scholarly journals Examining Whether Onfield Motor Incoordination Is Associated With Worse Performance on the SCAT5 and Slower Clinical Recovery Following Concussion

2021 ◽  
Vol 11 ◽  
Author(s):  
Grant L. Iverson ◽  
Ryan Van Patten ◽  
Andrew J. Gardner
Keyword(s):  
Assessment Tool ◽  
Rugby League ◽  
Head Impact ◽  
Balance Performance ◽  
Balance Test ◽  
Video Footage ◽  
Motor Incoordination ◽  
Medical Clearance ◽  
Impact Events ◽  
Balance Problems

Objective: To examine the relationship between video-identified onfield motor incoordination, the acute assessment of concussion, and recovery time during three seasons of National Rugby League (NRL) play.Methods: Blows to the head (“head impact events”) were recorded by sideline video operators and medical staff. Any player with a suspected concussion underwent a Head Injury Assessment in which he was taken off the field and medically evaluated, including the administration of the Sports Concussion Assessment Tool, 5th Edition (SCAT5). Video footage was later examined to determine the presence or absence of onfield motor incoordination following the head impact event.Results: Motor incoordination was identified in 100/1,706 head impact events (5.9%); 65 of the 100 instances of motor incoordination (65.0%) were ultimately medically diagnosed with a concussion. In 646 athletes for whom SCAT5 data were available, those with motor incoordination were more likely to report both dizziness and balance problems than those without motor incoordination, but there were no group differences on an objective balance test. Additionally, there was no relationship between presence/absence of motor incoordination and number of games missed or time to medical clearance for match play.Conclusion: In NRL players, motor incoordination is a readily observable onfield sign that is strongly associated with a medical diagnosis of concussion and with self-reported dizziness/balance problems. However, onfield motor incoordination is not associated with objective balance performance and it is not predictive of time to recover following concussion.

scholarly journals How Accurate are Concussed College Athlete’s Self-reported Balance Problems?

2019 ◽  
Vol 34 (5) ◽  
pp. 793-793
Author(s):  
A DaCosta ◽  
M Fasciana ◽  
A Crane ◽  
A LoGalbo
Keyword(s):  
Assessment Tool ◽  
Collegiate Athletes ◽  
Self Report ◽  
Balance Performance ◽  
Post Injury ◽  
Sports Concussion ◽  
Baseline Testing ◽  
Balance Problems ◽  
Balance Error

Abstract Purpose The Balance Error Scoring System (BESS) has been determined to be a reliable and valid measure of balance performance (Bell et al., 2011). Previous research indicates self-reported balance difficulties and postural stability are positively correlated (Broglio et al., 2009). Furthermore, athletes exhibit an increase in errors on the BESS following a concussion (McCrea et al., 2004). Methods 68 collegiate athletes (age 18-23; M=19.62, SD=1.44) received baseline, post-concussion, and follow-up evaluations. Balance performance was measured via the BESS on the Sports Concussion Assessment Tool-5th edition (SCAT5), while symptom reporting was measured by the SCAT5 and ImPACT neurocognitive testing. Results Multiple simple linear regressions were conducted, suggesting that changes in BESS performance from baseline to post-trauma significantly predicted self-report of “balance problems” at post-trauma on ImPACT (F(1, 66)=11.94, p=.001; R2=.15) and SCAT5 (F(1, 66)=5.73, p=.02; R2=.08). While baseline BESS errors were significantly correlated with post-trauma BESS errors (r=.29, p=.02), BESS errors at post-trauma did not significantly predict self-reporting of balance problems on either assessment. Conclusion Results suggest that self-reported balance difficulties following a concussion are an indicator of change in intraindividual balance performance, but not post-trauma balance performance alone. Furthermore, it provides clinical context as the individuals’ perception of change may be greater, impacting the likelihood of self-reporting of balance problems at post-trauma. These results support the clinical utility of examining pre- and post-injury changes in balance by including balance measurements in pre-participation baseline testing.

