ECSS Paris 2023: OP-MH40
INTRODUCTION: While the majority of patients suffering from concussive symptoms recover within 14 days, around 30 % of cases experience persistent impairments (i.e., post-concussion syndrome PPCS; [1]). In this population, symptoms such as ocular, vestibular and cognitive dysfunctions, fatigue, headache and anxiety [2] persist over weeks to months. Since these symptoms interfere with movement, athletes are often unable to sustain training and competition. While the isolated assessment of motor function does not capture the complex interactions between symptoms and athletic performance, dual-task (DT) paradigms are a promising approach to monitor cognitive-motor interferences (CMIs) in PPCS. This study aimed to review and map the current evidence on DT testing in the subgroup of PPCS with specific regard to the interaction of motor tasks, cognitive tasks, and affected PPCS domains. METHODS: This review adheres to the PRISMA-ScR guidelines [3]. Following the PEO framework, we searched three databases (MEDLINE, CINAHL and EMBASE) for original articles focusing on i) adult concussion patients with persistent symptoms > 14 days after injury, ii) assessing cognitive-motor dual-tasks and iii) quantifying CMI using motor and cognitive outcome measures. Of > 3000 identified records, eight articles met inclusion criteria. Alongside data extraction on patient characteristics, DT specifics, and main findings, a conceptual mapping linked PPCS domains with the identified cognitive and motor subtasks. RESULTS: All identified studies assessed 197 patients with PPCS (131 females; 37.3 ±12.9 years). Seven studies reported increased CMI in patients compared to healthy controls. Regarding motor tasks, six studies utilized gait, while two studies measured static balance tasks. Regarding cognitive tasks, six studies utilized arithmetic or word recall tasks to induce working memory, while four studies applied visual and auditory stroop tasks to induce inhibition. Conceptual mapping revealed strong connections between gait metrics, generic symptoms, and stroop tasks. Key PPCS domains such as fatigue, ocular dysfunction, and headache were not reflected by current dual-task paradigms. CONCLUSION: DT paradigms appear sensitive to persistent cognitive-motor deficits in PPCS and may serve as functional markers of recovery. While gait is the most prominent motor task applied, the use of cognitive tasks is underexplored and excludes cognitive flexibility and response times yet. Based on the extracted concept map of the current evidence, we developed a framework for DT assessments in PPCS in future studies. [1] Voormolen et al. (2019). The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury. Injury [2] Harmon et al. (2019). American Medical Society for Sports Medicine position statement on concussion in sport. BJSM [3] Tricco et al. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals Int Med
Read CV Daniel BüchelECSS Paris 2023: OP-MH40
INTRODUCTION: After a sport-related concussion, subtle neuromuscular deficits can persist beyond clearing return-to-play (RTP) criteria. While such deficits plausibly increase injury risk in association football (and other team sports), results of epidemiological studies are inconsistent. Differences in outcomes, comparator, duration of follow-up, sample size, and analytical methods arguably contribute to discrepancies between studies. Specifically, it seems imperative to compare concussions to other acute index injuries (as opposed to uninjured controls) when drawing conclusions about their specific consequences, as injury risk is known to be increased in the weeks following RTP from a musculoskeletal injury. More generally, data analysis should reflect transparent causal assumptions. Following these considerations, the present study compared post-RTP risk trajectories (hazard curves) between two index injury categories - concussion vs. acute injuries of the lower limb - using retrospective data from elite European football. METHODS: Time-loss injuries as well as match exposures for male players in top European leagues were collected from online sources. Episodes (index injury-RTP-subsequent injury) were constructed and only complete episodes with either a concussion or an acute lower limb index injury were included. Hazard curves were characterized as the local slope of the smoothed cumulative hazard from the respective Kaplan-Meyer-model [1]. Analyses were conducted for chronological time in days as well