A Model for Applying Situational Awareness Theory to the Return to Sport Continuum.

Background: Despite developing and implementing return to sport guidelines, high rates of re-injury remain. The return to sport continuum is a three-phase, criterion-based progression based on physical and psychological factors used to guide the sports medicine team in return to sport decision making. Situational awareness (SA) pertains to an athlete's knowledge of the dynamic environment (i.e., their ability to perceive the components in the environment, comprehend the meaning of the perceived information, and predict future actions based on that comprehension). SA can be applied on a cognitive continuum that encompasses three levels, each stage becoming more challenging with additional time constraints and increased uncertainty. Integrating the cognitive continuum with the return to sport continuum may optimize the return to sport process and enhance the athletes' preparedness for competition by incorporating cognitive challenges aligned with live competition. The purpose of this clinical commentary is to describe a return to sport model that integrates SA theory on the cognitive continuum with additional consideration for surrounding contextual factors. Level of Evidence: 5©The Author(s).

Computerized Cognitive Function Does Not Correlate With Choice Reaction Time During a Hopping Task.

CONTEXT: Cognitive performance has been shown to be associated with musculoskeletal injury risk. Cognitive assessments are often administered in controlled environments despite sport settings challenging cognition in uncontrolled, less predictable environments. Cognitive assessments should be representative of sport demands; thus, integrating motor with cognitive assessments may be more clinically relevant. Accordingly, the purpose of this research was to investigate the relationship between tablet-based cognitive tests and choice reaction time during a hopping task. DESIGN: Cross-sectional. METHODS: A total of 20 healthy participants volunteered to participate. Participants completed 3 tablet-based cognitive assessments. Average raw response time and fully corrected scores were used for analysis. In addition, participants completed a choice reaction hopping task to capture neuromuscular-cognitive reaction time. Participants completed a forward hop over a hurdle, landing on a single limb. Light sensors were utilized for the choice reaction component to capture reaction time in seconds, cue them when to hop, and indicate the landing limb. The relationship between the tablet-based cognitive assessments and reaction time during a hopping task was examined with Pearson correlations (α = .05). RESULTS: The choice reaction time from the hop task had a negligible correlation (r = -.20-.07) to the fully corrected tablet-based cognitive tests. The choice reaction time from the hop task had a negligible correlation (r = .02) to the average response time of the Pattern Comparison Processing Speed Test and a low correlation (r = .34-.36) to the Dimensional Change Card Sort Test and Flanker Inhibitory Control and Attention Test. CONCLUSIONS: This study determined that tablet-based cognitive assessments had trivial relationships to choice reaction time during a hopping task. This research has implications as clinicians aim to evaluate and analyze cognitive performance. Although reaction time was a critical component of all the assessments in this study, an individual's performance on a tablet-based assessment does not indicate performance during a functional reaction time assessment.

Neurocognitive function influences dynamic postural stability strategies in healthy collegiate athletes.

OBJECTIVES: Poorer neurocognitive performance may increase lower extremity injury risk due to alterations in biomechanics. However, it is unclear if poorer neurocognitive function may be associated with altered dynamic postural stability. Therefore, the purpose of this study was to investigate the relationship between neurocognitive performance and dynamic postural stability in healthy collegiate athletes. DESIGN: Cross-sectional cohort. METHODS: Forty-five Division-I collegiate athletes (21 males, 24 females; age: 19.69 ±â€¯1.50) completed neurocognitive assessments from the NIH Toolbox® (NIHTB). Three groups were established from the NIHTB composite score: high performers (HP), moderate performers (MP), and low performers (LP). Additionally, participants completed a dynamic hop-to-stabilization task. Accelerometer and gyroscopic data were recorded during landing through an inertial measurement unit (IMU) on the participant's low back. The root mean squared (RMS) of the accelerometer and gyroscope was calculated for the orthogonal planes and the resultant vector. Group differences for demographic variables, NIHTB composite scores, and IMU based measures were analyzed with one-way ANOVAs with Bonferroni post hoc analyses were performed. Cohen's d effect sizes were also calculated. RESULTS: Post hoc tests determined the LP group had higher vertical acceleration RMS values (p = 0.013, d = -0.85) and lower anteroposterior acceleration RMS values (p = 0.005, d = 0.95) compared to the HP group. CONCLUSIONS: Neurocognitive performance may influence dynamic postural stability strategies in athletes. Higher neurocognitive performers may use different approaches to perform difficult postural tasks by adopting strategies associated with lower vertical and higher anteroposterior acceleration compared to lower neurocognitive performers.