Relationship Between Cognitive Performance and Lower Extremity Biomechanics: Implications for Sports-Related Concussion

Background: Collegiate athletes with prior sports-related concussion (SRC) are at increased risk for lower extremity (LE) injuries; however, the biomechanical and cognitive mechanisms underlying the SRC-LE injury relationship are not well understood. Purpose: To examine the association between cognitive performance and LE land-and-cut biomechanics among collegiate athletes with and without a history of SRC and to determine the association among multiple cognitive testing batteries in the same athlete cohort. Study Design: Controlled laboratory study. Methods: A cohort of 20 collegiate athletes with prior SRC (9 men, 11 women; mean ± standard deviation [SD] age, 20.5 ± 1.3 years; mean ± SD time since last SRC, 461 ± 263 days) and 20 matched controls (9 men, 11 women; mean ± SD age, 19.8 ± 1.3 years) completed land-and-cut tasks using the dominant and nondominant limbs. LE biomechanical variables and a functional visuomotor reaction time (FVMRT) were collected during each trial. Athletes also completed the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) and Senaptec Sensory Station assessments. Results: In the SRC cohort, Pearson correlation coefficients indicated slower FVMRT was moderately correlated with decreased dominant limb ( r = –0.512) and nondominant limb ( r = –0.500) knee flexion, while increased dominant limb knee abduction moment was moderately correlated with decreased ImPACT Visual Memory score ( r = –0.539) and slower ImPACT Reaction Time ( r = 0.515). Most computerized cognitive measures were not associated with FVMRT in either cohort ( P > .05). Conclusion: Decreased reaction time and working memory performance were moderately correlated with decreased sagittal plane knee motion and increased frontal plane knee loading in collegiate athletes with a history of SRC. The present findings suggest a potential unique relationship between cognitive performance and LE neuromuscular control in athletes with a history of SRC injury. Last, we determined that computerized measures of cognitive performance often utilized for SRC management are dissimilar to sport-specific cognitive processes. Clinical Relevance: Understanding the relationship between cognitive performance and LE biomechanics in athletes with prior SRC may inform future clinical management strategies. Future research should prospectively assess cognitive and biomechanical measures, along with LE injury incidence, to identify mechanisms underlying the SRC-LE injury relationship.

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Y-Balance test asymmetry is greater in collegiate athletes with a history of concussion

Neurology ◽

10.1212/01.wnl.0000550655.96792.92 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S26.1-S26

Author(s):

Hoch Matthew ◽

Curry Nicole ◽

Hartley-Gabriel Emily ◽

Heebner Nicholas ◽

Hoch Johanna

Keyword(s):

Lower Extremity ◽

Injury Risk ◽

Collegiate Athletes ◽

Lower Extremity Injury ◽

Absolute Difference ◽

Group Differences ◽

Extremity Injury ◽

Balance Test ◽

Increased Risk ◽

History Of

Athletes with a history of concussion (HC) are at an increased risk of sustaining lower extremity injuries. It is unclear if these individuals exhibit dynamic postural control deficits associated with lower extremity injury risk. The purpose of this study was to determine if collegiate athletes with a HC demonstrate differences in Y-Balance Test (YBT) performance compared to athletes with no history of concussion (NHC). A total of 116 varsity and club athletes from a Division-I university participated. Forty participants reported a HC (female/male: 31/9, age: 20.0 ± 1.4 years, height: 169.3 ± 13.1 cm, mass: 68.4 ± 14.0 kg) while 76 reported NHC (female/male: 60/16, age: 20.0 ± 1.7 years, height: 168.5 ± 12.9 cm, mass: 68.7 ± 14.6 kg). Individuals with a current concussion or lower extremity injury, or a history of lower extremity surgery were excluded. Participants completed the YBT anterior reach direction barefoot on both limbs. The YBT was completed by maximally reaching anteriorly, maintaining balance, and returning to the starting position without errors. Participants completed 4 practice trials and 3 test trials. Reach distances were averaged and normalized to leg length. Between-limb asymmetry was calculated as the absolute difference between the left and right limbs. Separate independent t-tests examined group differences in normalized reach distances and asymmetry. The proportion of participants in each group with >4 cm of asymmetry was compared using a χ2 test. Alpha was set at 0.05 for all analyses. No group differences were identified in normalized reach distances for the left (HC: 61.4% ± 9.2%, NHC: 60.8% ± 6.2%, p = 0.88, ES = 0.08) or right (HC: 61.4% ± 6.2%, NHC: 60.2% ± 6.8%, p = 0.51, ES = 0.17) limbs. However, a greater proportion of HC participants demonstrated >4 cm asymmetry (HC: 40.0%, NHC: 19.7%; p = 0.02) and these participants exhibited greater asymmetry (HC: 3.87 ± 3.69 cm, NHC: 2.40 ± 2.13 cm, p = 0.03; ES = 0.53). Athletes with a HC exhibited greater asymmetry compared to athletes with NHC. Anterior reach asymmetries of >4 cm are associated with greater lower extremity injury risk. The YBT may provide a clinical technique to further explore the relationship between concussion and lower extremity injury.