Ghent Developmental Balance Test: A New Tool to Evaluate Balance Performance in Toddlers and Preschool Children

2012 ◽  
Vol 92 (6) ◽  
pp. 841-852 ◽  
Author(s):  
Alexandra De Kegel ◽  
Tina Baetens ◽  
Wim Peersman ◽  
Leen Maes ◽  
Ingeborg Dhooge ◽  
...  
Keyword(s):  
Interrater Reliability ◽  
Assessment Tool ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Control Group ◽  
Clinical Group ◽  
Balance Performance ◽  
Balance Test ◽  
Movement Assessment ◽  
Z Scores

Background Balance is a fundamental component of movement. Early identification of balance problems is important to plan early intervention. The Ghent Developmental Balance Test (GDBT) is a new assessment tool designed to monitor balance from the initiation of independent walking to 5 years of age. Objective The purpose of this study was to establish the psychometric characteristics of the GDBT. Methods To evaluate test-retest reliability, 144 children were tested twice on the GDBT by the same examiner, and to evaluate interrater reliability, videotaped GDBT sessions of 22 children were rated by 3 different raters. To evaluate the known-group validity of GDBT scores, z scores on the GDBT were compared between a clinical group (n=20) and a matched control group (n=20). Concurrent validity of GDBT scores with the subscale standardized scores of the Movement Assessment Battery for Children–Second Edition (M-ABC-2), the Peabody Developmental Motor Scales–Second Edition (PDMS-2), and the balance subscale of the Bruininks-Oseretsky Test–Second Edition (BOT-2) was evaluated in a combined group of the 20 children from the clinical group and 74 children who were developing typically. Results Test-retest and interrater reliability were excellent for the GDBT total scores, with intraclass correlation coefficients of .99 and .98, standard error of measurement values of 0.21 and 0.78, and small minimal detectable differences of 0.58 and 2.08, respectively. The GDBT was able to distinguish between the clinical group and the control group (t38=5.456, P<.001). Pearson correlations between the z scores on GDBT and the standardized scores of specific balance subscales of the M-ABC-2, PDMS-2, and BOT-2 were moderate to high, whereas correlations with subscales measuring constructs other than balance were low. Conclusions The GDBT is a reliable and valid clinical assessment tool for the evaluation of balance in toddlers and preschool-aged children.

Reliability of Using the Proposed International Consensus Video Signs of Potential Concussion for National Rugby League Head Impact Events

Neurosurgery ◽  
2020 ◽  
Author(s):  
Andrew J Gardner
Keyword(s):  
Characteristic Curve ◽  
Area Under The Curve ◽  
Rugby League ◽  
Head Impact ◽  
International Consensus ◽  
Global Consistency ◽  
Definition Of ◽  
Sensitivity Specificity ◽  
Individual Sports ◽  
Impact Events

Abstract BACKGROUND Consensus on the definition of extant video signs of concussion have recently been proposed by representatives of international sporting codes for global consistency across professional leagues. OBJECTIVE To review the reliability of the proposed international consensus video signs of concussion in National Rugby League (NRL) head impact events (HIEs). METHODS The video signs of concussion were coded for every HIE during the 2019 NRL season. Coding was conducted blinded to the concussion status. Frequency, sensitivity, specificity, and a receiver operating characteristic curve were calculated. RESULTS There were 943 HIEs identified over the 2019 NRL season, of which 106 resulted in a diagnosed concussion. The most frequently observed video sign in concussed athletes was blank/vacant look (54%), which was also the most sensitive video sign (0.54, CI: 0.44-0.63), while the most specific was tonic posturing (0.99, CI: 0.99-1.00). In 43.4% of diagnosed concussions none of the 6 video signs were present. The 6 video signs demonstrated a “fair” ability to discriminate between concussion and nonconcussion HIEs (area under the curve = 0.76). CONCLUSION International consensus agreement between collision sports for extant video signs of concussion and the definition of those extant video signs are clinically important. The selection of signs requires rigorous assessment to examine their predictive value across all sports and within individual sports, and to determine further video signs to compliment and improve the identification of possible concussion events within various sports. The current study demonstrated that, for NRL-related HIEs, the diagnostic accuracy of video signs varies.

scholarly journals The Hammer and the Nail: Biomechanics of Striking and Struck Canadian University Football Players

