Rehabilitation of Persistent Symptoms and Neurocognitive Deficits Following Sports-Related Concussion in a Professional Hockey Player: Case Study

ObjectiveTo demonstrate decreased post-concussive symptomatology and neurocognitive improvements in a professional hockey player following a multimodal, functional neurology approach to neurorehabilitation.BackgroundHockey is one of the top 3 sports in which concussions occur and has one of the top 10 highest participation numbers of sports in the northern hemisphere. The investigation of treatment modalities is warranted given the prevalence of hockey throughout society. This case study presents a 31-year-old male professional hockey athlete who had sustained 5 diagnosed concussions with additional suspected concussions throughout his career. His symptoms remained after independently receiving physical therapy and vestibular rehabilitation, causing an inability to continue playing hockey at a professional level.Design/MethodsThe patient was prescribed 10 treatment sessions over 5 contiguous days at an outpatient neurorehabilitation center specializing in functional neurology. The C3Logix neurocognitive assessment and graded symptom checklist were utilized at intake and discharge. Multimodal treatment interventions included transcranial photobiomodulation, non-invasive neuromodulation of the lingual branch of the trigeminal nerve, hand-eye coordination training, vestibular rehabilitation utilizing a three-axis whole-body off-axis rotational device, and cognitive training.ResultsOn intake, their composite symptom score was reported as 16/162, Trail Making Test Part B was 24.1 seconds, Simple Reaction Time was 274 milliseconds, and Choice Reaction Time was 496 milliseconds. On discharge, the patient experienced an 81% in self-reported symptoms, Trail Making Test Part B improved to 17 seconds (+29.46%), Simple Reaction Time was 252 milliseconds (8% faster), and Choice Reaction Time was 465 milliseconds (24% faster).ConclusionsThe present case study results demonstrated meaningful improvements in both self-rated concussion symptoms and neurocognitive performance for this patient. The Press suggest further investigation into functional neurology-based, multimodal, intensive approaches to decrease chronic post-concussion symptoms and improve neurocognitive performance in athletes that engage in hockey.

Study of Differences in Motor Reactions and Performances in Professional Ice Hockey Players and not Experienced Participants Using Virtual Reality (VR) Technology

The efficiency of performance in various sports has the development of certain specific skills at its core. In ice hockey, both the technical aspects (techniques, stance) and the cognitive ones (keeping attention on the puck, game strategy, etc.) are highly important. This study is aimed at the identification of specific features that determine the performance efficiency of professional hockey players. We used virtual reality (VR) to study the differences between professional ice hockey players and novices in terms of motor responses to the puck’s presentation on different levels of difficulty. The study involved 22 participants, 13 of them being professional ice hockey players (Mage=20±2.9; mean age of training experience М=14.18±3.8) and 9 being not experienced participants (Mage=20±1.4). The study showed that the stick response time of professional hockey players is significantly higher (0.98 ms vs 1.5 ms, p≤0.05) in more difficult situations close to a real game. Moreover, professionals proved to have more stable movement patterns of the knee and hip joints. They also make fewer head movements as a response to stimuli during all runs (0.66 vs 1.25, p≤0.05). Therefore, the results indicate specific spatial-temporal, technical and tactical, and energetic determinants, that ensure higher performance efficiency in hockey players

Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 2: which components differentiate concussed and non-concussed players?

ObjectivesTo examine the utility of Sport Concussion Assessment Tool (SCAT5) subcomponents in differentiating physician diagnosed concussed players from controls.MethodsWe evaluated 1924 professional hockey players at training camp using the National Hockey League (NHL) Modified SCAT5 prior to the 2018–2019 season. Over the course of the season, 314 English-speaking players received SCAT5 evaluations within 1 day of a suspected concussive event. Of these players, 140 (45%) were subsequently diagnosed with concussion by their team physicians.ResultsConcussed players reported more symptoms (Concussed M=8.52, SD=4.78; Control M=3.32, SD=3.97), and recalled fewer words than Controls on both the Immediate Memory (Concussed M=19.34, SD=4.06; Control M=21.53, SD=2.94) and Delayed Recall (Concussed z=−0.91; Control z=−0.09) tasks during the acute evaluation. Concussed players also made more errors than Controls on the mBESS and were more likely to report double vision and exhibit clinician-observed balance problems than controls. There were no between-group differences on the Concentration component of the SCAT5. Stepwise regression revealed that symptom report and list learning tasks both accounted for independent variance in identifying players diagnosed with concussion.ConclusionsThese findings provide support for use of the SCAT5 to assist in identifying concussed professional hockey players. When examining SCAT5 subtests, both symptom report and the 10-item word list accounted for independent variance in identifying concussion status in this sample of professional hockey players. The mBESS also differentiated Concussed players and Controls. The Concentration component of the SCAT5 did not significantly differentiate Concussed players and Controls.

