High School Competitive Diving Injuries: National Athletic Treatment Injury and Outcomes Network (NATION)

Purpose: Elite diving coaches and USA diving officials have become increasingly concerned about injury prevention among adolescent divers. However, little is known about such injuries. The purpose of this study was to describe the injuries among high school students who participated on high school diving teams. Subjects: High school students who participated on the diving teams of high schools that were included in the National Athletic Treatment, Injury and Outcomes Network (NATION) for 2011–2014. Methods: Descriptive epidemiology using injury exposure data on 56 boys\u27 Swimming and Diving teams and 55 girls\u27 Swimming and Diving teams from the National Athletic Treatment, Injury and Outcomes Network (NATION) for 2011–2014. Results: Only 12 injuries were reported, and 8 (67%) were concussions. The incidence of concussions was the same between boys and girls. Conclusion: Concussions are the highest reported injury among high school divers in the NATION data. Student athletes who had minor injuries may not have been evaluated by an athletic trainer. Researchers need better injury surveillance data for high school divers

The Effect of Concussion History on Lower Extremity Injury Risk in High School and Collegiate Athletes: A Systematic Review and Meta-Analysis

Sport-related concussions are a prevalent injury that result in sensorimotor dysfunction and altered neuromuscular control. Individuals recovering from a concussion display decreased postural sway during balance assessment and may possess prolonged balance deficits after return-to-play (RTP). Athletes who are experiencing impairments following RTP after a concussion may be at increased risk of lower extremity (LE) injury. The purpose of this study was to conduct a systematic review and meta-analysis of studies examining risk of LE musculoskeletal injury following a concussion in high school and collegiate athletes. An electronic database search of PubMed, CINAHL, MEDLINE, and SPORTDiscus was conducted on November 19, 2019 using the following terms: (“lower extremity” AND “injury” AND “concussion”). Articles were included if they were published between January 2000 and November 2019 and examined high school or collegiate athletes’ risk of sustaining a LE musculoskeletal injury following a concussion. Methodological quality of included studies was performed with the modified Downs and Black Checklist. Random effects meta-analysis modeling calculated summative relative risk (RR) for studies that reported sufficient data. Sixtyfive studies were initially retrieved. Following removal of duplicates and abstract assessment, nine studies were included in the systematic review. Eight of the studies were of good or excellent quality. Five of the nine studies were included in the meta-analysis. High school and college athletes who suffered a concussion possessed a 49% greater risk of sustaining a LE musculoskeletal injury than those without a history of a concussion (RR = 1.49[1.04, 2.14]). Therefore, LE injury risk is potentially increased in high school and college athletes following a concussion compared to those without recent history of concussion. Further research is needed to investigate the mechanism behind this increased risk. Clinical assessments throughout the concussion RTP protocol may need to be improved in order to detect lingering impairments caused by concussions.https://digitalcommons.odu.edu/gradposters2021_healthsciences/1008/thumbnail.jp

Effects of Increased Attention Allocation on Postural Stability Related to History of Concussion

Postural instability is among the most common symptoms associated with concussion. However, clinical screenings for concussion are heavily reliant on self-reports of cognitive symptoms such as nausea and headache to determine if a full recovery has been achieved. The objective of this study was to determine if impairments of postural stability that are associated with the acute stages of concussion persist beyond the current clinical standards for determination of recovery from concussion. Fifty-four healthy participants were recruited for the study and divided based on whether they reported having no history of concussion (n = 27) or whether they had been previously diagnosed with one or more concussions (n = 27). Individuals reporting a history of concussion averaged 2.26 (± 1.40) diagnoses and 6.91 (± 5.67) years since their most recent injury. Postural stability was assessed by having all participants stand on a force plate in order to track the center-of-pressure of their standing sway on both one and two legs, and under a single and dual-task condition implemented in the form of a concurrent cognitive task. Results revealed that individuals with a prior history of concussion exhibited greater postural sway displacement in the anterior-posterior (AP) plane (p = 0.033) as well as greater elliptical area of sway (p = 0.01) and reductions in sway regularity (p = 0.008) under dual-task conditions compared to individuals reporting no history of concussion. These findings indicate that balance impairments associated with concussion persist well beyond the resolution of cognitive symptoms. In particular, the results suggest that damage to neural tissue sustained from a concussion can impair an individual’s ability to allocate attention to multiple tasks at once and that these deficits can remain for years following the initial injury.https://digitalcommons.odu.edu/gradposters2020_healthsciences/1003/thumbnail.jp

The Effect of Concussion History on Lower Extremity Injury Risk in College Athletes: A Systematic Review and Meta Analysis

