The National Center for Catastrophic Sports Injury Research (NCCSIR) initiated a catastrophic injury (fatalities, disabilities, serious injuries) data collection system for high school and collegiate sports on a national level during the 1982–1983 school year.1 Cheerleading was not initially included until 2 collegiate cheerleaders suffered serious head injuries during the first year of data collection. Since that time, collegiate cheerleading has been associated with 31 catastrophic injuries and high school cheerleading with 73. Collegiate cheerleading accounted for 70.5% of all female catastrophic sports injuries and high school cheerleading for 65.2% of all high school female catastrophic sports injuries.
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MS and
MD DrPH
Cheerleading injuries are on the rise and are a significant source of injury to females. No published studies have described the epidemiology of cheerleading injuries by type of cheerleading team and event. To describe the epidemiology of cheerleading injuries and to calculate injury rates by type of cheerleading team and event. Prospective injury surveillance study. Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) online surveillance tool. Athletes from enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions. The numbers and rates of cheerleading injuries during a 1-year period (2006–2007) are reported by team type and event type. A cohort of 9022 cheerleaders on 412 US cheerleading teams participated in the study. During the 1-year period, 567 cheerleading injuries were reported; 83% (467/565) occurred during practice, 52% (296/565) occurred while the cheerleader was attempting a stunt, and 24% (132/563) occurred while the cheerleader was basing or spotting 1 or more cheerleaders. Lower extremity injuries (30%, 168/565) and strains and sprains (53%, 302/565) were most common. Collegiate cheerleaders were more likely to sustain a concussion (P = .01, rate ratio [RR] = 2.98, 95% confidence interval [CI] = 1.34, 6.59), and All Star cheerleaders were more likely to sustain a fracture or dislocation (P = .01, RR = 1.76, 95% CI = 1.16, 2.66) than were cheerleaders on other types of teams. Overall injury rates for practices, pep rallies, athletic events, and cheerleading competitions were 1.0, 0.6, 0.6, and 1.4 injuries per 1000 athlete-exposures, respectively. We are the first to report cheerleading injury rates based on actual exposure data by type of team and event. These injury rates are lower than those reported for other high school and collegiate sports; however, many cheerleading injuries are preventable.Abstract
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MS and
MD DrPH
Over the past several decades, cheerleaders have been performing fewer basic maneuvers and more gymnastic tumbling runs and stunts. As the difficulty of these maneuvers has increased, cheerleading injuries have also increased. To describe the epidemiology of cheerleading fall-related injuries by type of cheerleading team and event. Prospective injury surveillance study. Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) surveillance tool. Athletes from 412 enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions. The numbers and rates of cheerleading fall-related injuries during a 1-year period (2006–2007) are reported. A total of 79 fall-related injuries were reported during the 1-year period. Most occurred during practice (85%, 67/79) and were sustained by high school cheerleaders (51%, 40/79). A stunt or pyramid was being attempted in 89% (70/79) of cases. Fall heights ranged from 1 to 11 ft (0.30–3.35 m) (mean = 4.7 ± 2.0 ft [1.43 ± 0.61 m]). Strains and sprains were the most common injuries (54%, 43/79), and 6% (5/79) of the injuries were concussions or closed head injuries. Of the 15 most serious injuries (concussions or closed head injuries, dislocations, fractures, and anterior cruciate ligament tears), 87% (13/15) were sustained while the cheerleader was performing on artificial turf, grass, a traditional foam floor, or a wood floor. The fall height ranged from 4 to 11 ft (1.22–1.52 m) for 87% of these cases (13/15). Cheerleading-related falls may result in severe injuries and even death, although we report no deaths in the present study. The risk for serious injury increases as fall height increases or as the impact-absorbing capacity of the surfacing material decreases (or both).Abstract
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MS,
PhD, and
MD DrPH