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No Sex Differences in Risk for Lower-Extremity Musculoskeletal Injury in Concussed Amateur Rugby Players

Neurology ◽

10.1212/01.wnl.0000719980.86372.7f ◽

2020 ◽

Vol 95 (20 Supplement 1) ◽

pp. S12.1-S12

Author(s):

Katelyn Costantini ◽

Katie Hunzinger ◽

Charles Buz Swanik ◽

Thomas A. Buckley

Keyword(s):

Sex Differences ◽

Lower Extremity ◽

Collegiate Athletes ◽

Musculoskeletal Injury ◽

Future Research ◽

Ratio Test ◽

Male And Female ◽

Increased Risk ◽

History Of ◽

Rugby Players

ObjectiveTo examine sex differences between concussion and lower-extremity musculoskeletal injury (LE-MSI) in community male and female rugby players.BackgroundThere is an ∼2x elevated risk of post-concussion subsequent MSI in high school through professional athletes. However, the effect of sex on risk is inconsistent and sparse, and rugby provides an ideal population as it’s the only collision sport with the same rules for both sexes.Design/Methods1,037 rugby players (31.6 + 11.3 years, 59.1% male), with at least one year of rugby playing experience, participated in this study, completing an online injury history questionnaire to ascertain concussion (yes/no) and LE-MSI (yes/no) history. A chi-squared test was performed to determine the association between concussion and any LE-MSI; significant findings were followed up with a post hoc odds ratio test. A binary logistic regression with any LE-MSI (yes/no) as the outcome and concussion (yes/no) and sex (male/female) as predictors was performed to determine if there was a sex by concussion interaction.ResultsThere was a significant association between concussion and any LE-MSI for all groups (Overall: ?(1) =13.06, p < 0.001, OR = 2.30 [95% CI: 1.45–3.65]; Males: ?(1) =7.43 p = 0.006, OR = 2.21 [95% CI: 1.24–3.96]; and Females: ?(1) = 5.78, p = 0.016, OR = 2.48 [95% CI: 1.16–5.31]). However, there were no differences for risk of LE-MSI between males and females (p = 0.99, R2 = 0.024).ConclusionsBoth male and female community rugby players had a 2x greater risk of LE-MSI, given a history of concussion compared to those without a history of concussion, which aligns with previous studies focused on collegiate athletes. However, there was no difference in risk of LE-MSI between sexes, contrary to smaller, but more controlled studies. Future research should investigate the potential physiological mechanisms for increased risk of LE-MSI.

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Soccer-Specific Warm-Up and Lower Extremity Injury Rates in Collegiate Male Soccer Players

Journal of Athletic Training ◽

10.4085/1062-6050-48.4.08 ◽

2013 ◽

Vol 48 (6) ◽

pp. 782-789 ◽

Cited By ~ 85

Author(s):

Dustin R. Grooms ◽

Thomas Palmer ◽

James A. Onate ◽

Gregory D. Myer ◽

Terry Grindstaff

Keyword(s):

