Volume 59: Issue 3

Objective

To provide athletic trainers and team physicians with updated recommendations to the 2014 National Athletic Trainers’ Association (NATA) concussion position statement regarding concussion management, specifically in the areas of education, assessment, prognostic factors, mental health, return to academics, physical activity, rest, treatment, and return to sport.

Background

Athletic trainers have benefited from the 2 previous NATA position statements on concussion management, and although the most recent NATA position statement is a decade old, knowledge gains in the medical literature warrant updating several (but not all) recommendations. Furthermore, in various areas of the body of literature, current evidence now exists to address items not adequately addressed in the 2014 statement, necessitating the new recommendations. This document therefore serves as a bridge from the 2014 position statement to the current state of concussion evidence, recommendations from other organizations, and discrepancies between policy and practice.

Recommendations

These recommendations are intended to update the state of the evidence concerning the management of patients with sport-related concussion, specifically in the areas of education; assessment advances; prognostic recovery indicators; mental health considerations; academic considerations; and exercise, activity, and rehabilitation management strategies.

Nonoperative management after shoulder dislocation or subluxation remains a challenging and complex task. Accurate diagnosis of the condition and shared decision-making regarding operative and nonoperative management and timing of return to play is required. In this Current Clinical Concepts paper, we introduce a shoulder instability framework that addresses these fundamental clinical dilemmas. Valid clinical prognostic tools that can be used to predict recurrent shoulder instability are reviewed. The process of shared decision-making in the realm of shoulder instability is presented. Finally, a framework for progressive rehabilitation that addresses deficits in motor control, strength, and endurance in scapular and shoulder musculature

Context

Collegiate baseball players with professional aspirations often participate in summer leagues; foremost among them is the Cape Cod Baseball League (CCBL). Injuries acquired during the collegiate baseball season can be carried into the CCBL season and vice versa.

Objective

To assess the history of throwing arm injury and current functionality in midseason CCBL players.

Design

Cross-sectional study.

Setting

Online questionnaire.

Patients or Other Participants

A total of 123 CCBL players participated. Qualifying athletes were ≥18 years old and were rostered CCBL players with remaining collegiate eligibility.

Main Outcome Measure(s)

After collecting background information, we used the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire to assess the history of throwing arm injury and current functionality. The maximum KJOC score is 100.0; higher scores correspond with greater functionality.

Results

The mean KJOC score was 86.6 ± 14.5 (n = 92); 24.5% (23/94) of players reported a prior diagnosis of throwing arm injury other than a strain or sprain. A total of 49 (49/96, 51.0%) players had undergone rehabilitation for a throwing arm injury, and 7 (7/96, 7.3%) had experienced a medical procedure. Players with no previous treatment (n = 41, mean KJOC score = 88.9 ± 19.0) more frequently demonstrated KJOC scores of ≥90 than players with such treatment (n = 55, 80.9 ± 17.1; P < .001). The 18 players with time-loss arm injury in the last year had lower mean KJOC scores (71.3 ± 20.0) than players with no injury or time loss (90.3 ± 9.8; P < .001). Similarly, players who reported current arm trouble (n = 15) had lower KJOC scores (71.6 ± 17.5) than players with healthy arms (89.5 ± 11.9; P < .001).

Conclusions

The average KJOC score of the CCBL players was <90, with particularly low scores in athletes with prior arm injury and treatment.

Context

Evidence is emerging that core neurocognitive functions such as working memory and inhibitory control (ie, motor-response and attentional inhibition) are linked to the anterior cruciate ligament (ACL) injury risk. Research has been conducted in laboratory settings, but the contribution of neurocognition to actual ACL injuries under real-world conditions is unknown.

Objective

To describe the possible neurocognitive errors involved in noncontact ACL injury mechanisms.

Design

Case series.

Setting

Soccer matches.

Patients or Other Participants

A total of 47 professional male soccer players.

Main Outcome Measure(s)

Three independent reviewers evaluated 47 videos of players sustaining noncontact ACL injuries. Neurocognitive errors in inhibitory control were operationalized as follows: (1) motor-response inhibition was scored when a player demonstrated poor decision-making and approached the opponent with high speed that reduced the ability to stop or change the intended action and (2) an attentional error was scored when a player shifted his selective attention away from the relevant task to irrelevant stimuli.

Results

Of 47 noncontact ACL injuries, 26 (55%) were related to a pressing-type injury, 19 (73%) of which involved a deceiving action made by the opponent, suggesting poor inhibitory control of the defender. Of the remaining 21 noncontact ACL injuries (45%), 16 (76%) could be attributed to attentional errors. Agreement among the 3 raters was very good for all items except poor decision-making, which showed fair to good agreement (Fleiss κ = 0.71). Interrater reliability was excellent (intraclass correlation coefficient = 0.99–1.00).

Conclusions

Errors in motor-response inhibitory control and attentional inhibition were common during noncontact ACL injury events in professional male soccer players. The interrater agreement in detecting neurocognitive errors in general was very good.

We thank our 2023 manuscript reviewers for their hard work and dedication. We also thank retiring Senior Associate Editor Sandra J. Shultz, PhD, ATC, for her many years of service.

Thomas E. Abdenour, DHSc, ATC

John P. Abt, PhD, ATC

Julie Agel, MA, ATC

Arnel Aguinaldo, PhD, ATC

Kazuma Akehi, PhD, LAT, ATC

Alyssa L. Albrecht, MS

Gordon Alderink, PT, PhD

Jon Almquist, ATC

Alejandra Alonso-Calvete, PhD

Denise Alosa, MS, ATC

Saleh A. Alsaleh, PhD

Jenica D. Alvarez, EdD, MS

Bruce J. Anderson, MD

Melissa Anderson, PhD

Rebecca Anding, MS, RD/LD, CSSD

Siddhartha Angadi, PhD

Kristy Arbogast, PhD

Aubrey Armento,

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