Cheerleading-related injuries are on the rise. To date, no epidemiologic studies of cheerleading stunt-related injuries have been published. To describe and compare cheerleading stunt-related injuries by type of cheerleading team (All Star, college, high school, middle school, or recreation league) and event (practice, pep rally, athletic event, or cheerleading competition). Prospective injury surveillance study. Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) surveillance tool. Athletes from enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions. The numbers, types, and rates of cheerleading stunt-related injuries during a 1-year period (2006–2007) are reported. Stunt-related injuries accounted for 60% (338/567) of the injuries sustained by US cheerleaders who participated in the study and 96% (22/23) of the concussions and closed head injuries (CHIs) reported during the study. Collegiate cheerleaders were more likely to sustain a concussion or CHI than were cheerleaders on other types of teams (P = .02, odds ratio = 3.10, 95% confidence interval = 1.20, 8.06). Most injuries occurred while the cheerleader was spotting or basing another cheerleader (34%, 115/338), and these injuries comprised 32% (51/161) of all stunt-related strains and sprains. Four cheerleaders (1.2%, 4/335) were admitted to the hospital, and 9 cheerleaders (2.7%, 9/335) required surgery. Cheerleading stunts pose an increased risk for injury, especially in terms of sustaining a concussion or CHI. Spotters and bases were most likely to be injured during the performance of cheerleading stunts and were at risk for sustaining strain and sprain injuries. The ankle, lower back, and wrist were the sites most likely to be reinjured while performing cheerleading stunts.Abstract
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MS and
MD DrPH
Although playground surfaces have been investigated for fall impact attenuation, the surfaces that cheerleaders use have received little attention. To determine (1) the critical height for selected surfaces used by cheerleaders at or below which a serious head impact injury from a fall is unlikely to occur, (2) the critical heights for non–impact-absorbing surfaces for comparison purposes, and (3) the effect of soil moisture and grass height on gmax (which is defined as the multiple of g [acceleration due to gravity at the earth's surface at sea level: ie, 32.2 feet·s−1·s−1] that represents the maximum deceleration experienced during an impact) and the Head Injury Criterion (HIC) at the critical height for a dry grass surface. Observational study. A local cheerleading gym, indoor locations within the authors' institution, and various outdoor locations.
g
max, HIC, and critical height. Critical heights for the surfaces tested ranged from 0.5 ft (0.15 m) for concrete and vinyl tile installed over concrete to more than 11 ft (3.35 m) for a spring floor. Increases in grass height and soil moisture resulted in an increase in the critical height for grass surfaces. Only spring floors and 4-in (0.10-m)–thick landing mats placed on traditional foam floors had critical heights greater than 10.5 ft (3.20 m), thus providing enough impact-absorbing capacity for performance of 2-level stunts. The potential for serious head impact injuries can be minimized by increasing the shock-absorbing capacity of the surface, decreasing the height from which the person falls, or both. Cheerleaders and cheerleading coaches should use the critical heights reported in this study to compare the relative impact-absorbing capacities of the various surfaces tested, with critical height as an indicator of the impact-absorption capacity of the surface. The findings of this study can be used to select the most appropriate surface for the type of maneuver to be performed, based on the maximum height expected to be achieved by the cheerleader(s) during execution of the maneuver. Cheerleaders should not perform maneuvers at heights that exceed the critical height for the surface on which they are performing.Abstract
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PhD ATC,
PhD,
PhD ATC,
PhD ATC, and
PhD ATC
Health-related quality of life (HRQOL) is a global concept that takes into account the physical, psychological, and social domains of health. Determining the extent to which injury affects HRQOL is an important aspect of rehabilitation practice, enabling comparisons of clinical outcomes across different conditions in diverse patient groups. To examine the extent to which a self-reported recent injury affected HRQOL in adolescent athletes using 2 generic patient self-report scales. Cross-sectional study. High school classrooms and athletic training facilities. A convenience sample of uninjured (n = 160) and injured (n = 45) adolescent athletes. The independent variable was injury status: uninjured versus injured. All participants completed a self-administered brief health status questionnaire and the Short Form–36 Health Survey Questionnaire (SF-36) and Pediatric Outcomes Data Collection Instrument (PODCI) in a counterbalanced manner. Dependent variables included 8 subscale and 2 composite scores of the SF-36 and 5 subscale scores and 1 global score of the PODCI. Group differences were assessed with the Mann-Whitney U test (P ≤ .05) and reported as median and interquartile range. On the SF-36, the injured group demonstrated lower scores (P < .008) for physical functioning, limitations due to physical health problems, bodily pain, social functioning, and the physical composite. On the PODCI, the injured group reported lower scores (P < .01) on the pain and comfort subscale and the global score. Adolescent athletes with self-reported injuries demonstrated lower HRQOL than their uninjured peers. As expected, recent injury affected physical functioning and pain. Social functioning (on the SF-36) and global HRQOL (on the PODCI) also decreased, suggesting that injuries affected areas beyond the expected physical component of health. Clinicians need to recognize the full spectrum of negative influences that injuries may have on HRQOL in adolescent athletes.Abstract
