Concussion history is not a predictor of computerised neurocognitive performance.

BACKGROUND: The long term effects of self reported concussion on neurocognitive functioning have been found to be variable. OBJECTIVES: To evaluate cognitive performance on the Headminder concussion resolution index (CRI) and ImPACT assessment tests of subjects with and without a history of self reported concussion. METHODS: A retrospective analysis was completed on 235 Headminder CRI baseline assessments and 264 ImPACT baseline assessments. Participants were divided into four groups on the basis of reported number of concussions (zero, one, two, or three). Multivariate analysis of variance was used to evaluate differences between the concussion history groups on the two computer based concussion assessment programs. RESULTS: Multivariate analysis of variance indicated no significant difference between those with and without a history of concussion on the CRI (Lambda = 0.963, F((15, 627.05)) = 0.57, p = 0.898). It also revealed no significant differences between groups on the ImPACT test (Lambda = 0.951, F((12, 672.31)) = 1.07, p = 0.381). CONCLUSIONS: The results suggest that either long term cognitive decrements may not be associated with a history of concussion or the decrements may be subtle and undetectable by these computer programs.

Injury severity and neuropsychological and balance outcomes of four college athletes.

Recent evidence suggests significant short-term neurocognitive deficits following mild traumatic brain injury (MTBI) in sports. However, sequelae of mild head injuries is complicated by many factors including a history of multiple head injuries and injury severity. Few studies have considered the influence these variables may have on proper classification of a MTBI and their meaning for return-to-play guidelines. This study presents the short-term neuropsychological and balance outcomes of four college athletes who sustained mild head injuries of different severity (grade I, grade II, grade III and multiple head injured with a grade II based on American Academy of Neurology guidelines). The results demonstrated that self-report symptoms of concussion were slow to resolve in the grade III and multiple concussed individuals. For neuropsychological testing, Trails A & B, Symbol Digit Modalities Test and Digits Span Backwards were the most sensitive in identifying differences between the injuries. For balance assessments using the Neurocom Smart Balance System, the Sensory Organization Test and Reaction Time were also important variables in detecting differences among the various injuries. When these data are used together, it can assist physicians in determining safe return-to-play for athletes who sustain MTBI. There are contradindications in the numerous grading systems and return-to-play guidelines for MTBI. The results from this study provides new evidence which can be assimilated into a valid grading scale for MTBI sustained in sport.

Injuries to athletes with disabilities: identifying injury patterns.

Participation in sport activities for people with disabilities continues to gain in popularity. With participation in sports, there is an inherent risk of injury. A review of current sport epidemiological studies was used and we concluded that injury patterns for this population are similar to those for athletes without disabilities. Injury data from Paralympic competitions dating back to 1976 indicate that most elite athletes with disabilities seek medical care for illness and musculo-skeletal injuries. However, there are very limited injury data regarding Winter Paralympic events or skiing injuries. For those athletes who participate in Summer Paralympic events, abrasions, strains, sprains and contusions are more common than fractures and dislocations. However, location of injuries appears to be disability and sport dependent. Lower extremity injuries are more common in ambulatory athletes (visually impaired, amputee, cerebral palsy) and upper extremity injuries are more frequent in athletes who use a wheelchair. While it appears that the majority of the injuries occurring in this population are minor in nature, inconsistencies in the definition of injury in the literature make this conclusion tenuous. When injuries are expressed as time lost in participation, 52% of injuries resulted in 7 days lost or less, 29% in 8 to 21 days lost and 19% in greater than 22 days lost. The only prospective study addressing injury rates of athletes with disabilities in a manner consistent with other sport epidemiological studies found an injury rate of 9.3 injuries per 1000 athlete-exposures (AE). This injury rate is less than American football (10.1 to 15/1000 AE) and soccer (9.8/1000 AE), and greater than basketball (7.0/1000 AE). It is unclear whether comparative statistics such as these take into consideration the number of illness and injury episodes that resulted from the disability. Further complicating epidemiological studies for athletes with disabilities is the definition of the population and samples of convenience which are frequently used. These samples are often not representative of the multiplicity of disability conditions, levels of competition and range of sport activities available. Prospective studies comparing athletes to sedentary control individuals to measure differences in injury rates, type and frequency between and within disability groups, sports and levels of competition are desperately needed to further the knowledge of injury trends and develop and establish accurate injury prevention programmes.

