Sensitivity and Specificity of a Multimodal Approach for Concussion Assessment in Youth Athletes.

CONTEXT: Current international consensus endorses a multimodal approach to concussion assessment. However, the psychometric evaluation of clinical measures used to identify postconcussion performance deficits once an athlete is asymptomatic remains limited, particularly in the pediatric population. OBJECTIVE: To describe and compare the sensitivity and specificity of a multimodal assessment battery (balance, cognition, and upper and lower body strength) versus individual clinical measures at discriminating between concussed youth athletes and noninjured controls when asymptomatic. DESIGN: Prospective cohort study. SETTING: Hospital laboratory setting. PARTICIPANTS: A total of 32 youth athletes with a concussion and 32 matched (age and sex) noninjured control participants aged 10-18 years. INTERVENTION(S): Participants were administered preinjury (baseline) assessments of cognition (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]), balance (BioSway), and upper and lower body strength (grip strength and standing long jump). Assessments were readministered when concussed participants reported symptom resolution (asymptomatic time point). Noninjured control participants were reassessed using the same time interval as their concussion matched pair. Sensitivity and specificity were calculated using standardized regression-based methods and receiver operating characteristic curves. MAIN OUTCOME MEASURES: Outcome measures included baseline and postinjury ImPACT, BioSway, grip strength, and standing long jump scores. RESULTS: When asymptomatic, declines in performance on each individual clinical measure were seen in 3% to 22% of the concussion group (sensitivity = 3%-22%) compared with 3% to 13% of the noninjured control group (specificity = 87%-97%) (90% confidence interval). The multimodal battery of all combined clinical measures yielded a sensitivity of 41% and a specificity of 77% (90% confidence interval). Based on discriminative analyses, the multimodal approach was statistically superior compared with an individual measures approach for balance and upper and lower body strength, but not for cognition. CONCLUSIONS: Results provide a foundation for understanding which domains of assessment (cognition, balance, and strength) may be sensitive and specific to deficits once symptoms resolve in youth athletes. More work is needed prior to clinical implementation of a preinjury (baseline) to postinjury multimodal approach to assessment following concussion in youth athletes.

Grip Strength in Youth Ice Hockey Players: Normative Values and Predictors of Performance.

Toong, T, Wilson, KE, Urban, K, Paniccia, M, Hunt, AW, Keightley, M, and Reed, N. Grip strength in youth ice hockey players: Normative values and predictors of performance. J Strength Cond Res 32(12): 3503-3511, 2018-Grip strength is a simple, valid, and reliable tool for estimating overall muscular strength, a key component of health-related fitness and sport performance. To date, there is a paucity of up-to-date and developmentally sensitive grip strength norms specific to youth-athlete populations. The objectives of this study are to (a) establish normative grip strength values in youth ice hockey players, (b) descriptively compare these values with existing Canadian pediatric norms, and (c) explore the relationship between age, sex, body mass, and hockey playing level on grip strength performance. A sample of 690 male and female youth ice hockey players between the ages of 10 and 16 years were included. Participants completed assessments of maximal grip strength using a hand dynamometer on both hands. In addition, age, sex, body mass, and hockey playing level were collected. Maximal absolute grip strength, stratified by age and sex, was higher than previously published Canadian pediatric norms. Grip strength increased with age in both sexes. Males and females performed similarly until 12 years of age, after which point males had greater strength. Individuals with greater body mass had greater strength. For the nondominant hand, competitive players had greater strength than those playing house league or select. This study describes normative grip strength values in youth ice hockey players according to age, sex, body mass, and playing level. These athlete-specific norms may be used to help evaluate and monitor changes in grip strength over time in youth ice hockey players.

A narrative review on cervical interventions in adults with chronic whiplash-associated disorder.

Introduction: Whiplash injuries are common in society, but clinical interventions are inconclusive on the most effective treatment. Research and reviews have been completed with the goal of determining clinical interventions that are effective for whiplash injuries and disorders, but literature has not recently been summarised on best practices for cervical spine interventions for adults with chronic whiplash. Purpose: The objective of this narrative review is to update and expand on previous works, to provide recommendations for clinical interventions and future research in the area of cervical spine rehabilitation for adults with chronic whiplash-associated disorder. Method: The Arskey and O'Malley methodology was used for this narrative review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched from 2003 to April 2017. Two reviewers screened titles and abstracts for relevance to the review, and content analysis summarised the study findings. A total of 14 citations were included in the final review. Findings: Exercise-based interventions targeted at the cervical spine appear most beneficial for adults with chronic whiplash-associated disorder (WAD). Invasive interventions still require more rigorous studies to deem their effectiveness for this population. Conclusion: Further research is required to investigate and determine clinically relevant results for cervical spine intervention in patients with chronic WAD.