Preseason Vestibular Ocular Motor Screening in Children and Adolescents.

OBJECTIVES: The primary purpose of this study was to examine vestibular/ocular motor screening (VOMS) test performance in a sample of healthy youth ice hockey players. A particular focus was to investigate the potential effects of age and pre-existing health conditions, including concussion history, attention-deficit/hyperactivity disorder (ADHD), learning disability (LD), headaches/migraines, and depression/anxiety on preseason baseline VOMS performance, including the near point of convergence (NPC) distance. DESIGN: Cross-sectional cohort. SETTING: Outpatient physiotherapy clinic. PARTICIPANTS: Three hundred eighty-seven male youth hockey players, with an average age of 11.9 years (SD = 2.2, range = 8-17), completed the VOMS and responded to self- or parent-reported demographic and medical history questionnaires during preseason baseline assessments. INDEPENDENT VARIABLES ASSESSED: Age, sex, and mental and physical health history including ADHD, headaches, depression, anxiety, migraine, and LD. OUTCOME MEASURE: Vestibular/ocular motor screening. RESULTS: The large majority of boys scored within normal limits on the VOMS, ie, they reported no symptom provocation of more than 2 points on any VOMS subset (89%) and had a normal NPC distance, ie, <5 cm (78%). The individual VOMS subtests had low abnormality rates, and demographic and pre-existing health conditions, such as age, headache or migraine history, previous neurodevelopmental conditions, or mental health problems, were not associated with clinically meaningful symptom provocation during the VOMS. CONCLUSIONS: There was a low rate of abnormal findings for the individual VOMS subtests, with the exception of NPC distance, among male youth hockey players during preseason assessment.

Influence of emotional stimuli on lower limb cutaneous reflexes during human gait.

Previous research has shown that cutaneous reflexes are modulated when walking with a threat to stability. It is unclear if this reflex modulation is purely related to the context of the imposed threat or if emotional changes associated with the threat exert an independent influence on reflex excitability. This study investigated the influence of emotional stimuli on lower limb cutaneous reflexes during treadmill walking. Twenty-eight healthy young adults walked at a self-selected pace while viewing pictures that manipulated emotional arousal and valence (confirmed with electrodermal and self-report measures). Throughout each trial, cutaneous reflexes were evoked by electrically stimulating the sural nerve at heel contact, mid-stance, or toe off. Surface electromyography of the ipsilateral soleus (SOL), medial gastrocnemius (MG), tibialis anterior (TA), biceps femoris (BF), and vastus lateralis (VL) was recorded to assess reflexes. Highly arousing pictures, independent of valence, significantly facilitated TA, and trended toward facilitating SOL and BF reflexes during mid-stance. Unpleasant pictures, independent of arousal, significantly reduced reflex amplitudes in BF during mid-stance and TA during toe off. While changes in background muscle activity and step cadence were observed, they did not correlate with reflex changes. This study provides the first evidence that emotional stimuli exert an independent influence on cutaneous reflex excitability during gait. As cutaneous reflexes contribute to stability during gait, these findings support the notion that emotional state influences important sensorimotor processes underlying balance control.

Attention-deficit/hyperactivity disorder is associated with baseline child sport concussion assessment tool third edition scores in child hockey players.

OBJECTIVES: The objectives of this study were to report baseline, preseason data for the Child-SCAT3, stratified by attention deficit hyperactivity disorder (ADHD) status, and examine group differences in Child-SCAT3 performance between children with and without ADHD. DESIGN: Cross-sectional study. METHODS: Young male hockey players (n = 304), aged 8-12 years, were administered the Child-SCAT3 during pre-season. Child-SCAT3 measures included a 20-item symptom scale, a Standardised Assessment of Concussion Child Version (SAC-C), a modified Balance Error Scoring System (m-BESS), a tandem gait task, and a coordination test. RESULTS: Children with ADHD (n = 20) endorsed significantly more symptoms (d = 0.95) and greater symptom severity (d = 1.13) compared to children without ADHD. No statistically significant differences were found between groups on Child-SCAT3 measures of cognitive or physical functioning (e.g. balance and coordination). CONCLUSIONS: ADHD should be considered when interpreting Child-SCAT3 scores, especially symptom reporting, in the context of concussion assessment. Better understanding of symptom reporting in uninjured child athletes with ADHD can inform the clinical interpretation of symptoms at baseline and following an actual or suspected concussion. Normative data for the Child-SCAT3 that is not stratified by or otherwise accounts for ADHD status should be used with caution when appraising performance of children with ADHD.