A longitudinal study of injuries to athletes with disabilities.

This study investigated the number and type of injuries that occurred to athletes with disabilities from 1990-1996. The subjects were U.S. athletes who participated in the 1990 World Games and Championships, 1991 U.S. Paralympic Trials, 1992 Paralympic Games, the 1994 World Athletics Championship, and the 1996 Paralympic Games. A reportable injury was defined as an injury/illness that was evaluated by the U.S. Medical Staff during these competitions. Illnesses (29.8%) were the most commonly reported problem followed by muscular strains (22.1%). The most commonly injured body locations were the thorax/spine at 13.3%, the shoulder complex at 12.8%, the lower leg/ankle and toes at 12.0%. The majority of these injuries were musculoskeletal to include strains at 22.1%, sprains at 5.8%, contusion at 5.6%, and abrasions at 5.1%. An area of concern was the high number of strains to the thorax and spine when compared to other body locations and injury types. Attention should be paid to the musculature of the thorax/spine, shoulder and hip/thigh to help reduce the number of the injuries in this region.

Pain assessment in journal of athletic training articles 1992-1998: implications for improving research and practice.

OBJECTIVE: To examine, evaluate, and summarize the techniques used to assess pain in all the Original Research articles published in the Journal of Athletic Training from 1992 through 1998. A second objective was to determine whether any of the Original Research investigations that did not assess pain were on topics that included a pain component. A third purpose was to make recommendations for assessing pain in a clinical athletic training setting. DATA SOURCES: Every Original Research article published from 1992 through 1998 was reviewed independently by 2 of the authors to determine whether a pain assessment was included in the investigation and, if so, to evaluate the pain assessment technique used. DATA SYNTHESIS: A total of 23 (12.5%) of the 184 Original Research articles included some type of pain assessment. Most of these articles addressed the topics of delayed-onset muscle pain (43.5%), knee pain (17.4%), or pain resulting from cryotherapeutic procedures (17.4%). Most of the articles that included some type of pain measurement focused on the assessment of pain intensity using a category scale (17/23, 73.9%). In a substantial percentage of studies, a pain assessment tool that either lacked published supportive validity evidence (8/23, 34.8%) or was poorly constructed (because pain affect and pain intensity were confounded within a single scale) (7/23, 30.4%) was used. In a small number of articles on a topic directly relevant to pain (4/184, 2.2%), pain was not assessed, even though it could have provided useful information. CONCLUSIONS/RECOMMENDATIONS: Pain is a construct of interest to those conducting athletic training research. Pain measures were included in approximately 1 of every 8 Original Research articles published in the Journal of Athletic Training. However, investigators have too frequently measured pain in a limited fashion, often focusing only on pain intensity. Measuring other components of pain could provide additional opportunities for learning more about the relationships between pain and athletic training procedures. We recommend that athletic trainers involved in research, as well as those engaged in clinical practice, consider systematically employing valid, multidimensional measures of pain to better understand the relationships between pain and athletic training outcomes.

Intercollegiate ice hockey injuries: a causal analysis.

OBJECTIVE: The purpose of this study was to explore the relationships of position, mechanism of injury, type of injury, and body part injured to days lost. DESIGN: A causal analysis within a prospective cohort was used for this project. PARTICIPANTS: Seven schools from Hockey East and Eastern Collegiate Athletic Conference participated in this project for three consecutive competitive seasons. ASSESSMENT OF RISK FACTORS: The independent variables were position, mechanism of injury, and body part injured. MAIN OUTCOME MEASURES: The dependent variable was days lost due to injury. RESULTS: The entire causal model was statistically significant, with the variables of body part injured, mechanism of injury, and injury type accounting for 52% of the variance associated with days lost. The most important variable related to days lost was injury type and accounted for 43% of the variance associated with days lost. We found that fractures and dislocations resulted in an average of 22.22 days lost and sprains resulted in a mean of 13.61 days lost. CONCLUSION: The causal analysis demonstrated that body part injured, mechanism of injury, and injury type are important factors related to days lost. Those players who experience a fracture/dislocation or sprain of the lower extremity will tend to lose 2 weeks or more of participation. Studies such as this are useful in examining the multivariate circumstances surrounding an injury episode.

Athetosis increases resting metabolic rate in adults with cerebral palsy.

