Pilot Evaluation of a Novel Clinical Test of Reaction Time in National Collegiate Athletic Association Division I Football Players

Abstract Context: Evidence suggests that concussion prolongs reaction time (RT). We have developed a simple, reliable clinical tool for measuring reaction time that may be of value in the assessment of concussion in athletes. Objective: To compare baseline values of clinical RT (RTclin) obtained using the new clinical reaction time apparatus with computerized RT (RTcomp) obtained using a validated computerized neuropsychological test battery. Design: Cross-sectional study. Setting: Data were collected during a National Collegiate Athletic Association Division I collegiate football team's preparticipation physical examination session. Patients or Other Participants: Ninety-four Division I collegiate football players. Main Outcome Measure(s): The RTclin was measured using a 1.3-m measuring stick embedded in a weighted rubber disk that was released and caught as quickly as possible. The RTcomp was measured using the simple RT component of CogState Sport. Results: For the 68 athletes whose CogState Sport tests passed the program's integrity check, RTclin and RTcomp were correlated (r = 0.445, P < .001). Overall, mean RTclin was shorter and less variable than mean RTcomp (203 ± 20 milliseconds versus 268 ± 44 milliseconds; P < .001). When RTclin and RTcomp were compared between those athletes with (n = 68) and those without (n = 26) valid CogState Sport test sessions, mean RTclin was similar (202 ± 19 milliseconds versus 207 ± 23 milliseconds; P = .390), but mean RTcomp was different (258 ± 35 milliseconds versus 290 ± 55 milliseconds; P = .009). Conclusions: The RTclin was positively correlated with RTcomp and yielded more consistent reaction time values during baseline testing. Given that RTclin is easy to measure using simple, inexpensive equipment, further prospective study is warranted to determine its clinical utility in the assessment of concussion in athletes.

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Invalid Performance and the ImPACT in National Collegiate Athletic Association Division I Football Players

Journal of Athletic Training ◽

10.4085/1062-6050-48.6.20 ◽

2013 ◽

Vol 48 (6) ◽

pp. 851-855 ◽

Cited By ~ 18

Author(s):

Ashley J. Szabo ◽

Michael L. Alosco ◽

Andrew Fedor ◽

John Gunstad

Keyword(s):

National Collegiate Athletic Association ◽

Impact Testing ◽

Cognitive Testing ◽

Division I ◽

Cognitive Test ◽

Football Players ◽

Cross Sectional ◽

Validity Indices ◽

Informational Intervention ◽

The Impact

Context: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized cognitive test battery commonly used for concussion evaluation. An important aspect of these procedures is baseline testing, but researchers have suggested that many users do not use validity indices to ensure adequate effort during testing. No one has examined the prevalence of invalid performance for college football players. Objective: To examine the prevalence of invalid scores on ImPACT testing. Design: Cross-sectional study. Setting: National Collegiate Athletic Association Division I university. Patients or Other Participants: A total of 159 athletes (age = 20.3 ± 1.41 years; range = 17.8–23.7 years) from a Division I collegiate football team participated. Intervention(s): An informational intervention regarding the importance of concussion testing to promote safety was administered before testing for the most recent season. Main Outcome Measure(s): We examined preseason ImPACT testing data across a 3-year period (total assessments = 269). Based on invalid and sandbagging indices denoted by the ImPACT manual, protocols were examined to indicate how many invalid indices each athlete had. Results: A total of 27.9% (n = 75) of assessments were suggestive of invalid scores, with 4.1% (n = 11) suggesting invalid responding only, 17.5% (n = 47) indicating “sandbagging” only, and 6.3% (n = 17) showing both invalid and sandbagging responding. The informational intervention did not reduce the prevalence of invalid responding. Conclusions: These findings highlight the need for further information about the ImPACT validity indices and whether they truly reflect poor effort. Future work is needed to identify practices to reliably target and reduce invalid responding.

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Elevations in MicroRNA Biomarkers in Serum Are Associated with Measures of Concussion, Neurocognitive Function, and Subconcussive Trauma over a Single National Collegiate Athletic Association Division I Season in Collegiate Football Players

Journal of Neurotrauma ◽

10.1089/neu.2018.6072 ◽

2019 ◽

Vol 36 (8) ◽

pp. 1343-1351 ◽

Cited By ~ 14

Author(s):

Linda Papa ◽

Semyon M. Slobounov ◽

Hans C. Breiter ◽

Alexa Walter ◽

Tim Bream ◽

...

