Interpreting change on the Child Sport Concussion Assessment Tool 5th Edition

ObjectivesThe purpose of this study was to examine the one-year test-retest reliability of Child Sport Concussion Assessment Tool 5th Edition component scores and provide recommendations for interpreting change on its component tests.DesignA prospective cohort study was conducted across two years via the Advancing Healthcare Initiatives for Underserved Students (ACHIEVES) Project.MethodsParticipants were 219 children (ages 11 to 12, M = 11.7, SD = 0.5; 52.1% girls, 47.9% boys) playing competitive school-sponsored sports in nine middle schools across a large public-school division in Virginia, USA during the 2017-2018 and 2018-2019 academic years. Athletic Trainers administered the baseline Child Sport Concussion Assessment Tool 5th Edition each year.ResultsTest-retest reliability estimates for each Child Sport Concussion Assessment Tool 5th Edition component were low to moderate (ICCs=0.40-0.55). A minority of middle school athletes (15-31%) scored within a different normative classification range upon re-assessment. The following test-retest difference scores occurred in 20% or fewer of the sample: +5 total symptoms, +7 symptom severity, -2 in the Standardized Assessment of Concussion - Child Version total score, and +4 total Modified Balance Error Scoring System balance errors.ConclusionsChild Sport Concussion Assessment Tool 5th Edition component scores had poor to moderate test-retest reliability coefficients over a one-year period, though most children were classified as falling within the same interpretive category upon re-testing based on local norms. We report the raw score changes that were uncommon in our sample of uninjured children to help clinicians identify changes that might be clinically meaningful.     

Neuropsychological assessment of sport-related concussion

Assessment of concussion can be challenging for medical practitioners given the different factors associated with each individual injury. The use of neuropsychological testing provides an objective method in the evaluation and management of concussion. Over the last 20 years it has become increasingly useful in the realm of sports concussion and has been deemed a cornerstone of concussion management by the Concussion in Sport group at the International Symposia on Concussion in Sport. Neuropsychological assessment has evolved to using computer-based neurocognitive testing, which has become increasingly common over the last decade, especially in organized sports. Neuropsychological assessment has also proven to be effective in the detection of differences based on several individual factors, including age, gender, and history of prior concussion. Despite its documented value, neuropsychological assessment should be one of several tools used as part of the concussion assessment/management process.     

Supplement

The 20th International Symposium on the Forensic Sciences (ANZFSS) was held in Sydney, Australia, between September 5 and 9, 2010. The theme was ‘forensic science on trial’. Abstracts are provided here for all oral presentations given at the conference.     

Development of a technique for using 99mTc as an adsorbable tracer for hydrodynamic studies of fine sediments in suspension.

Labelling of fine sediment (phi < 62.5 microm) with 99mTc was achieved through laboratory experiments described in a previous work (Proceedings of an International Symposium on Isotope Techniques in Water Resources Development and Management. IAEA-SM-361/13, Vienna, Proceedings of the XIIIth Brazilian Symposium on Water Resources. Brazilian Association for Water Resources (ABRH), Belo Horizonte, paper 176, CD-rom (in Portuguese)). Comparative studies of the hydrodynamic behaviour of the labelled and unlabelled sediment, in order to validate the application of the labelled sediment in field studies, were further performed by means of sedimentation tests using the Andreasen pipette technique, and are presented here. Labelling without flocculation, which promotes the same sedimentation behaviour of the labelled and the natural sediment was only achieved using small quantities of SnCl2 dissolved in proportionately small volumes of HCI (0.3%), in the reduction of a 99mTcO4- eluted from a 99Mo generator.     

Exploration of US men’s professional sport organization concussion policies

Concussion policies are increasingly being developed and adopted among professional sports organizations. We sought to compare the policies of the National Hockey League (NHL), the National Basketball Association (NBA), the National Football League (NFL), and Major League Baseball (MLB). Our objective was to summarize each policy and evaluate the extent to which each policy is organization-specific and/or consistent with medical guidelines. We visited websites for the NHL, NBA, NFL, and MLB. We searched media articles reporting concussion policy. We utilized only publically available data. We collected information on each league’s approach to the definition of concussion, education provided about concussion, baseline testing requirements, minimum return to play time and return to play protocol. We found that concussion policies vary across these organizations. Most organizations utilize the Concussion in Sport Group (CISG) definition (2013) to define concussion. The NFL and NBA mandate preseason education. All organizations require some type of baseline testing. All organizations require sideline evaluation after suspected concussion. The NFL and MLB require Sport Concussion Assessment Tool (SCAT) testing for sideline evaluation of suspected concussion. MLB is the only organization to require minimum time before return to play. There is a return to play protocol in place for each organization. The NFL and MLB require independent neurologic consultation as part of their return to play protocol. There is variability in concussion policy among the professional sports organizations. The most pronounced variation from the CISG consensus statement is the variability in the minimum time to return to play. Further, the rules of the individual sports have a role in how concussion policy can be designed and implemented. Professional sports set an example for thousands of recreational sports enthusiasts so their publically available policies on concussion have a large impact.     