as for football exposure in weighted hours as time axis. Confidence intervals are based on bootstrapping. The role of differences in time loss between index injury categories was explored by resampling. Results were further scrutinized by comparing the distributions of observed time from RTP to the subsequent injury. RESULTS: While the post-RTP risk trajectory after acute lower limb injuries agrees with previous findings [1], two distinct features were salient after concussions: (a) A peak early after RTP and (b) Lower hazard / higher overall survival in the further course (from about 4 weeks onwards). The overall shape of risk trajectories was similar for the two time axes and unchanged by resampling for similar distributions of time loss between index injury categories. In auxiliary analyses, observed time-to-event was numerically higher after concussions for both time axes, although the 95% confidence intervals for the difference included zero (football exposure-to event: -45 to 168 weighted hours, chronological time-to-event: -8 to 25 days). CONCLUSION: Compared to musculoskeletal index injuries, injury risk trajectories after returning from a concussion are characterized by an early peak contrasting with lower risk beyond about 4 weeks after RTP. Importantly, these findings likely depend on a complex set of framework conditions (e.g. RTP protocols) and should therefore not be generalized beyond current elite European football. References: 1. Zhang et al., Sports Med, 2024
Read CV Anne HeckstedenECSS Paris 2023: OP-MH40
INTRODUCTION: Upper extremity performance tests are commonly used to assess shoulder function, injury risk, and return-to-sport readiness; however, most are performed under predictable conditions and fail to reflect the dynamic demands of sport. Therefore, this study aimed to develop a novel reactive upper extremity performance test integrating visuomotor demands with dynamic stability and to examine the intra- and inter-rater reliability of this Reactive Upper Quarter Y Balance Test (RUQYBT) in physically active males. METHODS: The RUQYBT uses the Upper Quarter Y Balance Test as a reference framework for reach directions, while incorporating a light-based visual stimulus system (Sportreact™, Zagreb, Croatia) to introduce unpredictable visuomotor demands. Visuomotor reaction time (VMRT) and response accuracy (ACC) were selected as outcome measures. Accuracy was calculated as: [Total number of stimuli - (missed stimuli + multiple responses + balance errors + additional attempts + decision errors)] / Total number of stimuli x 100. Sixteen physically active male volunteers (age: 20.2 ± 1.4 years; height: 178.8 ± 6.4 cm; body mass: 74.7 ± 12.9 kg) participated in the study. One familiarization session and two experimental sessions were conducted, during which participants performed both the UQYBT and RUQYBT three times per session. Individual reach distances obtained from the UQYBT were used solely to determine visual stimulus placement at 80% of the maximum reach distance during the RUQYBT. Two independent raters conducted the assessments. Intra-rater reliability was determined by comparing the first and second trial scores evaluated by the first rater, whereas inter-rater reliability was examined by comparing second trial scores independently evaluated by the first and second raters. VMRT and ACC values were averaged across trials, and intra- and inter-rater reliability were quantified using intraclass correlation coefficients (ICC). RESULTS: Mean VMRT values for intra-rater reliability were 0.86 ± 0.14 s and 0.85 ± 0.15 s for the first and second trials, respectively, with corresponding ACC values of 88.88 ± 10.23% and 85.76 ± 10.46%. For inter-rater reliability, mean VMRT and ACC values obtained from the second trial and evaluated by the second rater were 0.84 ± 0.15 s and 85.30 ± 10.42%, respectively. VMRT demonstrated excellent intra-rater (ICC = 0.98) and inter-rater (ICC = 0.99) reliability. ACC showed excellent inter-rater (ICC = 0.99) and good intra-rater reliability (ICC = 0.80). CONCLUSION: The RUQYBT is a novel, stand-alone upper extremity performance test integrating upper extremity dynamic stability with reactive visuomotor demands. The test demonstrated good to excellent intra- and inter-rater reliability in physically active young males. The RUQYBT enables the simultaneous assessment of physical performance and athlete adaptability within a more sport-specific context.
Read CV Gürsu SayarECSS Paris 2023: OP-MH40