Lower Extremity ◽

Injury Risk ◽

Collegiate Athletes ◽

Neuromuscular Control ◽

Soccer Players ◽

Lower Extremity Injury ◽

Research Centre ◽

Injury Incidence ◽

Extremity Injury ◽

Warm Up

Context: A number of comprehensive injury-prevention programs have demonstrated injury risk-reduction effects but have had limited adoption across athletic settings. This may be due to program noncompliance, minimal exercise supervision, lack of exercise progression, and sport specificity. A soccer-specific program described as the F-MARC 11+ was developed by an expert group in association with the Federation Internationale de Football Association (FIFA) Medical Assessment and Research Centre (F-MARC) to require minimal equipment and implementation as part of regular soccer training. The F-MARC 11+ has been shown to reduce injury risk in youth female soccer players but has not been evaluated in an American male collegiate population. Objective: To investigate the effects of a soccer-specific warm-up program (F-MARC 11+) on lower extremity injury incidence in male collegiate soccer players. Design: Cohort study. Setting: One American collegiate soccer team followed for 2 seasons. Patients or Other Participants: Forty-one male collegiate athletes aged 18–25 years. Intervention(s): The F-MARC 11+ program is a comprehensive warm-up program targeting muscular strength, body kinesthetic awareness, and neuromuscular control during static and dynamic movements. Training sessions and program progression were monitored by a certified athletic trainer. Main Outcome Measure(s): Lower extremity injury risk and time lost to lower extremity injury. Results: The injury rate in the referent season was 8.1 injuries per 1000 exposures with 291 days lost and 2.2 injuries per 1000 exposures and 52 days lost in the intervention season. The intervention season had reductions in the relative risk (RR) of lower extremity injury of 72% (RR = 0.28, 95% confidence interval = 0.09, 0.85) and time lost to lower extremity injury (P < .01). Conclusions: This F-MARC 11+ program reduced overall risk and severity of lower extremity injury compared with controls in collegiate-aged male soccer athletes.

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Are hypertensive patients with history of coronary artery disease at risk for silent lower extremity artery disease?

Journal of Basic and Clinical Physiology and Pharmacology ◽

10.1515/jbcpp-2021-0235 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Eka Prasetya Budi Mulia ◽

Kevin Yuwono ◽

Raden Mohammad Budiarto

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Lower Extremity ◽

Pearson Correlation ◽

Ankle Brachial Index ◽

Chi Square ◽

Hypertensive Patients ◽

History Of ◽

Artery Disease ◽

Lower Extremity Artery Disease

Abstract Objectives We aimed to investigate the association between hypertension and asymptomatic lower extremity artery disease (LEAD) in outpatients with known history of coronary artery disease (CAD). Methods Patients with known history of CAD who have been undergone coronary angiography and have significant coronary artery stenosis (more than 60%) were included. LEAD was defined as ankle-brachial index (ABI) < 0.9 in either leg. The risk of LEAD in hypertensive group was analyzed using chi-square test, and correlation between blood pressure (BP) and ABI was analyzed using Pearson correlation test in SPSS v.25. Results One hundred and four patients were included. 82.7% of patients were male. Mean age was 57.05 ± 7.97. The prevalence of hypertension was 35.6%, and the prevalence of LEAD was 16.3%. A higher proportion of LEAD was found in hypertensive (18.9%) compared to non-hypertensive (14.9%), although not statistically significant (OR: 1.33; 95% CI: 0.46 to 3.85; p=0.598). There was an association between ABI and systolic BP (p=0.016), but not with diastolic BP (p=0.102). Conclusions Our study showed that the prevalence of LEAD in hypertension, especially in the CAD population, is relatively high. There was no association between hypertension and LEAD, but a higher prevalence of LEAD was found in hypertensive patients. Nevertheless, LEAD screening is still recommended in hypertensive patients, especially in the CAD population, given the fact that outcomes of health and mortality are worse for those with concomitants of these diseases.

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Slower visuomotor reaction time in division-I collegiate athletes with a history of ankle sprain

Research in Sports Medicine ◽

10.1080/15438627.2021.1996361 ◽

2021 ◽

pp. 1-9

Author(s):

Kyeongtak Song ◽

Johanna M. Hoch ◽

Carolina Quintana ◽

Nicholas R. Heebner ◽

Matthew C. Hoch

Keyword(s):

Reaction Time ◽

Ankle Sprain ◽

Collegiate Athletes ◽

Division I ◽

History Of

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THE RELATIONSHIP BETWEEN AUDITORY REACTION TIME AND BODY BALANCE IN ELEMENTARY SCHOOL CHILDREN AT BAHA VILLAGE

Majalah Ilmiah Fisioterapi Indonesia ◽

10.24843/mifi.2019.v07.i03.p02 ◽

2019 ◽

Vol 7 (3) ◽

pp. 5

Author(s):

Putu Rian Pradhiva ◽

Ari Wibawa ◽

Ni Wayan Tianing

Keyword(s):