OBJECTIVES: To determine whether resting metabolic rate (RMR) is higher or lower in adults with cerebral palsy compared with the RMR of control subjects and to further examine physical characteristics of cerebral palsy that might affect RMR. DESIGN: Twenty-one adults with cerebral palsy (9 women, 12 men) were compared with 50 control subjects (25 men, 25 women) within the same age range (18 through 50 years). The following measurements were made: RMR by indirect calorimetry, anthropometrics, body composition, and habitual physical activity patterns. The study was conducted at the University of Vermont General Clinical Research Center and the Ball State University Human Performance Laboratory. STATISTICAL ANALYSES: Mean values +/- standard deviations, t tests, Pearson product-moment correlation coefficients, analysis of covariance, and stepwise multiple correlation regression analysis were used to examine the relationships among variables of interest. RESULTS: No significant differences were found in body weight, body mass index, fat mass, percentage body fat, and measured RMR between the two groups. The subjects with cerebral palsy were significantly shorter, had less fat-free mass, and expended fewer kilocalories in leisure time activities than the control subjects. After statistical adjustment for differences in fat-free mass, the subjects with cerebral palsy had a 14% (P < .001) higher adjusted RMR (1,742 kcal/day) compared with that of the control subjects (1,534 kcal/day). According to stepwise regression analysis, RMR was best predicted in the entire sample by fat-free mass and the presence or absence of athetosis (multiple R = .83, P < .001). The presence of cerebral palsy alone was not significantly correlated with RMR. CONCLUSIONS: The increased energy requirements of adults with cerebral palsy can be partially explained by athetotic movements. In this sample, the presence of athetosis increased RMR by an average of 524 kcal/day.

Reliability of the maximal aerobic power and ventilatory threshold in adults with cerebral palsy.

This study examines the test-retest reliability of the ventilatory threshold (VT) and the maximum oxygen uptake (VO2max) in adults with cerebral palsy (CP). Nine subjects completed two continuous incremental tests on either a wheelchair ergometer (WE, n = 5) or a cycle ergometer (CE, n = 4) to volitional fatigue. Metabolic and cardiorespiratory responses were continuously monitored during the tests with an automated metabolic cart interfaced with an electrocardiogram. Two experienced evaluators identified the VT using standardized respiratory gas exchange criteria. The reliability coefficient for the VO2max during the two trials was significant (r = 0.83, p < .05). However, there was no significant relationship (p > .05) between the two trials for the oxygen uptake (VO2) at the VT identified by the two evaluators (r = 0.45 and 0.43). The correlations for this variable between the two evaluators were highly significant on each trial (r = 0.99 and 1.00, p < .01). No significant differences were observed between the two trials for the VO2 at the VT and the VO2max. These results suggest that when monitoring the cardiorespiratory fitness of adults with CP, it may be more appropriate to evaluate the VO2max rather than the VT, because the former variable can be reliably determined in these individuals whereas the latter lacks consistency.

Dietary and anthropometric assessment of adults with cerebral palsy.

Research on nutrition and cerebral palsy (CP) has been directed at newborns and young children, leaving practitioners with a limited understanding of the nutritional status of the adult population. The purpose of this study was to determine the anthropometric profile and nutrient intakes of 86 adults with cerebral palsy. When compared with growth standards for healthy individuals, the mean body fat percentages and body mass indexes of both men and women with CP were within the normal range. However, 40% of the sample had heights below the 5th percentile for their age and gender, indicating permanent growth stunting. In general, the diets of these individuals were similar to the typical American diet. Both men and women had low nutrient adequacy ratios (NARs) for calcium (0.86 and 0.76, respectively); the women also had low NARs for iron (0.69) and niacin (0.86). Although nutrients obtained from supplements were not included in the NAR score, 26% of the men and 50% of the women reported using nutritional supplements. Fifty-five percent of the sample reported feeding problems. Multivariate analysis illustrated that individuals who participated in regular exercise programs had significantly higher mean adequacy ratios and lower body fat percentages than those who did not exercise regularly.

The injury experience of the competitive athlete with a disability: prevention implications.

