displayed improved reaction time cost (10.7%) during anticipated cutting compared with the concussed group (0.8%; P=.030). The control group displayed less trunk flexion than the concussed group during the nondominant anticipated cut (5.1° difference; P=.022). There were no other kinematic between-group differences (P≥.079). Conclusions: We observed subtle reaction time and kinematic differences between individuals with recent concussion and those without concussion more than a month after return to activity after concussion. The clinical interpretation of these findings remains unclear, but may have future implications for postconcussion management and rehabilitation

Hyperbaric oxygen therapy to treat acute sport-related traumatic brain injuries: A case series

We report on hyperbaric oxygen (HBO2) therapy used to improve postinjury outcomes in eight acutely concussed high school student-athletes (5 males, 3 females, mean age = 16.0 ± 1.2 years). Patients were randomly assigned into one of three intervention groups: (a) HBO2 therapy; (b) hyperbaric therapy with compressed medical-grade air (HBA); or (c) normobaric 100% O2 therapy. All patients completed five 1-hr treatments within the first 10 days following his or her concussion. Main outcome measures included mental status examination, symptom burden, and the number of days from injury until the physician permitted the student-athlete to return to activity. Patients receiving HBO2 treatment experienced the greatest absolute symptom reduction over the five treatment sessions. No meaningful differences were found in mental status examination. All participants returned to activity in a similar timeframe. HBO2 therapy may be an effective option for the acute treatment of postconcussion symptoms, particularly in young athletes presenting with a high symptom burden

The first decade of web-based sports injury surveillance: Descriptive epidemiology of injuries in US high school boys' ice hockey (2008-2009 through 2013-2014) and National Collegiate Athletic Association men's and women's ice hockey (2004-2005 through 2013-2014)

Context: Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided efforts to collect data on ice hockey injuries. Objective: To describe the epidemiology of injuries sustained in high school boy's ice hockey in the 2008-2009 through 2013-2014 academic years and collegiate men's and women's ice hockey in the 2004-2005 through 2013-2014 academic years using Web-based surveillance. Design: Descriptive epidemiology study. Setting: Online injury surveillance of ice hockey teams of high school boys (annual average ¼ 34), collegiate men (annual average ¼ 20), and collegiate women (annual average ¼ 11). Patients or Other Participants: Boys', men's, and women's ice hockey players who participated in practices and competitions during the 2008-2009 through 2013-2014 high school academic years or the 2004-2005 through 2013-2014 collegiate academic years. Main Outcome Measure(s): Athletic trainers collected time-loss (24 hours) injury and exposure data. We calculated injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis. Results: The High School Reporting Information Online system documented 831 boys' ice hockey time-loss injuries during 356 997 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 2611 men's ice hockey time-loss injuries during 552 642 AEs and 752 women's ice hockey injuries during 232 051 AEs. Injury rates were higher in collegiate men than in high school boys during 2008-2009 through 2013-2014 (4.38 versus 2.33/1000 AEs; IRR ¼ 1.88; 95% CI ¼ 1.73, 2.05) and collegiate women during 2004-2005 through 2013-2014 (IRR ¼ 1.46; 95% CI ¼ 1.34, 1.58). Most injuries occurred during competitions (boys ¼ 80.0%, men ¼ 66.9%, women ¼ 55.3%); injury rates were higher in competitions than in practices for boys (IRR ¼ 8.14; 95% CI ¼ 6.87, 9.65), men (IRR ¼ 6.58; 95% CI ¼ 6.06, 7.13), and women (IRR ¼ 3.63; 95% CI ¼ 3.14, 4.19). At all levels, most injuries occurred to the head/face and shoulder/clavicle and resulted in concussions, contusions, or ligament sprains. Conclusions: Injury rates varied across sports but were consistently higher in competitions than in practices. In competitions, concussions were common injuries, highlighting the need for continued development of injury-prevention strategies

The first decade of web-based sports injury surveillance: Descriptive epidemiology of injuries in US High School Girls' Field Hockey (2008-2009 Through 2013-2014) and National collegiate athletic association women's field hockey (2004-2005 through 2013-2014)

Context: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of data for girls' and women's field hockey injuries. Objective: To describe the epidemiology of injuries sustained in high school girls' field hockey in the 2008-2009 through 2013-2014 academic years and collegiate women's field hockey in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance. Design: Descriptive epidemiology study. Setting: Online injury surveillance from field hockey teams in high school girls (annual average=61) and collegiate women (annual average = 14). Patients or Other Participants: Girls' and women's field hockey players who participated in practices and competitions during the 2008-2009 through 2013-2014 high school academic years and the 2004-2005 through 2013-2014 collegiate academic years. Main Outcome Measure(s): Athletic trainers collected timeloss (≥24 hours) injury and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis were calculated. Results: The High School Reporting Information Online system documented 983 time-loss injuries during 569 551 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 996 time-loss injuries during 185 984 AEs. The injury rate from 2008-2009 through 2013-2014 was higher in college than in high school (3.25 versus 1.73/1000 AEs; IRR= 1.89; 95% CI = 1.63, 2.18). Most injuries occurred during practices in high school (52.0%) and college (60.7%). Injury rates were higher during competitions than practices in high school (IRR = 2.00; 95% CI = 1.76, 2.26) and college (IRR = 1.96; 95% CI = 1.73, 2.23). At both levels, injuries most commonly occurred to the lower extremity and head/face and resulted in muscle/tendon strains and contusions. However, injury patterns varied between practices and competitions. Conclusions: Injury rates and patterns varied across age groups and between practices and competitions, highlighting the need for development of targeted injury-prevention strategies at both levels of play