2021 ◽  
Author(s):  
Jeffrey S. Brooks ◽  
Adam Redgrift ◽  
Allen A. Champagne ◽  
James P. Dickey
Keyword(s):  
College Football ◽  
Head Impact ◽  
Football Players ◽  
Video Footage ◽  
Impact Location ◽  
Rule Changes ◽  
Left And Right ◽  
The Brain

AbstractThis study sought to evaluate head accelerations in both players involved in a football collision. Players on two opposing Canadian university teams were equipped with helmet mounted sensors during one game per season, for two consecutive seasons. A total of 276 collisions between 58 instrumented players were identified via video and cross-referenced with sensor timestamps. Player involvement (striking and struck), impact type (block or tackle), head impact location (front, back, left and right), and play type were recorded from video footage. While struck players did not experience significantly different linear or rotational accelerations between any play types, striking players had the highest linear and rotational head accelerations during kickoff plays (p ≤ .03). Striking players also experienced greater linear and rotational head accelerations than struck players during kickoff plays (p = .001). However, struck players experienced greater linear and rotational accelerations than striking players during kick return plays (p ≤ .008). Other studies have established that the more severe the head impact, the greater risk for injury to the brain. This paper’s results highlight that kickoff play rule changes, as implemented in American college football, would decrease head impact exposure of Canadian university football athletes and make the game safer.

scholarly journals Effect of Head Impact Exposures on Changes in Cognitive Testing

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876103 ◽  
Author(s):  
Eleni Diakogeorgiou ◽  
Theresa L. Miyashita
Keyword(s):  
Reaction Time ◽  
National Collegiate Athletic Association ◽  
Assessment Tool ◽  
Vital Signs ◽  
Head Impact ◽  
Cognitive Testing ◽  
Repeated Impact ◽  
Level Of Evidence ◽  
Head Impacts ◽  
Significant Difference

Background: Gaining a better understanding of head impact exposures may lead to better comprehension of the possible effects of repeated impact exposures not associated with clinical concussion. Purpose: To assess the correlation between head impacts and any differences associated with cognitive testing measurements pre- and postseason. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 34 National Collegiate Athletic Association Division I men’s lacrosse players wore lacrosse helmets instrumented with an accelerometer during the 2014 competitive season and were tested pre- and postseason with the Sport Concussion Assessment Tool (SCAT 3) and Concussion Vital Signs (CVS) computer-based neurocognitive tests. The number of head impacts >20 g and results from the 2 cognitive tests were analyzed for differences and correlation. Results: There was no significant difference between pre- and postseason SCAT 3 scores, although a significant correlation between pre- and postseason cognitive scores on the SCAT 3 and total number of impacts sustained was noted ( r = –0.362, P = .035). Statistically significant improvements on half of the CVS testing components included visual reaction time ( P = .037, d = 0.37), reaction time ( P = .001, d = 0.65), and simple reaction time ( P = .043, d = 0.37), but no correlation with head impacts was noted. Conclusion: This study did not find declines in SCAT 3 or CVS scores over the course of a season among athletes who sustained multiple head impacts but no clinical concussion. Thus, it could not be determined whether there was no cognitive decline among these athletes or whether there may have been subtle declines that could not be measured by the SCAT 3 or CVS.

Prediction of Rotating Machinery Vibration Using Balance Simulation With Measurement Uncertainty

1995 ◽  
Author(s):  
Rob P. Andrews
Keyword(s):  
Measurement Uncertainty ◽  
High Speed ◽  
Rotating Machinery ◽  
Lms Algorithm ◽  
Least Mean Square ◽  
Balance Performance ◽  
Element Analysis ◽  
Balance Test ◽  
Influence Coefficients ◽  
Test Process

Abstract Vibration predictions for rotating machinery with high-speed flexible rotors must account for the methods and limitations of the balance test process which determine the residual rotor unbalance. Vibration predictions based on finite element analysis (FEA) methods are highly dependent upon the assumed rotor unbalance amplitude and phase. The actual residual unbalance distribution depends upon the measured influence coefficients and the least-mean-square (LMS) algorithm used to calculate balance correction weights. Repeatability of the vibration measurements is a key factor in successful balancing. The vibration predictions described in this paper use estimates of final residual unbalance obtained by simulating the balance test process. The simulation uses FEA based influence coefficients, a test based measurement uncertainty (repeatability) model, and LMS balance weight calculations including the specified vibration target levels. The simulations can be used to predict the limit of balance performance of the machinery and to evaluate design options for impact on residual unbalance levels.