The purpose of this project was to describe the injury experiences of athletes with disabilities. A cross-disability instrument was developed to measure variables of interest. A retrospective survey was administered to 426 athletes who participated at the 1989 national competition of the National Wheelchair Athletic Association (NWAA), United States Association for Blind Athletes (USABA), and the United States Cerebral Palsy Athletic Association (USCPAA). The definition of injury was any trauma to the participant that occurred during any practice, training, or competition session that caused the athlete to stop, limit, or modify participation for 1 d or more. Thirty-two percent (N = 137) of the total respondents reported at least one time-loss injury. By organization, 26% of the total injuries were from the NWAA and 37% were from the USABA and USCPAA, respectively. The shoulder and arm/elbow accounted for 57% of the total NWAA injuries. Fifty-three percent of the injuries to the USABA athlete were to the lower extremity. Injuries to the USCPAA athlete were distributed among four body locations, knee (21%), shoulder (16%), forearm/wrist (16%), and leg/ankle (15%). The athlete with a disability demonstrated approximately the same percentage of injury as the athlete without a disability in similar sport activities. Biomechanical considerations of locomotion and specific sport skills should be analyzed by experts to reduce the percentage of injuries.

The injury experience and training history of the competitive skier with a disability.

The purpose of this investigation was to describe the training history and injury experience of the competitive skier with a disability. A retrospective survey was administered to 68 athletes who participated in the National Handicapped Sports and the United States Association for Blind Athletes Winter National Games held in March 1989. The frequency, length, and specific components of the practice session were obtained. The definition of injury was any trauma to the participant that occurred during any practice, training, or competitive session that resulted in the cessation, limitation, or modification of the athlete's participation for at least 24 hours. The athletes practiced aerobic, anaerobic, and strength training activities two times a week or less. Upper extremities were injured 1.4 times more often than the lower extremities. The number of chronic injuries was greater than the number of acute injuries for both the upper and lower extremity. The thigh and knee were involved in 30% of the acute injuries, followed by the shoulder (25%), and neck and spine (15%). For chronic injuries, the shoulder, thigh/knee complex, and arm and elbow accounted for 73.3% of the total injuries reported. The skier with a disability incurred approximately the same proportion of injuries as the skier without a disability. Conditioning programs should be developed to emphasize both the aerobic and anaerobic energy systems to reduce the number of injuries.

Intercollegiate ice hockey injuries: a three-year analysis.

The purpose of this study was to investigate the type, nature, and frequency of injuries sustained in intercollegiate ice hockey. Seven schools from the Eastern Collegiate Athletic Conference and Hockey East Conference participated from 1987 through 1990. There were 280 injuries reported with a total injury rate of 10.22/1000 athlete exposures (AE). The contest injury rate (14.73/1000 AE) was higher than practice (2.52/1000 AE). Forwards (11.40/1000 AE) had the highest rate of injury followed by the defense (9.90/1000 AE). Eighty-six percent of all injuries were sustained by a direct impact mechanism, of which person/ice contact had an injury rate of 4.20/1000 AE. The shoulder (1.86/1000 AE) and knee (1.61/1000 AE) were the most frequently injured body parts. The data reported are consistent with other studies, with contusions as the most common type of injury and a higher incidence of injury reported during competition. There was a low rate of head/face/neck injuries (1.13/1000 AE), which may be a result of the required use of helmets and face guards in this population.

Injuries to elite wheelchair athletes.

The purpose of this project was to describe the nature, type, and frequency of athletic injuries incurred by the elite wheelchair athlete. Nineteen athletes participated in a 1-year injury recall study at an elite wheelchair training camp. An injury was defined as anything the athlete expressed concern about and (a) caused a loss of participation due to an injury or illness or (b) an injury in which a fracture, dislocation, or subluxation occurred and the athlete was able to continue participation. There were 10 male and 9 female subjects who reported their injuries from 1 June 1987 to 31 May 1988. Fifty injuries were reported, strains and muscular injuries accounted for almost half of the injuries. Physicians were the primary care provider for 37% of the injuries, followed by physical therapists and athletic trainers at 26% and 15% respectively. Slightly over 57% of the injuries were classified as minor, missing 7 days or less of participation and 32% were classified as major, missing 22 days or more of participation. The upper extremity was the most frequently injured, followed by the lower extremity, head and spine, and illnesses. Conventional treatments of ice, heat, modalities, and medications, were the most common methods of treating these injuries. Flexibility and strength training programmes should be implemented throughout the competitive season. Careful consideration of the training programme and workout intensity should also be evaluated.