OCULOMOTOR FUNCTION IN ADOLESCENT ATHLETES FOLLOWING CONCUSSION

Background: Visual impairments affect up to 90% of patients post-concussion. These impairments may include deficits in fixation accuracy, smooth pursuit, saccadic latencies, vergence, accommodation, and vestibule-ocular reflexes. Quantitative assessment of oculomotor function may provide a sensitive and objective measure of concussion diagnosis and recovery since coordinated eye movements require the use of diverse and widely dispersed areas of the brain. This study quantified oculomotor function over time in adolescents following concussion. Hypothesis/Purpose: We hypothesized that adolescent concussion patients would demonstrate deficits of oculomotor function that would resolve by the time of return to play (RTP) and remain stable after RTP. Methods: 13 adolescent athletes diagnosed with mild to moderate concussion (7 male; mean age 15.1, SD 2.1, range 10-17 years) were prospectively evaluated at their initial visit (mean 18, range 4-43 days post-concussion), at the time of clearance to RTP (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days after RTP). 11 controls without past concussion or injury (3 male; mean age 12.3, SD 3.1, range 8-17 years) were also tested at similar time points. Eye tracking was recorded as participants followed a target moving on a screen in predefined patterns related to sinusoid and trapezoid smooth pursuit, vergence, saccade, and anti-saccade. Metrics characterizing the speed, accuracy, and variability of tracking were compared between groups and visits using t-tests and linear mixed-effects regression. Results: At their initial visit, patients tended to have greater overshoot and greater variability in tracking compared with controls (Table 1.1). Overshoot and variability of tracking during sinusoid smooth pursuit (both overall variability and variability of overshoot) decreased from initial visit to RTP (Table 1.2). Undershoot during sinusoid smooth pursuit tended to decrease from RTP to 1-month follow-up. The rate of convergence in the distance vergence task increased while the rate of divergence decreased between these time points. Conclusion: The main oculomotor deficits observed in concussed adolescents related to overshoot and variability of tracking during sinusoid smooth pursuit. These deficits resolved by the time of RTP and generally remained stable or continued improving after RTP. These results suggest that oculomotor function recovers sufficiently under current conservative treatment protocols. [Table: see text][Table: see text]

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STEP UP! LESS PHYSICAL ACTIVITY AFTER CONCUSSION IS ASSOCIATED WITH PROLONGED CLINICAL RECOVERY AMONG ADOLESCENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00038 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0003

Author(s):

Corrine N. Seehusen ◽

Julie C. Wilson ◽

Gregory A. Walker ◽

Sarah E. Reinking ◽

David R. Howell

Keyword(s):

Physical Activity ◽

Classification Accuracy ◽

Activity Level ◽

Return To Play ◽

Initial Visit ◽

Adolescent Athletes ◽

Post Injury ◽

Concussion Management ◽

Clinical Recovery ◽

Concussion Recovery

Background: While many adolescent athletes recover from concussion within one month, some will not recover within this timeframe. Concussion management guidelines have evolved to de-emphasize rest and promote early re-introduction of sub-symptomatic physical activity. However, the optimal levels of physical activity during concussion recovery have yet to be determined. Hypothesis/Purpose: To investigate the association between quantity, frequency and intensity of physical activity after concussion with clinical recovery, defined as return-to-play (RTP) clearance from their physician. Methods: We conducted an observational, prospective cohort study of 26 youth athletes who sustained a concussion and were evaluated at two time points: initial visit (<14 days post-injury) and RTP clearance visit. Participants reported concussion symptoms using the Post-Concussion Symptom Inventory (PCSI). Participants wore an activity tracking device for the first two weeks after initial visit. This allowed us to quantify average steps/day, exercise frequency (average workouts/week), exercise duration (average time/workout), and exercise intensity (average/maximum HR during workouts). We grouped participants by clinical recovery timing (RTP <28 days vs. ≥28 days post-injury) and compared physical activity measures using independent samples t-tests. We then identified the sensitivity, specificity, and classification accuracy of cutpoints for each exercise variable using a Receiver Operating Characteristic (ROC) and Area under the Curve (AUC) analysis. Results: Half (n=13) of the participants required ≥28 days to receive RTP clearance. The two groups were similar in age, proportion of females, and past concussion history (Table 1). Those who required ≥28 days for RTP clearance reported significantly greater symptom severity at the initial examination than the RTP <28 days group, despite similar initial visit timing (Table 1). During the two weeks after the initial visit, the RTP ≥28 days group took fewer steps/day, exercised fewer days/week, and exercised fewer total minutes/week (Table 2). Among the activity/exercise variables examined, the highest classification accuracy between groups consisted of ≥9,100 average steps/day, ≥4 sessions/week, and spending ≥135 total minutes/week exercising (Table 3). Conclusion: Higher daily step counts and more frequent/longer exercise sessions were associated with clearance for RTP within 28 days from concussion in adolescent athletes. These preliminary results further support the benefit of physical activity during concussion recovery. However, our study cannot assess the causal effect of these findings, given that those who felt better earlier may have been willing to participate in more physical activity. Further research is needed to develop duration-, frequency- and intensity-specific physical activity level guidelines to aid clinicians in concussion management. [Table: see text][Table: see text][Table: see text]