Responsiveness and Minimal Clinically Important Difference of the Brief-BESTest in People with COPD after Pulmonary Rehabilitation

2021 ◽  
Author(s):  
Cátia Paixão ◽  
Patrícia Rebelo ◽  
Ana Oliveira ◽  
Cristina Jácome ◽  
Joana Cruz ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Minimal Clinically Important Difference ◽  
Secondary Analysis ◽  
Balance Training ◽  
Chronic Obstructive ◽  
Balance Performance ◽  
Balance Test ◽  
Obstructive Pulmonary Disease ◽  
Clinically Important Difference ◽  
6 Minute Walk Test

Abstract Objective The Brief-Balance Evaluation Systems Test (Brief-BESTest) is a comprehensive, reliable, and valid balance test that provides valuable information to guide balance training in people with chronic obstructive pulmonary disease (COPD). Its clinical interpretability is, however, currently limited, as cutoff points to identify clinically relevant changes in people with COPD after pulmonary rehabilitation are still lacking. This study aimed to establish the responsiveness and minimal clinically important difference (MCID) for the Brief-BESTest in people with COPD after pulmonary rehabilitation (PR). Methods A secondary analysis of data from 2 previous studies was conducted. The modified British Medical Research Council (mMRC) dyspnea scale, the 6-Minute Walk Test (6-MWT), and the Brief-BESTest (0–24 points) were collected in people with COPD pre/post a 12-week PR program including balance training. The MCID was computed using anchor- and distribution-based methods. Changes in the 6-MWT and the mMRC were assessed and used as anchors. The pooled MCID was computed using the arithmetic weighted mean (2/3 anchor- and 1/3 distribution-based methods). Results Seventy-one people with COPD [69 years (SD = 8); 76% male; FEV1 = 49.8%predicted (SD = 18%)] were included. There was a significant improvement in the Brief-BESTest after PR [mean difference = 3 points (SD = 3)]. Significant correlations were found between the Brief-BESTest and the mMRC (r = −.31) and the 6-MWT (r = .37). The pooled MCID was 3.3 points. Conclusion An improvement of at least 3 points in the Brief-BESTest in people with COPD will enhance the interpretability of PR effects on balance performance of this population and guide tailored interventions. Impact The Brief-BESTest outcome measure is comprehensive, easily administered, and simple to interpret in clinical practice. This study represents a significant contribution toward the clinical interpretation of changes in balance in people with COPD following PR.

scholarly journals Effects of balance training on balance performance in youth: role of training difficulty

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Simon Schedler ◽  
Florian Tenelsen ◽  
Laura Wich ◽  
Thomas Muehlbauer
Keyword(s):  
Task Difficulty ◽  
Balance Training ◽  
Gait Velocity ◽  
Balance Performance ◽  
Timed Up And Go ◽  
Balance Test ◽  
Cross Sectional ◽  
Time Dynamic ◽  
Balance Task ◽  
Functional Reach Test