Elementary School ◽

Reaction Time ◽

School Children ◽

Elementary School Children ◽

Pearson Correlation ◽

Body Balance ◽

Increased Risk ◽

Data Output ◽

Auditory Reaction Time ◽

The Relationship

Balance in children is one of the most important things to notice during its development. Increased risk of loss ofbalance is often associated with a slow reaction time. The purpose of this study was to determine the relationshipbetween auditory reaction time and body balance in students at Elementary School in Baha village. This research wasconducted in March 2018 with cross sectional analytic study design. Samples were taken by simple random samplingmethod with 96 samples. The sample age range is 8 - 10 years. The independent variable is auditory reaction timemeasured using computerized reaction time test software. Dependent variable is body balance measured usingPediatric Balance Scale. The relationship between two variables was analyze using Pearson Correlation test. There isa significant correlation between auditory reaction time to body balance, based on data output from analysis withsignificance <? (p = 0,006). Furthermore, based on data output known Correlation Coefficient of -0.228 which meansthe existence of negative and linear relationship. There was a significant relationship between auditory reaction timeand body balance in elementary school children in Baha Village.Keywords: Reaction Time, Auditory, Balance, Children

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B-52 Improvements in Cognitive Functioning in Inactive Professional Fighters

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.135 ◽

2019 ◽

Vol 34 (6) ◽

pp. 998-998

Author(s):

L Bennett ◽

C Bernick ◽

W Ng

Keyword(s):

Reaction Time ◽

Cognitive Functioning ◽

Sample Size ◽

Cognitive Performance ◽

Processing Speed ◽

Verbal Memory ◽

Vital Signs ◽

Health Study ◽

Time Points ◽

Increased Risk

Abstract Objective Repetitive head injuries common in combat sports have been associated with increased risk for cognitive dysfunction. Interestingly, the Professional Fighter’s Brain Health Study (PFBHS) team has observed improvements in fighters’ cognitive performance following their transition to inactive fighting status. As this phenomenon was explored, it was hypothesized that fighters’ cognitive performance will initially improve following their discontinuation of fighting. Methods Longitudinal demographic, fighting history, and cognitive functioning data from 31 fighters who discontinued fighting during their participation in the PFBHS. Cognitive functioning was assessed via CNS Vital Signs and C3/iComet computerized batteries. Number of professional fights, as well as inactive fighting status, was determined using published professional online records. Fighters were considered inactive if they had gone two or more years without a professional match. Results Paired-samples t test was conducted to evaluate cognitive functioning in fighters at time 1 (actively fighting) and time 2 (inactive fighting status). When comparing cognitive function at across time points, performance on CNS Vital Signs measures of verbal memory, processing speed, psychomotor speed, and reaction time, as well as C3/iComet measures of set-shifting and complex reaction time, significantly improved at time 2 (all p’s < 0.05). Interestingly, performance did not improve across time points on a C3/iComet measure of processing speed (Trailmaking Test Part A). Conclusions Cognitive performance improved on most measures when fighters transitioned to inactive fighting status. Given the limited sample size, future analysis is necessary to evaluate the relationship between fighting status and cognitive performance in a larger sample size.

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Lower Extremity Biomechanics Differ in Prepubescent and Postpubescent Female Athletes during Stride Jump Landings

Journal of Applied Biomechanics ◽

10.1123/jab.19.2.139 ◽

2003 ◽

Vol 19 (2) ◽

pp. 139-152 ◽

Cited By ~ 13

Author(s):

Chris J. Hass ◽

Elizabeth A. Schick ◽

John W. Chow ◽

Mark D. Tillman ◽

Denis Brunt ◽

...

Keyword(s):

Lower Extremity ◽

Repeated Measures ◽

High Speed ◽

Female Athletes ◽

Neuromuscular Control ◽

Common Mechanism ◽

Inverse Dynamic ◽

Recreational Athletes ◽

Increased Risk ◽

Resultant Forces

Epidemiological evidence suggests the incidence of injury in female athletes is greater after the onset of puberty and that landing from a jump is a common mechanism of knee injury. This investigation compared lower extremity joint kinematics and joint resultant forces and moments during three types of stride jump (stride jump followed by a static landing; a ballistic vertical jump; and a ballistic lateral jump) between pre- and postpubescent recreational athletes to provide some insight into the increased incidence of injury. Sixteen recreationally active postpubescent women (ages 18–25 years) and 16 recreationally active prepubescent girls (ages 8–11 years) participated in this study. High speed 3D videography and force plate data were used to record each jumper’s performance of the stride jumps, and an inverse dynamic procedure was used to estimate lower extremity joint resultant forces and moments and power. These dependent variables were submitted to a 2 × 3 (Maturation Level × Landing Sequence) MANOVA with repeated measures on the last factor. The findings indicated that postpubescents landed with the knee more extended (4.4°) and had greater extension moments (approximately 30% greater hip and knee extension moments) and powers (40% greater knee power). Further, the post-pubescent athletes had greater knee anterior/posterior forces as well as medio-lateral resultant forces. The differences found between the two groups suggest there may be anatomical and physiological changes with puberty that lead to differences in strength or neuromuscular control which influence the dynamic restraint system in these recreational athletes. A combination of these factors likely plays a role in the increased risk of injury in postpubescent females.

