Does early exercise intolerance effect time to return to play, symptom burden, neurocognition, Vestibular-Ocular-Motor (VOM) function and academic ability in acutely concussed student-athletes?

INTRODUCTION: Early Exercise Intolerance (EEI) is associated with delayed recovery and longer time to Return To Play (RTP), but this has not been established.Participants; (n = 52, male n = 30) UK university-aged rugby-union student-athletes. METHODS: Student-athletes completed baseline screening (July-October 2021 and 2022). The test battery was repeated within 48 h, 4, 8 and 14 days after a Sports-Related Concussion (SRC) with the Buffalo Concussion Bike or Treadmill Test to set sub-symptom heart rate threshold. Student-athletes then completed a controlled early exercise protocol in-between reassessment (days 3, 5-7 and 9-13). Those with EEI were compared to those with early-exercise tolerance. OUTCOME MEASURES: Post-Concussion Symptom Scale, Immediate Post-Concussion and Cognitive Test, Vestibular-Ocular Motor Screening Tool and the Revised Perceived Academic Impact Tool. RESULTS: EEI was seen throughout the initial 14-days post-SRC (23.8%, 22.4%, 25.5%. 25.0%). EEI was associated with a slower reaction time within 48 h (-0.01 (-0.030-0.043) Vs 0.06 (0.033-0.24), p = 0.004) and greater VOMS scores within 48 h; (0.00 (0.00-4.00) Vs 5.50 (2.75-9.00), p = 0.016) and 4 days (0.00 (0.00-2.00) Vs 5.00 (0.00-6.00), p = 0.044). RTP was 12.5 days longer in those with EEI at 14-days post-SRC. CONCLUSION: EEI is prevalent following an SRC in university-aged student-athletes and was associated with delayed recovery and RTP.

Musculoskeletal injury or Sports-Related Concussion (SRC) in a season of rugby union does not affect performance on concussion battery testing in university-aged student-athletes.

BACKGROUND: Sub-concussive and concussive impacts sustained during contact sports such as rugby may affect neurocognitive performance, vestibular-ocular-motor function, symptom burden and academic ability. METHOD: Student-athletes (n = 146) participating in rugby union British Universities or domestic competitions were assessed on the Immediate Post-Concussion and Cognitive Test, Post-Concussion Symptom Scale, vestibular-oculo-motor screening tool and revised perceived academic impact tool. Individual change from pre-season (July-September 2021) to 2-weeks following last exposure to contact (April-July 2022) was analysed. RESULTS: Symptom burden significantly worsened (p=0.016) over the season. Significant improvements on verbal memory (p=0.016), visual memory (p=0.008) and motor processing speed (p=0.001) suggest a possible learning effect. Surprisingly, the number of days lost to concussion significantly and positively affected performance on verbal memory (p = 0.018) and reaction time (p = 0.027). Previous concussive events significantly predicted a worsening in symptom burden (p < 0.028), as did in-season concussive events, predicting improved verbal memory (p = 0.033) and symptom burden change (p = 0.047). Baseline performance significantly affected change on several neurocognitive tests, with low-scorers showing more improvement over the season. CONCLUSION: Participation in rugby union was not associated with deleterious effects on brain function. Previous concussive events and in-season factors, possibly related to learning effects, may explain improvement in cognitive function across the season.

Fifty years of performance-related sports biomechanics research.

Over the past fifty years there has been considerable development in motion analysis systems and in computer simulation modelling of sports movements while the relevance and importance of functional variability of sports technique has become increasingly recognised. Technical developments for experimental work have led to increased, and still increasing, subject numbers. Increased subjects per study give better statistical power, the ability to utilise different data analyses, and thus the determination of more subtle and nuanced factors. The overall number of studies has also increased massively. Most actions in sport can, and have, been studied at some level with even the more challenging ones, such as player on player impacts, having some developing research. Computer simulation models of sports movements have ranged from simple (one or two segment) models to very complex musculoskeletal models and have used parameters ranging from the generic to individual-specific. Simple models have given insights into the key mechanics of movement while individual-specific model optimisations have been used to improve athlete performance. Our depth of understanding of the mechanics of sports techniques has increased across a wide range of sports. In the future there is likely to be more development and use of markerless motion capture, individual-specific model parameters, and more consideration of motor control aspects in the analysis of sports technique.