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TREATMENT PATTERNS OF NEWLY DIAGNOSED PEDIATRIC ULCERATIVE COLITIS AND CROHN’S DISEASE PATIENTS IN THE IMPROVECARENOW REGISTRY

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa347.050 ◽

2021 ◽

Vol 27 (Supplement_1) ◽

pp. S22-S23

Author(s):

Theresa Hunter ◽

Wendy Komocsar ◽

Richard Colletti ◽

Chunyan Liu ◽

Keith Benkov ◽

...

Keyword(s):

United States ◽

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

The United States ◽

Current Treatment ◽

Treatment Patterns ◽

Initial Visit ◽

Newly Diagnosed ◽

Time Points

Abstract Objectives The objective of this study was to assess current treatment patterns of pediatric ulcerative colitis (UC) and Crohn’s disease (CD) patients, using data in the ImproveCareNow (ICN) registry. Methods Pediatric (2–17 years) patients in the United States who were newly diagnosed with UC or CD between June 1, 2013-December 31, 2019, who had their first recorded ICN visit within 6 months of diagnosis and who were actively followed for at least 12 months (± 90 days) were included in this study. Descriptive statistics of baseline patient demographics were summarized for the overall IBD patient population and separately for UC and CD. Treatment patterns (including use of corticosteroids, 5-aminosalicylic acid (5-ASA), 6-mercaptopurine/azathioprine (6-MP/AZA), methotrexate, tumor necrosis factor inhibitors (TNFi) [adalimumab, infliximab, certolizumab, golimumab, and their biosimilars], ustekinumab, vedolizumab, and other medications [natalizumab and tofacitinib]) were assessed at the initial baseline visit, and at 1-year and 3-year time points. Results A total of 6,504 pediatric IBD patients (UC=1,784; CD=4,720) were included in this study. Patients had a mean age at diagnosis of 13.0 years (UC=13.2; CD=12.9), 57.1% were male (UC=49.6%; CD=60.0%), and 81.0% were White (UC=81.2%; CD=81.0%) (Table 1). At the initial ICN visit, 46.4% of UC patients were prescribed a corticosteroid, while 19.8% received a 5-ASA, 12.6% received a TNFi, 10.4% received a 6-MP/AZA, 3.0% received methotrexate, and 0.3% received vedolizumab. At the initial visit, 40.2% of CD patients were prescribed a corticosteroid, while 29.1% received a TNFi, 18.5% received a 6-MP/AZA, 12.4% received methotrexate, and 3.3% received a 5-ASA. At the 1-year and 3-year time points, rates of 5-ASA and corticosteroid use decreased among UC patients; however, rates of 6-MP/AZA, methotrexate, and TNFi increased (Table 2). Similarly, at the 1-year and 3-year time points, rates of corticosteroids among CD patients decreased; however, rates of methotrexate and TNFi increased (Table 2). There was also an increase in use of ustekinumab and vedolizumab over time among UC and CD patients. Conclusion These results highlight the current treatment patterns of pediatric UC and CD patients in the United States. At the initial ICN visit, the 46% of UC and 40% of CD patients were receiving corticosteroids, however, at 1-year and 3-years after initial visit, over 30% of UC patients and over 60% of CD patients were receiving TNF inhibitors with considerably reduced corticosteroid use.

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Validation of a Modified Algometer to Measure Mechanical Nociceptive Thresholds in Awake Dogs

BioMed Research International ◽

10.1155/2015/375421 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Ubedullah Kaka ◽

Hui Cheng Chen ◽

Yong Meng Goh ◽

Adamu Abdul Abubakar ◽

Sharida Fakurazi ◽

...