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MS,
PhD LAT ATC,
PhD LAT ATC CSCS,
PhD LAT ATC, and
DO
Repetitive throwing at high velocities leads to altered range of motion (ROM) in the dominant shoulder compared with the nondominant shoulder in overhead-throwing athletes. Loss of glenohumeral internal rotation (IR), or glenohumeral internal-rotation deficit (GIRD), is associated with shoulder injuries. Therefore, GIRD should be evaluated during the clinical examination of the thrower's shoulder. To assess glenohumeral ROM in competitive baseball and softball athletes at 3 intervals over the course of an athletic season in order to (1) examine changes in ROM over time and (2) monitor the prevalence of GIRD. Observational, repeated-measures study. Collegiate athletic training room. Forty-eight healthy National Collegiate Athletic Association (NCAA) Division I or Division II athletes (age = 19 ± 1 years, height = 174 ± 14 cm, mass = 77.8 ± 18.1 kg; 19 softball, 29 baseball players). We measured glenohumeral IR, external rotation (ER), total arc (ER + IR), and GIRD at 3 times: prefall, prespring, and postspring. We calculated GIRD in 2 ways: as the difference in IR between dominant and nondominant shoulders and as the percentage of the total arc. In the dominant shoulder, ER increased during the season (F2,96 = 17.433, P < .001), but IR remained the same (F2,96 = 1.839, P = .17). The total arc in the dominant shoulder increased between time intervals (F2,96 = 14.030, P < .001); the mean difference between prefall and postspring measurements was 9.694° (P < .001), and the mean difference between prefall and postspring measurements was 10.990° (P < .001). In the nondominant shoulder, ER increased over the season (F2,96 = 23.395, P < .001), but IR did not change over the season (F2,96 = 0.087, P = .90). The total arc in the nondominant shoulder increased between prefall and prespring measurements and between prefall and postspring measurements (F2,96 = 18.552, P < .001). No changes were noted in GIRD over time. However, more athletes with GIRD were identified with the GIRD (IR difference) calculation in prefall (n = 6) than in prespring (n = 1) and postspring (n = 4) (Cochran Q = 5.2, P = .07). In addition, more athletes with GIRD were identified with the GIRD (% total arc) calculation in postspring (n = 6) than in prefall (n = 5) or prespring (n = 4) (Cochran Q = 2.6, P = .27). Healthy NCAA Division I and Division II athletes did not display changes in glenohumeral IR over an athletic season. However, they gained in ER and total arc during the season in both shoulders. Future researchers should investigate changes over multiple seasons. The 2 methods of calculating GIRD identified different athletes as having GIRD, indicating that additional investigation is warranted to determine the clinical benefits of each method.Abstract
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PhD LAT ATC,
MS LAT ATC, and
PhD
Clinicians use neuromuscular control exercises to enhance joint position sense (JPS); however, because standardizing such exercises is difficult, validations of their use are limited. To evaluate the acute effects of a neuromuscular training exercise with a handheld vibrating dumbbell on elbow JPS acuity. Crossover study. University athletic training research laboratory. Thirty-one healthy, college-aged volunteers (16 men, 15 women, age = 23 ± 3 years, height = 173 ± 8 cm, mass = 76 ± 14 kg). We measured and trained elbow JPS using an electromagnetic tracking device that provided auditory and visual biofeedback. For JPS testing, participants held a dumbbell and actively identified the target elbow flexion angle (90°) using the software-generated biofeedback, followed by 3 repositioning trials without feedback. Each neuromuscular training protocol included 3 exercises during which participants held a 2.55-kg dumbbell vibrating at 15, 5, or 0 Hz and used software-generated biofeedback to locate and maintain the target elbow flexion angle for 15 seconds. We calculated absolute (accuracy) and variable (variability) errors using the differences between target and reproduced angles. Training protocols using 15-Hz vibration enhanced accuracy and decreased variability of elbow JPS (P ≤ .005), whereas 5-Hz vibration did not affect accuracy (F1,61 = 2.625, P = .100) but did decrease variability (F1,61 = 7.250, P = .009). The control condition and 0-Hz training protocol had no effect on accuracy or variability (P ≥ .200). Our results suggest these neuromuscular control exercises, which included low-magnitude, low-frequency handheld vibration, may enhance elbow JPS. Future researchers should examine vibration of various durations and frequencies, should include injured participants and functional multijoint and multiplanar measures, and should examine long-term effects of training protocols on JPS and injury.Abstract