Keyword(s):

National Collegiate Athletic Association ◽

Neurocognitive Function ◽

Division I ◽

Football Players ◽

Collegiate Football

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Concussion-Prevention Strategies Used in National Collegiate Athletic Association Divisions I and II Women's Soccer

Journal of Athletic Training ◽

10.4085/1062-6050-142-19 ◽

2020 ◽

Vol 55 (5) ◽

pp. 469-474

Author(s):

Kori K. Jeffries ◽

Tedd J. Girouard ◽

Richard D. Tandy ◽

Kara N. Radzak

Keyword(s):

Online Survey ◽

National Collegiate Athletic Association ◽

Athletic Trainers ◽

Cross Sectional Study ◽

Division I ◽

Prevention Strategies ◽

Cross Sectional ◽

Effective Prevention ◽

Knowledge And Beliefs ◽

Women's Soccer

Context Whereas much attention has been paid to identifying mechanisms for decreasing concussion rates in women's soccer players, which strategies are currently being used is unknown. In addition, athletic trainers' (ATs') knowledge and beliefs about the efficacy of concussion-prevention practices have not been studied. Objectives To evaluate the concussion-prevention strategies being used in National Collegiate Athletic Association Division I and Division II women's soccer and identify the beliefs of certified ATs regarding mechanisms for preventing concussion. Design Cross-sectional study. Setting Online survey. Patients or Other Participants A total of 223 women's soccer team ATs employed at Division I or II universities. Main Outcome Measure(s) A survey instrument of structured questions and open-ended, follow-up questions was developed to identify the use of cervical-strengthening programs, headgear, and other techniques for preventing concussion. Questions also addressed ATs' beliefs regarding the effectiveness of cervical strengthening, headgear, and mouthguards in concussion prevention. Data were collected via questionnaire in Qualtrics survey software. Descriptive statistics of frequencies and percentages were calculated for close-ended questions. Open-ended questions were evaluated for common themes, which were then reported by response frequency. Results Cervical strengthening or stability for concussion prevention was reported by 38 (17.12%) respondents; 153 (69.86%) ATs believed that cervical strengthening would aid in concussion prevention. Seventy-eight (35.49%) reported that their players wore headgear. Nineteen (8.76%) believed that soccer headgear prevented concussions; 45 (20.74%) believed that mouthguards prevented concussions. Education in proper soccer technique was reported by 151 (69.59%) respondents. Fourteen (0.06%) respondents cited nutritional strategies for concussion prevention. Conclusions Although ATs believed that cervical strengthening could help prevent concussions, few had implemented this strategy. However, the ATs whose teams used headgear outnumbered those who believed that headgear was an effective prevention strategy. Based on our findings, we saw a disconnect among the current use of concussion-prevention strategies, ATs' beliefs, and the available evidence.

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Between-Seasons Test-Retest Reliability of Clinically Measured Reaction Time in National Collegiate Athletic Association Division I Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-46.4.409 ◽

2011 ◽

Vol 46 (4) ◽

pp. 409-414 ◽

Cited By ~ 42

Author(s):

James T. Eckner ◽

Jeffrey S. Kutcher ◽

James K. Richardson

Keyword(s):

Reaction Time ◽

Repeated Measures ◽

National Collegiate Athletic Association ◽

Collegiate Athletes ◽

Division I ◽

Clinical Test ◽

Retest Reliability ◽

Physical Examinations ◽

Division I Athletes ◽

Test Retest Reliability

Context: Reaction time is typically impaired after concussion. A clinical test of reaction time (RTclin) that does not require a computer to administer may be a valuable tool to assist in concussion diagnosis and management. Objective: To determine the test-retest reliability of RTclin measured over successive seasons in competitive collegiate athletes and to compare these results with a computerized measure of reaction time (RTcomp). Design: Case series with repeated measures. Setting: Preparticipation physical examinations for the football, women's soccer, and wrestling teams at a single university. Patients or Other Participants: 102 National Collegiate Athletic Association Division I athletes. Intervention(s): The RTclin was measured using a measuring stick embedded in a weighted rubber disk that was released and caught as quickly as possible. The RTcomp was measured using the simple reaction time component of CogState Sport. Main Outcome Measure(s): Data were collected at 2 time points, 1 season apart, during preparticipation physical examinations. Outcomes were mean simple RTclin and RTcomp. Results: The intraclass correlation coefficient estimates from season 1 to season 2 were 0.645 for RTclin (n = 102, entire sample) and 0.512 for RTcomp (n = 62 athletes who had 2 consecutive valid baseline CogState Sport test sessions). Conclusions: The test-retest reliability of RTclin over consecutive seasons compared favorably with that of a concurrently tested computerized measure of reaction time and with literature-based estimates of computerized reaction time measures. This finding supports the potential use of RTclin as part of a multifaceted concussion assessment battery. Further prospective study is warranted.