Keyword(s):

Body Temperature ◽

Washout Period ◽

Crossover Design ◽

Morphine Injection ◽

Similar Time ◽

Time Points ◽

Threshold Levels ◽

Baseline Values ◽

Foot Pad ◽

Mechanical Thresholds

This study was conducted to validate the use of a modified algometer device to measure mechanical nociceptive thresholds in six dogs. Dogs were administered morphine intravenously (IV) at 1 mg/kg or saline at equivolume in a crossover design with one-week washout period. Mechanical nociceptive thresholds were determined before, after the administration of treatments at 5 minutes, and hourly for 8 hours. Thresholds were recorded at the carpal pad, metacarpal foot pad, tibia, femur, and abdomen. Heart rates, body temperature, and respiration were recorded at similar time points. Thresholds increased significantly (P<0.05) from baseline values for up to 3 hours at tibia and abdomen, 4 hours at metacarpal pad, and 5 hours at the carpal pad and femur. Hypothermia, bradycardia, and change in respiration were observed in all dogs after morphine injection. Saline did not alter any threshold levels during the eight-hour study period, indicating no evidence of tolerance, learned avoidance, or local hyperaesthesia. The device and methods of testing were well tolerated by all the dogs. Results suggest that the modified algometer and method of application are useful to measure nociceptive mechanical thresholds in awake dogs.

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Return to Play in Adolescent Athletes With Symptomatic Spondylolysis Without Listhesis: A Meta-Analysis

Global Spine Journal ◽

10.1177/2192568217734520 ◽

2017 ◽

Vol 8 (2) ◽

pp. 190-197 ◽

Cited By ~ 5

Author(s):

Samuel C. Overley ◽

Steven J. McAnany ◽

Steve Andelman ◽

Jun Kim ◽

Robert K. Merrill ◽

...

Keyword(s):

Event Rate ◽

Meta Analysis ◽

Relevant Literature ◽

Nonoperative Treatment ◽

Return To Play ◽

Q Value ◽

Adolescent Athletes ◽

Cochrane Reviews ◽

Pars Interarticularis ◽

Q Statistic

Study Design: Meta-analysis. Objectives: To assess return to play (RTP) rates in adolescent athletes with lumbar spondylolysis without spondylolisthesis treated conservatively or operatively. Methods: A review of Medline, EMBASE, and Cochrane Reviews was performed. The pooled results were performed by calculating the effect size based on the logit event rate. Studies were weighted by the inverse of the variance. Confidence intervals were reported at 95%. Heterogeneity was assessed using the Q statistic and I2 value. Results: The initial literature search resulted in 724 articles, of which 29 were deemed relevant on abstract review. Overall, 11 studies provided data for 376 patients with a pars interarticularis defect. Return to athletic competition, based on logit event rate, was found to be statistically favored after both nonoperative and operative treatment (92.2% vs 90.3%). There was no heterogeneity noted among the studies reporting nonoperative treatment ( Q value of 4.99 and I2 value of 0). There was mild heterogeneity within the operative studies ( Q value of 3.54 and I2 value of 15.18). Conclusions: Adolescent athletes RTP 92.2% of the time with nonoperative management, compared with 90.3% when treated operatively, though both treatment groups strongly favor RTP. As this is the first study to pool results of all relevant literature, it provides strong evidence to guide decision making and help manage expectations in this unique patient population.

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Objective Functional Assessment After a Head Injury Using Movement and Activity in Physical Space Scores: A Case Report

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.07 ◽

2014 ◽

Vol 49 (4) ◽

pp. 568-575 ◽

Cited By ~ 1

Author(s):

James L. Farnsworth ◽

Danielle McElhiney ◽

Shannon David ◽

Gaurav Sinha ◽

Brian G. Ragan

Keyword(s):