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PhD RD LDN FACSM,
BS, and
BSN
To our knowledge, no one has compared the prepractice hydration status of male and female National Collegiate Athletic Association (NCAA) Division I athletes or has studied the effects of the menstrual cycle phase on women's prepractice hydration status. To report prepractice hydration status of collegiate athletes and determine the factors that might influence that status. Cross-sectional, descriptive study. University sports team practices. Participants included 138 male and 125 female athletes (age = 19.9 ± 1.3 years, height = 165.8 ± 42.9 cm, mass = 77.4 ± 17.5 kg) from an NCAA Division I New England university. One spontaneously voided (spot) urine sample was collected from each participant before his or her team practice and was measured 2 times. A refractometer was used to analyze the amount of light that passed through a small drop of urine and assess urine specific gravity. Fluid intake and menstrual history for women were also collected. Three hydration-status groups were defined based on the American College of Sports Medicine and National Athletic Trainers' Association criteria: (1) euhydrated, which was urine specific gravity less than 1.020; (2) hypohydrated, from 1.020 to 1.029; and (3) significantly hypohydrated, equal to or more than 1.030. Thirteen percent of student-athletes appeared significantly hypohydrated, with a mean urine specific gravity of 1.031 ± 0.002 (χ2 = 12.12, P < .05); 53% appeared hypohydrated, with a mean urine specific gravity of 1.024 ± 0.003 (χ2 = 12.12, P < .05); and 34% appeared euhydrated, with a mean urine specific gravity of 1.012 ± 0.005 (χ2 = 0.03, P > .05). A greater percentage of men (47%) than women (28%) were hypohydrated (χ2 = 8.33, P < .05). In women, no difference was evident between the luteal and follicular phases of their menstrual cycles (χ2 = 0.02, P > .05). Before activity, athletes were hypohydrated at different levels. A greater percentage of men than women were hypohydrated. Menstrual cycle phase did not appear to affect hydration in women.Abstract
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Observational Studies
EdD ATC,
PhD ATC FNATA, and
PhD ATC
Appropriate methods for evaluating clinical proficiencies are essential to ensuring entry-level competence in athletic training. To identify the methods Approved Clinical Instructors (ACIs) use to evaluate student performance of clinical proficiencies. Cross-sectional design. Public and private institutions in National Athletic Trainers' Association (NATA) District 4. Approved Clinical Instructors from accredited athletic training education programs in the Great Lakes Athletic Trainers' Association, which is NATA District 4 (N = 135). Participants completed a previously validated survey instrument, Methods of Clinical Proficiency Evaluation in Athletic Training, that consisted of 15 items, including demographic characteristics of the respondents and Likert-scale items (1 = strongly disagree to 5 = strongly agree) regarding methods of clinical proficiency evaluation, barriers, educational content areas, and clinical experience settings. We used analyses of variance and 2-tailed, independent-samples t tests to assess differences among ACI demographic characteristics and the methods, barriers, educational content areas, settings, and opportunities for feedback regarding clinical proficiency evaluation. Qualitative analysis of respondents' comments was completed. The ACIs (n = 106 of 133 respondents, 79.7%) most often used simulations to evaluate clinical proficiencies. Only 59 (55.1%) of the 107 ACIs responding to a follow-up question reported that they feel students engage in a sufficient number of real-time evaluations to prepare them for entry-level practice. An independent-samples t test revealed that no particular clinical experience setting provided more opportunities than another for real-time evaluations (t119 range, −0.909 to 1.796, P ≥ .05). The occurrence of injuries not coinciding with the clinical proficiency evaluation timetable (4.00 ± 0.832) was a barrier to real-time evaluations. Respondents' comments indicated much interest in opportunities and barriers regarding real-time clinical proficiency evaluations. Most clinical proficiencies are evaluated via simulations. The ACIs should maximize real-time situations to evaluate students' clinical proficiencies whenever feasible. Athletic training education program administrators should develop alternative methods of clinical proficiency evaluations.Abstract
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PhD ATC,
MA,
PhD ATC, and
PhD