Abstract Background Cross-sectional studies have shown that balance performance can be challenged by the level of task difficulty (e.g., varying stance conditions, sensory manipulations). However, it remains unclear whether the application of different levels of task difficulty during balance training (BT) leads to altered adaptations in balance performance. Thus, we examined the effects of BT conducted under a high versus a low level of task difficulty on balance performance. Methods Forty male adolescents were randomly assigned to a BT program using a low (BT-low: n = 20; age: 12.4 ± 2.0 yrs) or a high (BT-high: n = 20; age: 12.5 ± 2.5 yrs) level of balance task difficulty. Both groups trained for 7 weeks (2 sessions/week, 30–35 min each). Pre- and post-training assessments included measures of static (one-legged stance [OLS] time), dynamic (10-m gait velocity), and proactive (Y-Balance Test [YBT] reach distance, Functional Reach Test [FRT]; Timed-Up-and-Go Test [TUG]) balance. Results Significant main effects of Test (i.e., pre- to post-test improvements) were observed for all but one balance measure (i.e., 10-m gait velocity). Additionally, a Test x Group interaction was detected for the FRT in favor of the BT-high group (Δ + 8%, p < 0.001, d = 0.35). Further, tendencies toward significant Test x Group interactions were found for the YBT anterior reach (in favor of BT-high: Δ + 9%, p < 0.001, d = 0.60) and for the OLS with eyes opened and on firm surface (in favor of BT-low: Δ + 31%, p = 0.003, d = 0.67). Conclusions Following 7 weeks of BT, enhancements in measures of static, dynamic, and proactive balance were observed in the BT-high and BT-low groups. However, BT-high appears to be more effective for increasing measures of proactive balance, whereas BT-low seems to be more effective for improving proxies of static balance. Trial registration Current Controlled Trials ISRCTN83638708 (Retrospectively registered 19th June, 2020).

scholarly journals Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets

2012 ◽  
Vol 117 (6) ◽  
pp. 1092-1099 ◽  
Author(s):  
Ann-Christine Duhaime ◽  
Jonathan G. Beckwith ◽  
Arthur C. Maerlender ◽  
Thomas W. McAllister ◽  
Joseph J. Crisco ◽  
...  
Keyword(s):  
Collegiate Athletes ◽  
Head Impact ◽  
Ice Hockey ◽  
Future Research ◽  
Impact Event ◽  
Head Impacts ◽  
Presenting Symptoms ◽  
Wide Range ◽  
Impact Events ◽  
Specific Impact

Object Concussive head injuries have received much attention in the medical and public arenas, as concerns have been raised about the potential short- and long-term consequences of injuries sustained in sports and other activities. While many student athletes have required evaluation after concussion, the exact definition of concussion has varied among disciplines and over time. The authors used data gathered as part of a multiinstitutional longitudinal study of the biomechanics of head impacts in helmeted collegiate athletes to characterize what signs, symptoms, and clinical histories were used to designate players as having sustained concussions. Methods Players on 3 college football teams and 4 ice hockey teams (male and female) wore helmets instrumented with Head Impact Telemetry (HIT) technology during practices and games over 2–4 seasons of play. Preseason clinical screening batteries assessed baseline cognition and reported symptoms. If a concussion was diagnosed by the team medical staff, basic descriptive information was collected at presentation, and concussed players were reevaluated serially. The specific symptoms or findings associated with the diagnosis of acute concussion, relation to specific impact events, timing of symptom onset and diagnosis, and recorded biomechanical parameters were analyzed. Results Data were collected from 450 athletes with 486,594 recorded head impacts. Forty-eight separate concussions were diagnosed in 44 individual players. Mental clouding, headache, and dizziness were the most common presenting symptoms. Thirty-one diagnosed cases were associated with an identified impact event; in 17 cases no specific impact event was identified. Onset of symptoms was immediate in 24 players, delayed in 11, and unspecified in 13. In 8 cases the diagnosis was made immediately after a head impact, but in most cases the diagnosis was delayed (median 17 hours). One diagnosed concussion involved a 30-second loss of consciousness; all other players retained alertness. Most diagnoses were based on self-reported symptoms. The mean peak angular and rotational acceleration values for those cases associated with a specific identified impact were 86.1 ± 42.6g (range 16.5–177.9g) and 3620 ± 2166 rad/sec2 (range 183–7589 rad/sec2), respectively. Conclusions Approximately two-thirds of diagnosed concussions were associated with a specific contact event. Half of all players diagnosed with concussions had delayed or unclear timing of onset of symptoms. Most had no externally observed findings. Diagnosis was usually based on a range of self-reported symptoms after a variable delay. Accelerations clustered in the higher percentiles for all impact events, but encompassed a wide range. These data highlight the heterogeneity of criteria for concussion diagnosis, and in this sports context, its heavy reliance on self-reported symptoms. More specific and standardized definitions of clinical and objective correlates of a “concussion spectrum” may be needed in future research efforts, as well as in the clinical diagnostic arena.

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