Occlusal measurement method can affect SEMG activity during occlusion.

Occlusal indicators are widely used in dental treatment to measure tooth contacts that occur during occlusion. However, the presence of an indicator may affect the mechanics of occlusion and lead to invalid tooth contact data. The objective of this study was to determine the effect of four indicators (Parkell, silk, T-Scan(®) sensor and paper) on surface electromyography (SEMG) activity during occlusion. Twenty-three subjects performed strong bites and maximum clenches onto the four indicators and natural dentition. Surface electromyography recordings of anterior temporalis and superficial masseter activity and the subjects' perception of each indicator were measured. SEMG activity with the T-Scan(®) sensor and paper was significantly different (higher masseter activity; P < 0·05) compared to that for natural dentition. The Parkell and silk gave no significant differences to natural dentition. Similarly, subjects perceived that T-Scan(®) sensor and paper had the greatest effect on occlusion and were the least comfortable (P < 0·05). Thus, the very plastic T-Scan(®) sensor and very thick articulating paper both affected SEMG activity during occlusion and, therefore, may not provide valid tooth contact information for dental treatment. In conclusion, occlusal indicators can change SEMG activity during occlusion which may affect the validity of the measurements they provide.

Comparing different approaches for determining joint torque parameters from isovelocity dynamometer measurements.

Strength, or maximum joint torque, is a fundamental factor governing human movement, and is regularly assessed for clinical and rehabilitative purposes as well as for research into human performance. This study aimed to identify the most appropriate protocol for fitting a maximum voluntary torque function to experimental joint torque data. Three participants performed maximum isometric and concentric-eccentric knee extension trials on an isovelocity dynamometer and a separate experimental protocol was used to estimate maximum knee extension angular velocity. A nine parameter maximum voluntary torque function, which included angle, angular velocity and neural inhibition effects, was fitted to the experimental torque data and three aspects of this fitting protocol were investigated. Using an independent experimental estimate of maximum knee extension angular velocity gave lower variability in the high concentric velocity region of the maximum torque function compared to using dynamometer measurements alone. A weighted root mean square difference (RMSD) score function, that forced the majority (73-92%) of experimental data beneath the maximum torque function, was found to best account for the one-sided noise in experimental torques resulting from sub-maximal effort by the participants. The suggested protocol (an appropriately weighted RMSD score function and an independent estimate of maximum knee extension angular velocity) gave a weighted RMSD of between 11 and 13 Nm (4-5% of maximum isometric torque). It is recommended that this protocol be used in generating maximum voluntary joint torque functions in all torque-based modelling of dynamic human movement.

Neuromuscular function in healthy occlusion.

This study aimed to measure neuromuscular function for the masticatory muscles under a range of occlusal conditions in healthy, dentate adults. Forty-one subjects conducted maximum voluntary clenches under nine different occlusal loading conditions encompassing bilateral posterior teeth contacts with the mandible in different positions, anterior teeth contacts and unilateral posterior teeth contacts. Surface electromyography was recorded bilaterally from the anterior temporalis, superficial masseter, sternocleidomastoid, anterior digastric and trapezius muscles. Clench condition had a significant effect on muscle function (P = 0.0000) with the maximum function obtained for occlusions with bilateral posterior contacts and the mandible in a stable centric position. The remaining contact points and moving the mandible to a protruded position, whilst keeping posterior contacts, resulted in significantly lower muscle activities. Clench condition also had a significant effect on the per cent overlap, anterior-posterior and torque coefficients (P = 0.0000-0.0024), which describe the degree of symmetry in these muscle activities. Bilateral posterior contact conditions had significantly greater symmetry in muscle activities than anterior contact conditions. Activity in the sternocleidomastoid, anterior digastric and trapezius was consistently low for all clench conditions, i.e. <20% of the maximum voluntary contraction level. In conclusion, during maximum voluntary clenches in a healthy population, maximum masticatory muscle activity requires bilateral posterior contacts and the mandible to be in a stable centric position, whilst with anterior teeth contacts, both the muscle activity and the degree of symmetry in muscle activity are significantly reduced.