Computerized neurocognitive testing is becoming popular among clinicians evaluating sport-related concussions across all levels of sport. Baseline neurocognitive testing has been recommended to provide more accurate representation of the preconcussion cognitive status of individual athletes. However, little is known about the use of baseline neurocognitive testing in concussion assessment and management. To examine implementation and practice trends of sports medicine professionals using baseline neurocognitive testing at the high school and collegiate levels. Quantitative survey research. Online survey. Certified athletic trainers (ATs) from approximately 1209 US institutions listed on the ImPACT Web site were recruited. A total of 399 ATs completed the survey, for a response return rate of 32.7%. Survey questions addressed educational level, years of certification, employment setting, percentage of athletes baseline tested, and accuracy of baseline tests. Other items addressed postconcussive neurocognitive testing protocols and scenarios for return-to-play decisions based on neurocognitive testing. Nearly all ATs (94.7%) administered baseline computerized neurocognitive testing to their athletes. However, only 51.9% examined these baseline tests for validity. The majority of ATs indicated that they administer baseline neurocognitive tests most frequently to football players (88.4%), followed by women's soccer players (78.8%) and men's soccer players (71.2%). Nearly all respondents (95.5%) stated that they would not return a symptomatic athlete to play if the athlete's neurocognitive scores were back to baseline. However, when asked if they would return an athlete who is symptom free but who scores below his or her baseline, 86.5% responded no, 9.8% responded yes, and 3.8% indicated that it depended on the importance of the competition. The use of baseline testing, baseline testing readministration, and postconcussion protocols among ATs is increasing. However, the ATs in this study reported that they relied more on symptoms than on neurocognitive test scores when making return-to-play decisions.Abstract
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PhD MPH,
MA, and
PhD
High school athletes sustain more than 1.4 million injuries annually. National high school sports injury surveillance forms the foundation for developing and evaluating preventive interventions to reduce injury rates. For national surveillance, individuals must report consistently and accurately with little one-on-one interaction with study staff. To examine the feasibility of relying on high school coaches as data reporters in a national, Internet-based sports injury surveillance study, using the same methods that have already proven successful in the National High School Sports-Related Injury Surveillance Study, which calls on certified athletic trainers (ATs) as reporters. Prospective injury surveillance study. Eighteen United States high schools Athletic trainers and varsity coaches for football, boys' and girls' soccer, and boys' and girls' basketball. Quantity and quality of exposure and injury reports. All enrolled ATs participated, compared with only 43.0% of enrolled coaches. Participating ATs submitted 96.7% of expected exposure reports, whereas participating coaches submitted only 36.5%. All ATs reported athlete exposures correctly, compared with only 2 in 3 coaches. Participating ATs submitted 338 injury reports; participating coaches submitted only 55 (16.3% of the 338 submitted by ATs). Injury patterns differed between AT-submitted and coach-submitted injury reports, with ATs reporting a higher proportion of ankle injuries and coaches reporting a higher proportion of knee injuries. The reports submitted by ATs and coaches for the same injury had low agreement for diagnosis and time loss, with only 63.2% and 55.3% of pairs, respectively, providing the same response. The ATs lacked more responses for demographic questions, whereas coaches lacked more responses regarding the need for surgery. Whenever possible, ATs should be the primary data reporters in large, national studies. In high schools without access to an AT, researchers must be willing to devote significant time and resources to achieving high participation and compliance from other reporters.Abstract
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PhD ATC FNATA,
PhD ATC,
PhD ATC, and
PhD ATC
