A controlled early-exercise rehabilitation program commencing within 48 hours of a Sports-Related Concussion improves recovery in UK student-athletes: A prospective cohort study.

OBJECTIVES: Explore if implementing an individualised Sub-Symptom Heart Rate Threshold (SSHeRT) rehabilitation program within 48 hours versus physical rest for 14 days affects recovery following SRC in university-aged student-athletes. DESIGN: Prospective, observational cohort study. METHODS: Two UK university-aged student-athlete rugby union cohorts were compared (Physical Rest Group (PRG), n = 140, July 2019-March 2020 and Controlled Early-Exercise Group (CEG), n = 167, July 2021-April 2023). Both groups completed the test battery (Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion and Cognitive Test (ImPACT), Vestibular-Ocular Motor Screening Tool (VOMS)) during pre-season to provide a baseline and within 48 hours, at 4, 8, 14-days post-SRC and at Return to Play (RTP). The PRG (n = 42) physically rested for 14 days as per the nationwide community guidelines. The CEG (n = 52) followed the SSHeRT rehabilitation program. Individual change to baseline was used in all analyses. RESULTS: The CEG performed better on ImPACT's verbal memory at 4 (PRG; -5.5 (-10.8-0.0), CEG; 1.0 (-2.0-10.5), p = 0.05) and 14 days (PRG; -2.0 (-10.0-3.0), CEG; 4.0 (-1.0-11.0), p = 0.05) and on the VOMS at 4 (PRG; 3.0 (0.0-12.0), CEG; 0.0 (0.0-5.0), p = 0.03, OR; 2.910) and 14-days post-SRC (PRG; 0.0 (0.0-1.0), CEG; 0.0 (0.0-0.0), OR; 5.914). Near point convergence was better at all time points for the CEG. The CEG was 26.7 % more likely to have RTP within 30 days, and 6.7 and 5.1 times more likely to have resumed non-contact and contact academic activities by 4 days. CONCLUSIONS: SSHeRT is safe, can be used within 48 hours of a SRC and may hasten university-aged student-athletes recovery following an SRC.

The Effectiveness of Home-Based Exergames Training on Cognition and Balance in Older Adults: A Comparative Quasi-Randomized Study of Two Exergame Interventions.

Background and Objectives: The effectiveness of exergames on fall risk and related physical and cognitive function in older adults is still unclear, with conflicting findings. The discrepancy in these results could be due to the different components and task-specific demands of individual exergame interventions. This open-label quasi-randomized study aimed to compare the efficacy of 2 different home-based dual-task exergame treatments on cognition, mobility, and balance in older people. Research Design and Methods: Fifty older adults (65-85 years of age) were allocated to one of two 8-week exergame interventions: Cognitive-Intensive Exergame Training (CIT) or Physical-Intensive Exergame Training (PIT). Cognitive functions, balance, and mobility were assessed at baseline and after 8 weeks. Group × time interaction was measured by repeated-measure ANOVA, and both intention-to-treat (ITT) and per-protocol (PP) analyses were performed to assess the effectiveness of exergame interventions. Results: ITT analyses showed that improvement in visual processing speed and visuospatial working memory was greater in the CIT group, with a medium effect size (p = .04; η2 = 0.09 and p = .01; η2 = 0.12). The improvement in verbal memory and attention was significant within both groups (p < .05), but this improvement was not different between the groups (p > .05). A significant improvement in balance was also observed in the PIT group, with a medium effect size (p = .04; η2 = 0.09). Although mobility improved significantly in both groups (p < .01), there was no significant difference between groups (p = .08). These results were largely supported by the PP analysis. Discussion and Implications: Dual-task exergame training can improve mobility and cognition in older adults. However, the different cognitive and physical demands of these interventions may have varying impacts on fall risk and related physical or cognitive functions. Therefore, a training program that includes both cognitive and physical domains with appropriate intensity is essential for the development of tailored exergame interventions to reduce fall risk in older adults.

Earlier detection facilitates skilled responses to deceptive actions.

High-skilled and recreational rugby players were placed in a semi-immersive CAREN Lab environment to examine susceptibility to, and detection of, deception. To achieve this, a broad window of seven occlusion times was used in which participants responded to life-size video clips of an opposing player 'cutting' left or right, with or without a deceptive sidestep. Participants made full-body responses to 'intercept' the player and gave a verbal judgement of the opponent's final running direction. Response kinematic and kinetic data were recorded using three-dimensional motion capture cameras and force plates, respectively. Based on response accuracy, the results were separated into deception susceptibility and deception detection windows then signal detection analysis was used to calculate indices of discriminability between genuine and deceptive actions (d') and judgement bias (c). Analysis revealed that high-skilled and low-skilled players were similarly susceptible to deception; however, high-skilled players detected deception earlier in the action sequence, which enabled them to make more effective behavioural responses to deceptive actions.

The effect of uphill and downhill slopes on centre of pressure movement, alignment and shot outcome in mid-handicap golfers.