INTRODUCTION: Collegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury. OBJECTIVE: To conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes. METHODS: A literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, [ concussion OR brain injury OR mild traumatic brain injury OR mTBI ] AND [ lower extremity injury OR musculoskeletal injury ]. Articles were included if they were published between January 2000 and July 2021 and examined collegiate athletes\u27 risk of sustaining a lower extremity musculoskeletal injury following a concussion. Methodological quality of included studies was performed with a modified Downs and Black Checklist. The primary outcome of interest was the risk of sustaining a lower extremity musculoskeletal injury following a concussion. A random effects meta-analysis was conducted in which a summative relative risk (RR) for sustaining a lower extremity injury in athletes with and without a history of concussion was calculated. RESULTS: Seven studies met the eligibility criteria to be included in the systematic review. There were 348 athletes in the concussion group and 482 control athletes in the included studies. Most of the studies were of good or excellent quality. Five of the seven studies were able to be included in the meta-analysis. College athletes who suffered a concussion possessed a 58% greater risk of sustaining a lower extremity musculoskeletal injury than those who did not have a history of a concussion (RR = 1.58[1.30, 1.93]). CONCLUSIONS: Lower extremity injury risk is potentially increased in college athletes following a concussion compared to those without a history of a concussion. Further research is needed to investigate the mechanism behind this increased risk. Clinical assessments throughout the concussion return-to-play protocol may need to be improved in order to detect lingering impairments caused by concussions. LEVEL OF EVIDENCE: 1

A Systematic Review of Center of Mass as a Measure of Dynamic Postural Control Following Concussion

BACKGROUND: The incidence of sports-related concussion in the US is between 1.6-3.8 million annually. Identification of ongoing impairment post-concussion continues to be challenging, as research indicates many patients are cleared for return to activity while still suffering subclinical impairment of function. Purpose: To identify and review the current literature on the use of center of mass (COM) during gait as a potential indicator variable after concussive injury. Study Design: Systematic Review. METHODS: A Pubmed search was undertaken utilizing search terms involving gait performance and concussion. Study inclusion criteria included: (1) COM used as a variable in data analysis, (2) study population included individuals diagnosed with concussion, (3) postural control was evaluated throughout the recovery process. Articles were excluded if they were systematic reviews, unedited manuscripts, meta-analyses, or were more than 15 years old. RESULTS: Search of the PubMed database identified six articles which matched the determined criteria. The average STROBE score was 26.5/34 (range from 23-30). The areas that had the poorest scoring were bias, study size, statistical methods, participants, descriptive data, and main results. Results of the review indicate that COM displacement was higher in concussion groups with a sufficiently taxing task, such as a dual task paradigm. CONCLUSION: Center of mass measures during gait may be an indicator of ongoing concussive injury involvement after clinical indications have subsided. LEVEL OF EVIDENCE: 2a

Models of Video Feedback for Youth Athletes Performing an American Football Tackle

Context: Video feedback is an expeditious method for improving athlete safety when performing activities with an inherent risk of injury. Providing appropriate and validated feedback during tackling training in American football may be a mechanism for athletes to learn safe tackling performance. Objective: To determine the effect of video feedback in the instruction of tackling form. Design: Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 32 youth football athletes (28 boys, 4 girls; age ¼ 11.8 6 0.8 years) participated in 1 day of training. Of those, 14 participants completed 2 additional days of training and a 48-hour retention and transfer test. Intervention(s): Video feedback using self as model, expert as model, combined self and expert model, and oral feedback to promote safe tackling performance in a laboratory environment. Main Outcome Measure(s): Shoulder extension, cervical extension, trunk angle, pelvis height, and step length by training block and over time. Results: For the 1-day training group, main effects for time were observed for shoulder extension (P\u3c .01), cervical extension (P = .01), pelvis height (P\u3c .01), and step length (P\u3c .01), with better performance for pelvis height and step length after combined feedback. For the 3-day training group, main effects of time were identified in pelvis height (P\u3c .01) and step length (P\u3c .01), with combined feedback showing better performance than other methods in shoulder extension and pelvis height. Combined feedback resulted in better performance compared with its component parts and oral feedback alone. In the combined model, participants viewed both their performance and the expert model, enabling them to see the difference between current and required performance. Conclusions: Combined feedback may be superior to other forms of feedback in improving movement performance. This effect can be generalized across disciplines that provide instruction and feedback in movement

Comparison of a Head Mounted Impact Measurement Device to the Hybrid III Anthropomorphic Testing Device in a Controlled Laboratory Setting