To determine whether concentric evertor muscle weakness was associated with functional ankle instability (FAI). We conducted an electronic search through November 2007, limited to English, and using PubMed, Pre-CINAHL, CINAHL, and SPORTDiscus. A forward search was conducted using the Science Citation Index on studies from the electronic search. Finally, we conducted a hand search of all selected studies and contacted the respective authors to identify additional studies. We included peer-reviewed manuscripts, dissertations, and theses. We evaluated the titles and abstracts of studies identified by the electronic searches. Studies were selected by consensus and reviewed only if they included participants with FAI or chronic ankle instability and strength outcomes. Studies were included in the analysis if means and SDs (or other relevant statistical information, such as P values or t values and group n's) were reported for FAI and stable groups (or ankles). Data were extracted by the authors independently, cross-checked for accuracy, and limited to outcomes of concentric eversion strength. We rated each study for quality. Outcomes were coded as either fast or slow velocity (ie, equal to or greater than 110°/s or less than 110°/s, respectively). Data included the means, SDs, and group sample sizes (or other appropriate statistical information) for the FAI and uninjured groups (or ankles). The standard difference in the means (SDM) for each outcome was calculated using the pooled SD. We tested individual and overall SDMs using the Z statistic and comparisons between fast and slow velocities using the Q statistic. Our analysis revealed that ankles with FAI were weaker than stable ankles (SDM = 0.224, Z = 4.0, P < .001, 95% confidence interval = 0.115, 0.333). We found no difference between the fast- and slow-velocity SDMs (SDMFast = 0.189, SDMSlow = 0.244, Q = 29.9, df = 24, P = .187). Because of the small SDM, this method of measuring ankle strength in the clinical setting may need to be reevaluated.Abstract
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PhD ATC
Broglio SP, Puetz TW. The effect of sport concussion on neurocognitive function, self-report symptoms, and postural control: a meta-analysis. Sports Med. 2008;38(1):53–67. How effective are various concussion assessment techniques in detecting the effects of concussion on cognition, balance, and symptoms in athletes? Studies published between January 1970 and June 2006 were identified from the PubMed and PsycINFO databases. Search terms included concussion, mild traumatic brain injury, sport, athlete, football, soccer, hockey, boxing, cognition, cognitive impairment, symptoms, balance, and postural control. The authors also handsearched the reference list of retrieved articles and sought the opinions of experts in the field for additional studies. Studies were included if they were published in English; described a sample of athletes concussed during athletic participation; reported outcome measures of neurocognitive function, postural stability, or self-report symptoms; compared the postconcussion assessments with preseason (healthy) baseline scores or a control group; completed at least 1 postinjury assessment within the first 14 days after the concussion (to reflect neurometabolic recovery); and provided enough information for the authors to calculate effect sizes (means and SDs at baseline and postinjury time points). Selected studies were grouped according to their outcome measure (neurocognitive function, symptoms, or postural control) at initial and follow-up (if applicable) time points. Excluded articles included review articles, abstracts, case studies, editorials, articles without baseline data, and articles with data extending beyond the 14-day postinjury time frame. From each study, the following information was extracted by one author and checked by the second author: participant demographics (sport, injury severity, incidence of loss of consciousness, and postconcussion assessment times), sample sizes, and baseline and postconcussion means and SDs for all groups. All effect sizes (the Hedge g) were computed so that decreases in neurocognitive function and postural control or increases in symptom reports resulted in negative effect sizes, demonstrating deficits in these domains after concussion. The authors also extracted the following moderators: study design (with or without control group), type of neurocognitive technique (Standardized Assessment of Concussion, computerized test, or pencil-and-paper test), postconcussion assessment time, and number of postconcussion assessments. The search identified 3364 possible abstracts, which were then screened by the authors, with 89 articles being further reviewed for relevancy. Fifty articles were excluded because of insufficient data to calculate effect sizes, lack of a baseline assessment or control group, or because the data had been published in more than one study. The remaining 39 studies met all of the inclusion criteria and were used in the meta-analysis; 34 reported neurocognitive outcome measures, 14 provided self-report symptom outcomes, and 6 presented postural control as the dependent variable. The analyzed studies included 4145 total participants (concussed and control) with a mean age of 19.0 ± 0.4 years. The quality of each included study was also evaluated by each of the 2 authors independently using a previously published 15-item scale; the results demonstrated excellent agreement between the raters (intraclass correlation coefficient = 0.91, 95% confidence interval [CI] = 0.83, 0.95). The quality appraisal addressed randomization, sample selection, outcome measures, and statistical