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Repetitive head impacts in a collegiate football season: Exposure and effects

International Journal of Sports Science & Coaching ◽

10.1177/17479541211027277 ◽

2021 ◽

pp. 174795412110272

Author(s):

Laura D Wilson ◽

Rachel A Hildebrand ◽

Trang Le ◽

Brett A McKinney

Keyword(s):

Reaction Time ◽

American Football ◽

Division I ◽

Football Players ◽

Short Term ◽

Head Impacts ◽

Repetitive Head Impacts ◽

The Past ◽

Acute Increase ◽

Collegiate Football

This study describes exposure to repetitive head impacts (RHI) by player position and activity during a collegiate football season, and investigates the relationship between RHI and acute (i.e., daily and weekly) and short-term (i.e., pre- to post-season) changes in balance, reaction time, symptoms, and cognition. We recorded RHI exposure in twenty Division I collegiate American football players during a single season using the Riddell InSite system. Participants sustained 4,586 impacts (4.20% high impact, i.e., >63 g; 95.79% low impact, i.e., 20–63 g). Greatest exposure to RHI was observed in running backs and defensive ends during games, and tight ends and defensive ends during practices. Running plays and team drills placed players at greatest risk for exposure during practice. Cumulative RHI exposure across the season was associated with short-term declines in reaction time (p = 0.045), but not balance or cognition. Acute decline in balance was associated with the number of impacts sustained in the past week (p < 0.05), but not the past 24 hours (p > 0.05). Acute increase in total symptom score was also associated with the number of impacts sustained in the past week (p < 0.01), but not the past 24 hours (p > 0.05). Reaction time did not decline based on impact exposure in the past 24 hours or week. This study identifies activities and positions that may put players at risk for RHI exposure, and demonstrates that RHI sustained during the course of typical American football play by non-concussed individuals may result in small changes in balance, reaction time, and symptoms, but not cognition.

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Protective Football Headgear and Peripheral Visuomotor Ability in NCAA Football Athletes: The Role of Facemasks and Visors

Journal of Functional Morphology and Kinesiology ◽

10.3390/jfmk6020034 ◽

2021 ◽

Vol 6 (2) ◽

pp. 34

Author(s):

Christopher G. Ballmann ◽

Anna C. Covington ◽

Rachel A. Miller ◽

Rebecca R. Rogers

Keyword(s):

Reaction Time ◽

Division I ◽

Football Players ◽

Visual Areas ◽

Peripheral Areas ◽

Player Performance ◽

Collegiate Football ◽

Visuomotor Performance

The purpose of this investigation was to determine the effects of varying facemask reinforcement and visor tint on peripheral visuomotor abilities in collegiate football players. Division I NCAA football players (n = 14) completed two peripheral visuomotor experiments: (1) Varying facemask reinforcement, (2) Varying visor tinting. In experiment 1, participants were tested under the following conditions: baseline (no helmet; BL), helmet + light (HL), helmet + medium (HM), helmet + heavy (HH), and helmet + extra heavy (HXH) reinforced facemasks. In experiment 2, participants were tested under the following conditions: baseline (no helmet; BL), helmet only (HO), helmet + clear (HCV), helmet + smoke-tinted (HSV), and helmet + mirror-tinted (HMV) visors. For each condition, a 60 s peripheral visuomotor test was completed on a Dynavision D2 visuomotor board. For experiment 1, the BL peripheral reaction time (PRT) was faster than all facemask conditions (p < 0.05). Furthermore, PRT was impaired with the HXH compared to HL (p < 0.001), HM (p < 0.001), and HH (p = 0.001). Both HH and HXH resulted in the potentiation of PRT impairments in the outermost and inferior peripheral visual areas (p < 0.05). In experiment 2, BL PRT was faster than all helmeted conditions (p < 0.05). Additionally, PRT was slower in HSV (p = 0.013) and HMV (p < 0.001) conditions compared to HO. HMV resulted in slower PRT in all peripheral areas (p < 0.05) while PRT was impaired only in outer areas for HSV (p < 0.05). Wearing protective football headgear impairs peripheral visuomotor ability. Lighter reinforced facemasks and clear visors do not appear to exacerbate impairment. However, heavier reinforced facemasks and tinted visors further decrease visuomotor performance in outer and inferior visual areas, indicating a potential need for considerations of on-field player performance and safety.