The aim of the study was to examine changes in centre of pressure (COP) movement, alignment and shot outcome during golf shots from flat, uphill, and downhill slopes by mid-handicap golfers. Twelve male golfers hit balls with a six-iron from the flat and 5° slopes while kinematics and kinetics of the swing were collected. A launch monitor measured performance outcomes. A shift in the COP was found during the backswing when playing on a slope, but disappeared during the downswing. Golfers attempted to align the body perpendicular to the slope at the start of the swing resulting in COP movement towards the lower foot, but were not able to maintain this throughout the swing, like low handicap golfers. There was no significant difference in stance width, but golfers placed the ball closer to the uphill foot on a slope. Ball speed was not significantly affected by the slope, but launch angle and ball spin were. Golfers were more likely to hit shots to the left from an uphill slope and to the right for a downhill slope. No consistent compensatory adjustments in alignment at address were found, with differences in final ball position due to lateral spin.

The Effect of Uphill and Downhill Slopes on Weight Transfer, Alignment, and Shot Outcome in Golf.

The aim of the study was to examine changes in weight transfer, alignment, and shot outcome during golf shots from flat, uphill, and downhill slopes. Twelve elite male golfers hit 30 shots with a 6-iron from a computer-assisted rehabilitation environment used to create 5° slopes while collecting 3-dimensional kinematics and kinetics of the swing. A launch monitor measured performance outcomes. A shift in the center of pressure was found throughout the swing when performed on a slope, with the mean position moving approximately 9% closer to the lower foot. The golfers attempted to remain perpendicular to the slope, resulting in weight transfer toward the lower foot. The golfers adopted a wider stance in the sloped conditions and moved the ball toward the higher foot at address. Ball speed was not significantly affected by the slope, but launch angle and ball spin were. As the coaching literature predicted, golfers were more likely to hit shots to the left from an uphill slope and to the right from a downhill slope. No consistent compensatory adjustments in alignment at address or azimuth were found, with the change in final shot dispersion resulting from the lateral spin of the ball.

Balance control strategies during perturbed and unperturbed balance in standing and handstand.

Insights into sensorimotor control of balance were examined by the assessment of perturbed and unperturbed balance in standing and handstand postures. During perturbed and unperturbed balance in standing, the most prevalent control strategy was an ankle strategy, which was employed for more than 90% of the time in balance. During perturbed and unperturbed balance in handstand, the most prevalent control strategy was a wrist strategy, which was employed for more than 75% of the time in balance. In both postures, these strategies may be described as a single segment inverted pendulum control strategy, where the multi-segment system is controlled by torque about the most inferior joint with compensatory torques about all superior joints acting in the same direction to maintain a fixed orientation between superior segments. In contrast to previous literature, surprisingly little time was spent in a mixed strategy, representing less than 1% of time in standing balance and approximately 2% of time in handstand balance. Findings indicate that although the central nervous system may employ a number of control strategies during a trial, these strategies are employed individually rather than simultaneously.

The effect of ball impact location on racket and forearm joint angle changes for one-handed tennis backhand groundstrokes.

Recreational tennis players tend to have higher incidence of tennis elbow, and this has been hypothesised to be related to one-handed backhand technique and off-centre ball impacts on the racket face. This study aimed to investigate for a range of participants the effect of off-longitudinal axis and off-lateral axis ball-racket impact locations on racket and forearm joint angle changes immediately following impact in one-handed tennis backhand groundstrokes. Three-dimensional racket and wrist angular kinematic data were recorded for 14 university tennis players each performing 30 "flat" one-handed backhand groundstrokes. Off-longitudinal axis ball-racket impact locations explained over 70% of the variation in racket rotation about the longitudinal axis and wrist flexion/extension angles during the 30 ms immediately following impact. Off-lateral axis ball-racket impact locations had a less clear cut influence on racket and forearm rotations. Specifically off-longitudinal impacts below the longitudinal axis forced the wrist into flexion for all participants with there being between 11° and 32° of forced wrist flexion for an off-longitudinal axis impact that was 1 ball diameter away from the midline. This study has confirmed that off-longitudinal impacts below the longitudinal axis contribute to forced wrist flexion and eccentric stretch of the wrist extensors and there can be large differences in the amount of forced wrist flexion from individual to individual and between strokes with different impact locations.

Evaluating feedback time delay during perturbed and unperturbed balance in handstand.

Feedback delays in balance are often assessed using muscle activity onset latencies in response to discrete perturbations. The purpose of the study was to calculate EMG latencies in perturbed handstand, and determine if delays are different to unperturbed handstand. Twelve national level gymnasts completed 12 perturbed and 10 unperturbed (five eyes open and five closed) handstands. Forearm EMG latencies during perturbed handstands were assessed against delay estimates calculated via: cross correlations of wrist torque and COM displacement, a proportional and derivative model of wrist torque and COM displacement and velocity (PD model), and a PD model incorporating a passive stiffness component (PS-PD model). Delays from the PD model (161±14ms) and PS-PD model (188±14ms) were in agreement with EMG latencies (165±14ms). Cross correlations of COM displacement and wrist torque provided unrealistically low estimates (5±9ms). Delays were significantly lower during perturbed (188±14ms) compared to unperturbed handstand (eyes open: 207±12ms; eyes closed: 220±19ms). Significant differences in delays and model parameters between perturbed and unperturbed handstand support the view that balance measures in perturbed testing should not be generalised to unperturbed balance.