Athletic Training ◽

Objective Measure ◽

Physical Space ◽

Recovery Process ◽

Living Environment ◽

Return To Play ◽

Functional Score ◽

Gps Receiver ◽

Novel Approach ◽

Objective Functional

Objective: To describe the potential benefit of using a global positioning system (GPS) and accelerometry as an objective functional-activity measure after concussion by creating Movement and Activity in Physical Space (MAPS) scores. Background: A 21-year-old female soccer player suffered a blow to the back of the head from an opponent's shoulder during an away match. No athletic trainer was present. She played the remainder of the match and reported to the athletic training facility the next day for evaluation. Differential Diagnosis: Concussion. Treatment: The athlete was removed from all athletic activities. Her symptoms were monitored based on the Zurich guidelines. She was also instructed to wear an accelerometer on her hip and to carry an on-person GPS receiver at all times for 10 days. Her total symptom scores for the 4 symptomatic days were 82, 39, 49, and 36. Her mean MAPS functional score for symptomatic days 3 through 5 was 900.9 and for asymptomatic days 6 through 11 was 2734.9. Uniqueness: We monitored the patient's function during the concussion-recovery process using an on-person GPS receiver and accelerometer to calculate personalized MAPS scores. This novel approach to measuring function after injury may provide a useful complementary tool to help with return-to-play decisions. Conclusions: An on-person GPS receiver and accelerometer were used to observe the patient's physical activity in a free-living environment, allowing for an objective measure of function during recovery. Her MAPS scores were low while she was symptomatic and increased as she became asymptomatic. We saw the expected inverse relationship between symptoms and function. In situations where accuracy of reported symptoms may be a concern, this measure may provide a way to verify the validity of, or raise doubts about, self-reported symptoms.

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DUAL-TASK BALANCE CONTROL IN ADOLESCENT ATHLETES FOLLOWING CONCUSSION

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00152 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0015

Author(s):

Tracy Zaslow ◽

Camille Burton ◽

Nicole M. Mueske ◽

Adriana Conrad-Forrest ◽

Bianca Edison ◽

...

Keyword(s):

Dual Task ◽

Verbal Fluency ◽

Walking Speed ◽

Balance Control ◽

Dynamic Balance ◽

Center Of Mass ◽

Quiet Standing ◽

Return To Play ◽

Treatment Protocols ◽

Single Task

Background: Previous research has identified deficient dual-task balance control at the time of return to play (RTP) and possible worsening after RTP in older adolescents/young adults with concussion. These findings have not been investigated in younger patients with concussion. Hypothesis/Purpose: We hypothesized that concussed adolescents would have slower walking speed and increased medial-lateral (ML) center of mass (COM) movement, which would normalize by the time of RTP but worsen after resuming activity. Methods: 13 adolescent concussion patients (7 male; age 10-17 years) were prospectively evaluated at their initial visit (IV) (mean 18, range 4-43 days post-concussion), at RTP clearance (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days post-RTP) along with 11 controls (3 male) seen for similarly timed visits. Standing balance was assessed using range and root mean squared (RMS) COM motion in the anterior-posterior (AP) and ML directions during standing on both legs with eyes open while performing quiet standing, dual-task audio Stroop, side-to-side head turns, and side-to-side thumb tracking tasks. Dynamic balance was assessed using walking speed and COM ML range and velocity during walking alone and with side-to-side head turns and verbal fluency (reciting words starting with “F”) dual tasks. Patients were compared against controls using t-tests, and changes over time were evaluated using linear mixed-effects regression. Results: During standing, patients had higher COM ML RMS than controls at IV during head turns and higher COM AP range during thumb tracking. COM ML motion decreased from IV to RTP (head turns range -6.5mm, p=0.058; head turns RMS -16.8mm, p=0.002; thumb range 9.2mm, p=0.012) and increased from RTP to 1 month follow-up (head turns RMS +10.0mm, p=0.040; Stroop RMS +8.4mm, p=0.086). Patients walked slower than controls at IV during all tasks, and COM ML range was higher in patients vs. controls during verbal fluency at IV and RTP. Walking speed increased from IV to RTP during verbal fluency (+7.8cm/s, p=0.044), from RTP to post-RTP in single task walking (+6.1cm/s, p=0.041), and at each successive visit during head turns (+6.0cm/s and +6.5cm/s, p<0.07). COM ML range also decreased in patients from IV to RTP with verbal fluency (-14.7mm, p=0.011) and from RTP to post-RTP in single task walking ( 4.0mm, p=0.061). Conclusion: Adolescent concussion patients had deficits in static and dynamic balance control at initial presentation. This tended to improve by RTP and only worsened post-RTP for dual-task ML control during standing, suggesting that current conservative treatment protocols are appropriate.

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Smooth pursuit and saccadic abnormalities in first-episode schizophrenia

Psychological Medicine ◽

10.1017/s0033291798006722 ◽

1998 ◽

Vol 28 (3) ◽

pp. 685-692 ◽

Cited By ~ 77

Author(s):

S. B. HUTTON ◽

T. J. CRAWFORD ◽

B. K. PURI ◽

L.-J. DUNCAN ◽

M. CHAPMAN ◽

...