The need for muscle co-contraction prior to a landing.

In landings from a flight phase the mass centre of an athlete experiences rapid decelerations. This study investigated the extent to which co-contraction is beneficial or necessary in drop landings, using both experimental data and computer simulations. High speed video and force recordings were made of an elite martial artist performing drop landings onto a force plate from heights of 1.2, 1.5 and 1.8m. Matching simulations of these landings were produced using a planar 8-segment torque-driven subject-specific computer simulation model. It was found that there was substantial co-activation of joint flexor and extensor torques at touchdown in all three landings. Optimisations were carried out to determine whether landings could be effected without any co-contraction at touchdown. The model was not capable of landing from higher than 1.05m with no initial flexor or extensor activations. Due to the force-velocity properties of muscle, co-contraction with net zero joint torque at touchdown leads to increased extensor torque and decreased flexor torque as joint flexion velocity increases. The same considerations apply in any activity where rapid changes in net joint torque are required, as for example in jumps from a running approach.

Lower limb influence on standing arm-cranking ('grinding').

Standing arm-cranking ('grinding') is predominantly an upper-body exercise, however, the contribution of the legs to this activity is unknown. The purpose of the study was to examine the influence of normal lower-limb movement on physiological strain during arm-cranking. Eight elite professional America's Cup grinders performed two exercise trials, on an adjustable standing arm-crank ergometer with SRM powercrank, in a cross-over design. Each trial comprised of two 5-min stages at the same work rate ( approximately lactate threshold) with the knee joint splinted or normal movement available. Vertical ground reaction forces (VGRF) and knee joint angle were determined from two force plates and sagittal plane video, respectively. Work rate was identical for the two conditions (246 (14) vs. 246 (13) W, p=0.7). Knee joint range of motion and unilateral VGRF amplitude were greater during normal compared with splinted arm-cranking (both p<0.01). There was no difference in VO2 (p=0.2) between the two conditions, however, there was greater VCO2 (8%, p=0.001), RER (11%, p<0.001), V(E) (17%, p<0.001) and HR (7 (3) beats.min(-1), p<0.001) during splinted compared with normal arm-cranking. Furthermore, the rise in BLa was greater after splinted than normal arm-cranking (4.8 (0.8) vs. 3.7 (1.0) mmol.L(-1), p=0.04). These data suggest that the lower-limbs play an integral role in standing arm-cranking, and restricted leg movement markedly affects the cardiovascular and metabolic responses to this activity.

The role of the heel pad and shank soft tissue during impacts: a further resolution of a paradox.

The aim of this study was to test the hypothesis that the motion of the soft tissue of the lower leg contributes significantly to the attenuation of the forces during heel impacts. To examine this, a two-dimensional model of the shank and heel pad was developed using DADS. The model contained a heel pad element and a rigid skeleton to which was connected soft tissue which could move relative to the bone. Simulations permitted estimation of heel pad properties directly from heel pad deformations, and from the kinematics of an impacting pendulum. These two approaches paralleled those used in vitro and in vivo, respectively. Measurements from the pendulum indicated that heel pad properties changed from those found in vitro to those found in vivo as relative motion of the bone and soft tissue was allowed. This would indicate that pendulum measures of the in vivo heel pad properties are also measuring the properties of the whole lower leg. The ability of the wobbling mass of the shank to dissipate energy during an impact was found to be significant. These results demonstrate the important role of both the heel pad and soft tissue of the shank to the dissipation of mechanical energy during impacts. These results provide a further clarification of the paradox between the measurements of heel pad properties made in vivo and in vitro.

Dynamics of self-injurious behaviors.

Self-injurious behavior was examined in a case study of head-banging by an 8-year-old girl with profound mental retardation and an autistic disorder. Trajectories of the arm movements and impact forces of the head blows were determined from a dynamic analysis of videotapes. Results revealed a high degree of cycle-to-cycle consistency in the qualitative dynamics of the limb motions, with one hand motions being faster than those with two hands (inphase and antiphase) and the motions with the helmet about 25% faster than those without the helmet. The impact force of SIBs as a percentage of body weights are near the low end of forces generated in boxing blows and karate hits.