analysis, among other methodologic considerations. Quality scores of the included studies ranged from 5.25 to 9.00 (scored from 0–15). The initial assessment demonstrated a deficit in neurocognitive function (Z = 7.73, P < .001, g = −0.81 [95% CI = −1.01, −0.60]), increase in self-report symptoms (Z = 2.13, P = .03, g = −3.31 [95% CI = −6.35, −0.27]), and a nonsignificant decrease in postural control (Z = 1.29, P = .19, g = −2.56 [95% CI = −6.44, 1.32]). For the follow-up assessment analyses, a decrease in cognitive function (Z = 2.59, P = .001, g = −26 [95% CI = −0.46, −0.06]), an increase in self-report symptoms (Z = 2.17, P = .03, g = −1.09 [95% CI = −2.07, −0.11]), and a nonsignificant decrease in postural control (Z = 1.59, P = 0.11, g = −1.16 [95% CI = −2.59, 0.27]) were found. Neurocognitive and symptom outcomes variables were reported in 10 studies, and the authors were able to compare changes from baseline in these measures during the initial assessment time point. A difference in effect sizes was noted (QB(1) = 5.28, P = .02), with the increases in self-report symptoms being greater than the associated deficits in neurocognitive function. Sport-related concussion had a large negative effect on cognitive function during the initial assessment and a small negative effect during the first 14 days postinjury. The largest neurocognitive effects were found with the Standardized Assessment of Concussion during the immediate assessment and with pencil-and-paper neurocognitive tests at the follow-up assessment. Large negative effects were noted at both assessment points for postural control measures. Self-report symptoms demonstrated the greatest changes of all outcomes variables, with large negative effects noted both immediately after concussion and during the follow-up assessment. These findings reiterate the recommendations made to include neurocognitive measures, postural control tests, and symptom reports into a multifaceted concussion battery to best assess these injuries.Abstract
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Case Reports
EdD ATC and
MS
To characterize the diagnosis of pulmonary embolism in collegiate student-athletes and to raise awareness among sports medicine providers of the possibility of this potentially fatal disease in the student-athlete population. An 18-year-old, previously healthy National Collegiate Athletic Association Division I female gymnast complained of intense pain, bilaterally, deep in her chest. The athlete was referred to her team physician, who identified normal vital signs but referred her to the emergency room because of significant pain. The student-athlete was diagnosed with bilateral pulmonary emboli in the emergency room. Pneumonia, renal calculi, upper urinary tract infection, intercostal muscle strain or rib fracture, pancreatitis, gall bladder disease, gastritis, ulceration, esophagitis, infection, tumor, pulmonary embolism. The student-athlete was immediately placed on anticoagulants for 6 months. During that time, she was unable to participate in gymnastics and was limited to light conditioning. Documented cases of female student-athletes developing a pulmonary embolism are lacking in the literature. Two cases of pulmonary embolism in male high school student-athletes have been documented, in addition to many cases in elderly and sedentary populations. All health care providers, including sports medicine professionals, should be aware that this condition may be present among student-athletes. During the initial evaluation, prescreening should include questions about any previous or family history of pulmonary embolism or other blood clots. Athletes who answer positively to these questions may have a higher likelihood of pulmonary embolism and should be referred for testing.Abstract
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Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making
Landon B. LempkePhD, ATC,
Benjamin L. BrettPhD, and
Douglas P. TerryPhD,ABPP
Driving After Concussion: Clinical Measures Associated with Post-concussion
Kumiko Hashida,
Julia Drattell,
Kim Love,
Robert C. Lynall,
Russell K. Gore,
Hannes Devos, and
Julianne D. Schmidt
The role of shoulder posture in pitching mechanics and injury risk in high school baseball pitchers
Yi-Hsuan WengPT, MS,
Tsun-Shun HuangPT, PhD, and
Jiu-Jenq LinPT, PhD
Corticospinal Excitability during Standing and Its Association with Postural Control Following Acute Lateral Ankle Sprain.
Joosung Kim,
Arlette C. Perry,
Kevin A. Jacobs,
Brian Arwari,
Soyeon Ahn, and
Kyung-Min Kim
The socio-economic cost of anterior cruciate ligament injuries and lateral ankle sprains in amateur football and basketball.
Nikki RommersPT PhD,
Lieselot LongéPT MSc,
Winnie DebeckerPT MSc,
Nikie PeetersPT MSc,
Bruno TassignonPT PhD,
Eva HuysmansPT PhD,
Koen PutmanPT PhD,
Johan VanlauweMD PhD,
David BeckwéePT PhD,
Nicky Van MelickPT PhD, and
Christophe EechautePT PhD
JAT eISSN: 1938-162X
JAT ISSN: 1062-6050
ATEJ ISSN: 1947-380X
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