Background: Reports estimate that 1.6 to 3.8 million cases of concussion occur in sports and recreation each year in the United States. Despite continued efforts to reduce the occurrence of concussion, the rate of diagnosis continues to increase. The mechanisms of concussion are thought to involve linear and rotational head accelerations and velocities. One method of quantifying the kinematics experienced during sport participation is to place measurement devices into the athlete’s helmet or directly on the athlete’s head. Purpose: The purpose of this research to determine the accuracy of a head mounted device for measuring the head accelerations experienced by the wearer. This will be accomplished by identifying the error in Peak Linear Acceleration (PLA), Peak Rotational Acceleration (PRA) and Peak Rotational Velocity (PRV) of the device. Study Design: Laboratory study. Methods: A helmeted Hybrid III 50th percentile male headform was impacted via a pneumatic ram from the front, side, rear, front oblique and rear oblique at speeds from 1.5 to 5 m/s. The X2 Biosystems xPatch® (Seattle, WA) sensor was placed on the headform’s right side at the approximate location of the mastoid process. Measures of PLA, PRA, PRV from the xPatch ® and Hybrid III were analyzed for Root Mean Square Error (RMSE), and Absolute and Relative Error (AE, RE). Result: Seventy-six impacts were analyzed. All measures of correlation, fixed through the origin, were found to be strong: PLA R2 =0.967 p \u3c 0.01, PRA R2 =0.933 p \u3c 0.01, PRV R2 =0.999 p \u3c 0.00. PLA RMSE was 34%, RE 31.0% ± 14.0, and AE 31.1% ± 13.7. PRA RMSE was 23.4%, RE -6.7 ± 22.4 and AE 18.9% ± 13.8. PRV RMSE was 2.2%, RE 0.1 ± 2.2, and AE 1.8 ± 1.3. Conclusion: Without including corrections for effect of skin artifact, the xPatch® produces measurements highly correlated with the gold standard yet above the average error of testing devices in both PLA and PRA, but a low error in PRV. PLA measures from the xPatch® system demonstrated a high level of correlation with the PLA data from the Hybrid III mounted data collection system. Level of Evidence:

Epidemiology of Knee Sprains in Youth, High School, and Collegiate American Football Players

Context: Assessment of health-related quality of life (HRQOL) after injury is important. Differences in HRQOL between nonathletes and athletes and between injured and uninjured athletes have been demonstrated; however, the evidence has not been synthesized. Objective: To answer the following questions: (1) Does HRQOL differ among adolescent and collegiate athletes and nonathletes? (2) Does HRQOL differ between injured adolescent and collegiate athletes or between athletes with a history of injury and uninjured athletes or those without a history of injury? Data Sources: We systematically searched CINAHL, MEDLINE, SPORTDiscus, and PubMed. A hand search of references was also conducted. Study Selection: Studies were included if they used generic instruments to compare HRQOL outcomes between athletes and nonathletes and between uninjured and injured athletes. Studies were excluded if they did not use a generic instrument, pertained to instrument development, or included retired athletes or athletes with a chronic disease. Data Extraction: We assessed study quality using the modified Downs and Black Index Tool. Bias-corrected Hedges g effect sizes and 95% confidence intervals (CIs) were calculated. The Strength of Recommendation Taxonomy (SORT) was used to determine the overall strength of the recommendation. A random-effects meta-analysis was performed for all studies using the composite or total score. Data Synthesis: Eight studies with modified Downs and Black scores ranging from 70.6% to 88.4% were included. For question 1, the overall random-effects meta-analysis was weak (effect size = 0.27, 95% confidence interval = 0.14, 0.40; P \u3c .001). For question 2, the overall random-effects meta-analysis was moderate (effect size = 0.68, 95% confidence interval = 0.42, 0.95; P \u3c .001). Conclusions: Grade A evidence indicates that athletes reported better HRQOL than nonathletes and that uninjured athletes reported better HRQOL than injured athletes. However, the overall effect for question 1 was weak, suggesting that the differences between athletes and nonathletes may not be clinically meaningful. Clinicians should monitor HRQOL after injury to ensure that all dimensions of health are appropriately treated

Inter-Rater Agreement and Validity of a Tackling Performance Assessment Scale in Youth American Football

Background: Long term neurologic injury and concussion have been identified as risks from participation in American football. Altering tackling form has been recommended to reduce the risk of neurologic injury caused by head accelerations when tackling. The purpose of this research is to determine the inter-rater agreement and validity of the Qualitative Youth Tackling System (QYTS), a six-item feedback scale to correct tackling form, when utilized by novice and expert raters. Hypothesis: Experienced raters will have higher levels of agreement with each other and with motion capture when compared to novice raters. Methods: Both novice and experienced raters viewed video of youth athletes (ages 9-13) tackling a dummy in a laboratory setting along. The raters identified successful performance according to a binary rating scale for each component. Analysis of both the raters\u27 agreement with each other and with an objective motion capture measure were completed. Results: Fliess\u27 Kappa measures between all raters were found to be moderate for head placement (k=.48), fair for cervical extension (k=.38), trunk inclination (k=.37), shoulder extension (k=.27) and step length (k=.29), and there was no agreement for pelvic height (k=.-16). When compared to the dichotomized validation measures of each of the five components provided by the motion capture system the average Cohen\u27s Kappa agreement was substantial for pelvic height (k=.63), fair for step length (k=.34), cervical extension (k=.40), trunk inclination (k=.35), and slight for shoulder extension (k=.16). The experienced raters out-performed the novice raters in all categories. Conclusion: The results of this study indicate that skilled raters are better able to identify the movement patterns included in the QYTS when compared to a validation measure as well have higher rates of interrater agreement than novice raters. Level of Evidence: 3