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Cognitive Function in Older Diabetic Subjects with a History of Alcohol Abuse

Psychological Reports ◽

10.2466/pr0.101.4.1125-1132 ◽

2007 ◽

Vol 101 (3_suppl) ◽

pp. 1125-1132 ◽

Cited By ~ 7

Author(s):

Judith A. Hudetz ◽

David C. Warltier

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Alcohol Abuse ◽

Verbal Memory ◽

Cognitive Test ◽

Diabetic Patients ◽

Delayed Recall ◽

Immediate Recall ◽

Increased Risk ◽

History Of

Either diabetes or alcohol abuse can impair cognitive function, especially at older ages. Whether a history of alcohol abuse increases the risk for cognitive impairment in diabetic patients has not been examined. Cognitive function of type 2 diabetic subjects with a history of alcohol abuse was expected to be more impaired than that of subjects with either diabetes or alcohol abuse alone. Men, >55 years of age, were categorized as 15 alcoholic-diabetic; 15 alcoholic-nondiabetic; 15 nonalcoholic-diabetic; 15 nonalcoholic-nondiabetic, and matched on age, sex, and education. Participants' verbal memory, visuospatial memory, and executive functions were assessed using a neurocognitive test battery. Significant interactions of diabetes and alcoholism for Visual Delayed Recall, Story Immediate Recall, and Story Delayed Recall implied that diabetes and alcohol abuse enhanced each other's effect in lowering cognitive test scores. Alcohol abuse history in older diabetic subjects presents an increased risk for cognitive impairment.

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Association of Competition Volume, Club Sports, and Sport Specialization With Sex and Lower Extremity Injury History in High School Athletes

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738117714160 ◽

2017 ◽

Vol 9 (6) ◽

pp. 518-523 ◽

Cited By ~ 49

Author(s):

Eric G. Post ◽

David R. Bell ◽

Stephanie M. Trigsted ◽

Adam Y. Pfaller ◽

Scott J. Hetzel ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Sport Participation ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes ◽

Level Of Evidence ◽

Increased Risk ◽

History Of ◽

Club Sport

Background: High school athletes are increasingly encouraged to participate in 1 sport year-round to increase their sport skills. However, no study has examined the association of competition volume, club sport participation, and sport specialization with sex and lower extremity injury (LEI) in a large sample of high school athletes. Hypothesis: Increased competition volume, participating on a club team outside of school sports, and high levels of specialization will all be associated with a history of LEI. Girls will be more likely to engage in higher competition volume, participate on a club team, and be classified as highly specialized. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: High school athletes completed a questionnaire prior to the start of their competitive season regarding their sport participation and previous injury history. Multivariable logistic regression analyses were used to investigate associations of competition volume, club sport participation, and sport specialization with history of LEI, adjusting for sex. Results: A cohort of 1544 high school athletes (780 girls; grades 9-12) from 29 high schools completed the questionnaire. Girls were more likely to participate at high competition volume (23.2% vs 11.0%, χ2 = 84.7, P < 0.001), participate on a club team (61.2% vs 37.2%, χ2 = 88.3, P < 0.001), and be highly specialized (16.4% vs 10.4%, χ2 = 19.7, P < 0.001). Athletes with high competition volume, who participated in a club sport, or who were highly specialized had greater odds of reporting a previous LEI than those with low competition volume (odds ratio [OR], 2.08; 95% CI, 1.55-2.80; P < 0.001), no club sport participation (OR, 1.50; 95% CI, 1.20-1.88; P < 0.001), or low specialization (OR, 2.58; 95% CI, 1.88-3.54; P < 0.001), even after adjusting for sex. Conclusion: Participating in high sport volume, on a club team, or being highly specialized was associated with history of LEI. Girls were more likely to participate at high volumes, be active on club teams, or be highly specialized, potentially placing them at increased risk of injury. Clinical Relevance: Youth athletes, parents, and clinicians should be aware of the potential risks of intense, year-round participation in organized sports.

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