Shoulder Instability, Performance and Return to Play in National Hockey League Athletes

Objectives: Hockey players are at risk for various injury due to the aggressive nature of gameplay with the rate of shoulder injuries ranges from 8.6% to 21.9%. Although performance and return to play outcomes following shoulder instability events have been analyzed in other contact sports, there is a paucity of information on the effects amongst professional hockey players. Our study investigates the incidence of shoulder instability events in the National Hockey League (NHL) and the subsequent effect on return-to-play (RTP) and player performance. We hypothesized that NHL players sustaining a shoulder instability event returned to play at a high rate without significant changes in player performance after injury. Methods: A total of 67 confirmed in-season shoulder instability events were identified in the NHL between 2003 - 2017. Demographic characteristics and performance statistics one year prior to injury and one year following injury were collected and analyzed. Overall RTP was determined and differences in performance following injury were compared to experience-matched, era-matched, position-matched and age-matched controls. A separate analysis was performed comparing differences in performance as a function of operative and nonoperative treatment. Results: An average of 4.19 shoulder dislocations occurred per season in the NHL with an overall incidence rate of 0.020 instability events per 1000 game exposures (CI 0.017-0.027) with no significant differences between forwards and defensemen (p = 0.871). Overall, 33.8% of players suffered season ending injuries but 98.5% of all players were able to return to play with an average of 26.3±20.8 regular season games missed. Compared to controls, players suffering a shoulder instability event experienced an increase in both average time on ice and shooting percentage upon returning to gameplay (p = 0.002, p <0.001, respectively) yet there were no significant differences in seasons played, goals, assists and points per game; offensive, defensive and overall point shares compared to controls. In terms of treatment, 47.8% of all players were treated operatively with half of these players treated with surgery after suffering season-ending injuries. Compared to operative treatment, conservatively managed players experienced a significant decrease in points per game after injury (p = 0.034), however there were no significant differences in number of seasons played, goals per game, assists per game, offensive, defensive and overall point shares between treatment groups. Conclusion: Regardless of treatment, professional hockey players experience a high rate of return to play with acceptable performance outcomes following in-game shoulder instability events. Surgical management can be beneficial as an increase in points per game was seen in those treated operatively compared to players managed nonoperatively.

Losing the identity of a hockey player: the long-term effects of concussions

Aim: To describe what suffering multiple concussions meant for former semi-professional or professional hockey players who were forced to end their career. Results: Nine former Swedish hockey players, who once played on national or professional teams were interviewed. The interviews were analyzed with reference to hermeneutic phenomenology to interpret and explain their experiences. The theme of losing one’s identity as a hockey player was constructed from five subthemes: being limited in everyday life, returning to the hockey stadium as soon as possible, forming a post career identity, lacking understanding and support, and preventing injuries by respecting other players. Conclusion: The former hockey players struggled with developing their off-the-ice identities and with finding other sources of meaning for their lives.

A Comprehensive Nonoperative Rehabilitation Program Including Blood Flow Restriction for a Talus Fracture in a Professional Hockey Player: A Case Report

A 22-year-old male professional hockey player sustained a nondisplaced talus fracture. We present a comprehensive nonsurgical rehabilitation that includes blood flow restriction (BFR) training. Pain and function measures improved throughout the rehabilitation. Lower limb circumference did not change postinjury. The patient returned to play in less than 7 weeks, while current talar fracture management protocols indicate surgical fixation and 6 weeks of immobilization. BFR training may be useful in injury rehabilitation, negating muscle atrophy and increasing muscle strength while allowing the patient to exercise at relatively low loads. This is the first case of BFR training implemented in early fracture rehabilitation of an athlete.