Keyword(s):

Smooth Pursuit ◽

Saccadic Eye Movements ◽

First Episode ◽

Schizophrenic Patients ◽

Drug Naïve ◽

Saccade Task ◽

Pursuit Velocity ◽

First Episode Schizophrenia ◽

Oculomotor Function ◽

Smooth Pursuit Eye Tracking

Background. Previous studies of oculomotor dysfunction in schizophrenia have tended to concentrate on abnormalities of smooth pursuit eye tracking in chronic medicated patients. We report the results of a study of smooth pursuit, reflexive and antisaccade performance in drug naive and antipsychotic treated first-episode schizophrenic patients.Methods. Smooth pursuit and saccadic eye movements were recorded in 36 first-episode schizophrenic patients and 36 controls matched for age and estimated IQ. The schizophrenic patients were divided into drug-naive (N=17) and antipsychotic treated groups (N=19).Results. Smooth pursuit velocity gain was significantly lower than controls only in the drug-naive patients. The treated patients did not differ significantly from either the controls or the untreated group. In an antisaccade paradigm both treated and drug-naive schizophrenic patients demonstrated an increased number of errors, but only drug-naive patients also demonstrated an increased latency in initiating correct antisaccades.Conclusions. These impairments are unlikely to be due to a generalized deficit in oculomotor function in the schizophrenic groups, as there were no differences between the groups in saccadic metrics on a reflexive saccade task. The results show that both smooth pursuit and saccadic abnormalities are present at the onset of schizophrenia and are integral to the disorder.

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Return to Play in Adolescent Athletes with Symptomatic Spondylolysis without Listhesis: a Meta-Analysis

The Spine Journal ◽

10.1016/j.spinee.2016.07.517 ◽

2016 ◽

Vol 16 (10) ◽

pp. S376-S377 ◽

Cited By ~ 1

Author(s):

Samuel C. Overley ◽

Steven J. McAnany ◽

Steven Andelman ◽

Jun Kim ◽

Samuel K. Cho ◽

...

Keyword(s):

Meta Analysis ◽

Return To Play ◽

Adolescent Athletes

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Changes in Patient-Reported Outcome Measures From the Time of Injury to Return to Play in Adolescent Athletes at Secondary Schools With an Athletic Trainer

Journal of Athletic Training ◽

10.4085/1062-6050-553-15 ◽

2019 ◽

Vol 54 (2) ◽

pp. 170-176 ◽

Cited By ~ 1

Author(s):

Janet E. Simon ◽

Alison R. Snyder Valier ◽

Zachary Y. Kerr ◽

Aristarque Djoko ◽

Stephen W. Marshall ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Knee Injury ◽

Outcome Measure ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Return To Play ◽

Foot And Ankle ◽

Adolescent Athletes ◽

Patient Reported ◽

Ability Measure

Context Typically, athletic trainers rely on clinician-centered measures to evaluate athletes' return-to-play status. However, clinician-centered measures do not provide information regarding patients' perceptions. Objective To determine whether clinically important changes in patient-reported outcomes were observed from the time of lower extremity injury to the time of return to play in adolescent athletes. Design Cross-sectional study. Setting The National Athletic Treatment, Injury and Outcomes Network (NATION) program has captured injury and treatment data in 31 sports from 147 secondary schools across 26 states. A subsample of 24 schools participated in the outcomes study arm during the 2012−2013 and 2013−2014 academic years. Patients or Other Participants To be included in this report, student-athletes must have sustained a knee, lower leg, ankle, or foot injury that restricted participation from sport for at least 3 days. A total of 76 initial assessments were started by athletes; for 69 of those, return-to-play surveys were completed and analyzed. Main Outcome Measure(s) All student-athletes completed generic patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS] survey, Global Rating of Change scale, and Numeric Pain Rating Scale) and, depending on body region, completed an additional region-specific measure (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure). All applicable surveys were completed at both the initial and return-to-play time points. Means and standard deviations for the total scores of each patient-reported outcome measure at each time point were calculated. Change scores that reflected the difference from the initial to the return-to-play time points were calculated for each participant and compared with established benchmarks for change. Results The greatest improvement in patient-reported outcomes was in the region-specific forms, with scores ranging from 9.92 to 37.73 on the different region-specific subscales (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure; scores range from 0−100). The region-specific subscales on average still showed a 21.8- to 37.5-point deficit in reported health at return to play. The PROMIS Lower Extremity score increased on average by 13 points; all other PROMIS scales were within normative values after injury. Conclusions Adolescent athletes who were injured at a high school with an athletic trainer may have shown improvement in patient-reported outcomes over time, but when they returned to play, their outcome scores remained lower than norms from comparable athlete groups.

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