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POST-CONCUSSIVE CHANGES IN BALANCE AND POSTURAL STABILITY MEASURED WITH CANESENSE™ AND THE BALANCE ERROR SCORING SYSTEM (BESS) IN DIVISION I COLLEGIATE FOOTBALL PLAYERS: A CASE SERIES

International Journal of Sports Physical Therapy ◽

10.26603/ijspt20190296 ◽

2019 ◽

Vol 14 (2) ◽

pp. 296-307 ◽

Cited By ~ 1

Author(s):

Luis A. Feigenbaum ◽

Kyoung J Kim ◽

Ignacio A. Gaunaurd ◽

Lee D. Kaplan ◽

Vincent A. Scavo ◽

...

Keyword(s):

Scoring System ◽

Postural Stability ◽

Case Series ◽

Division I ◽

Football Players ◽

Balance Error Scoring System ◽

Collegiate Football ◽

Balance Error

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Portuguese Patient Dignity Question: A cross-sectional study of palliative patients cared for in primary care

Palliative & Supportive Care ◽

10.1017/s1478951520000164 ◽

2020 ◽

Vol 18 (6) ◽

pp. 658-661

Author(s):

Mafalda Lemos Caldas ◽

Miguel Julião ◽

Ana João Santos ◽

Harvey Max Chochinov

Keyword(s):

Primary Care ◽

Health Care Providers ◽

Cross Sectional Study ◽

Care Providers ◽

Sectional Study ◽

Clinical Tool ◽

Cross Sectional ◽

Old Patients ◽

Promising Tool ◽

Palliative Patients

AbstractIntroductionThe Patient Dignity Question (PDQ) is a clinical tool developed with the aim of reinforcing the sense of personhood and dignity, enabling health care providers (HCPs) to see patients as people and not solely based on their illness.ObjectiveTo study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC).MethodA cross-sectional study using 20 palliative patients cared for in a PC unit. A post-PDQ satisfaction questionnaire was developed.ResultsTwenty participants were included, 75% were male; average age was 70 years old. Patients found the summary accurate, precise, and complete; all said that they would recommend the PDQ to others and want a copy of the summary placed on their family physician's medical chart. They felt the summary heightened their sense of dignity, considered it important that HCPs have access to the summary and indicated that this information could affect the way HCPs see and care for them. The PDQ-PT's took 7 min on average to answer, and 10 min to complete the summary.Significance of resultsThe PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. Future trials are now warranted.

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Managing the Return to Football During the COVID-19 Pandemic: A Survey of the Head Team Physicians of the Football Bowl Subdivision Programs

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121992045 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712199204

Author(s):

Alexander D. Slabaugh ◽

John W. Belk ◽

Jonathan C. Jackson ◽

Richard J. Robins ◽

Eric C. McCarty ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

National Collegiate Athletic Association ◽

College Football ◽

Cross Sectional Study ◽

Return To Play ◽

World Health ◽

Cross Sectional ◽

Football Bowl Subdivision ◽

Health Organization

Background: COVID-19 is a severe respiratory virus that spreads via person-to-person contact through respiratory droplets. Since being declared a pandemic in early March 2020, the World Health Organization had yet to release guidelines regarding the return of college or professional sports for the 2020-2021 season. Purpose: To survey the head orthopedic surgeons and primary care team physicians for the National Collegiate Athletic Association (NCAA) Football Bowl Subdivision (FBS) football teams so as to gauge the management of common COVID-19 issues for the fall 2020 college football season. Study Design: Cross-sectional study. Methods: The head team orthopaedic surgeons and primary care physicians for all 130 FBS football teams were surveyed regarding their opinions on the management of college football during the COVID-19 pandemic. A total of 30 questions regarding testing, return-to-play protocol, isolating athletes, and other management issues were posed via email survey sent on June 5, 2020. Results: Of the 210 team physicians surveyed, 103 (49%) completed the questionnaire. Overall, 36.9% of respondents felt that it was unsafe for college athletes to return to playing football during fall 2020. While the majority of football programs (96.1%) were testing athletes for COVID-19 as they returned to campus, only 78.6% of programs required athletes to undergo a mandatory quarantine period before resuming involvement in athletic department activities. Of the programs that were quarantining their players upon return to campus, 20% did so for 1 week, 20% for 2 weeks, and 32.9% quarantined their athletes until they had a negative COVID-19 test. Conclusion: While US Centers for Disease Control and Prevention guidelines evolve and geographic regions experience a range of COVID-19 infections, determining a universal strategy for return to socialization and participation in sports remains a challenge. The current study highlighted areas of consensus and strong agreement, but the results also demonstrated a need for clarity and consistency in operations, leadership, and guidance for medical professionals in multiple areas as they attempt to safely mitigate risk for college football players amid the COVID-19 pandemic.

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