Defining asymptomatic status following sports concussion: fact or fallacy?

The current management of sports concussion involves a return to the baseline 'asymptomatic' status prior to returning to play and training. Unfortunately, although the term 'asymptomatic' is widely used it has not been operationally defined. This review identifies the need to formally define the term 'asymptomatic' as used in sports concussion, discusses some of the challenges associated with its definition and offers some possible solutions for further debate. The operational definition of the term 'asymptomatic' may provide the stimulus for further informed discussion at a future meeting of the international Concussion in Sport group, and by other peak sports medicine bodies involved in management guideline development.     

The Auger Effect in biology and medicine. Looking back

Abstract

Purpose: The Auger Effect entered biology in 1967 in a quantal step leading to a burst of experimental work on basic and applied cell- and molecular biology and medicine, which is briefly described.

Conclusion: The relevance of this work again appears in the agenda of the 7th International Symposium on Physical, Cellular, Molecular and Medical Aspects of Auger Processes, held in Jülich, Germany, in 2011.     

The "value added" of neurocognitive testing after sports-related concussion

BACKGROUND: Neurocognitive testing has been endorsed as a "cornerstone" of concussion management by recent Vienna and Prague meetings of the Concussion in Sport Group. Neurocognitive testing is important given the potential unreliability of athlete self-report after injury. Relying only on athletes' reports of symptoms may result in premature return of athletes to contact sport, potentially exposing them to additional injury. HYPOTHESIS: Use of computer-based neurocognitive testing results in an increased capacity to detect postconcussive abnormalities after injury. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: High school and college athletes with a diagnosed concussion were tested 2 days after injury. Postinjury neurocognitive performance (Immediate Postconcussion Assessment and Cognitive Testing) and symptom (postconcussion symptom) scores were compared with preinjury (baseline) scores and with those of an age- and education-matched noninjured athlete control group. "Abnormal" test performance was determined statistically with Reliable Change Index scores. RESULTS: Sixty-four percent of concussed athletes reported a significant increase in symptoms, as judged by postconcussion symptom scores, compared with preinjury baseline at 2 days after injury. Eighty-three percent of the concussed sample demonstrated significantly poorer neurocognitive test results relative to their own baseline performance. The addition of neurocognitive testing resulted in a net increase in sensitivity of 19%. Ninety-three percent of the sample had either abnormal neurocognitive test results or a significant increase in symptoms, relative to their own baseline; 30% of a control group demonstrated either abnormalities in neurocognitive testing or elevated symptoms, as judged by postconcussion symptom scores. For the concussed group, use of symptom and neurocognitive test results resulted in an increased yield of 29% overreliance on symptoms alone. In contrast, 0% of the control group had both symptoms and abnormal neurocognitive testing. CONCLUSION: Reliance on patients' self-reported symptoms after concussion is likely to result in underdiagnosis of concussion and may result in premature return to play. Neurocognitive testing increases diagnostic accuracy when used in conjunction with self-reported symptoms.     

International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes

Challenging environmental conditions, including heat and humidity, cold, and altitude, pose particular risks to the health of Olympic and other high-level athletes. As a further commitment to athlete safety, the International Olympic Committee (IOC) Medical Commission convened a panel of experts to review the scientific evidence base, reach consensus, and underscore practical safety guidelines and new research priorities regarding the unique environmental challenges Olympic and other international-level athletes face. For non-aquatic events, external thermal load is dependent on ambient temperature, humidity, wind speed and solar radiation, while clothing and protective gear can measurably increase thermal strain and prompt premature fatigue. In swimmers, body heat loss is the direct result of convection at a rate that is proportional to the effective water velocity around the swimmer and the temperature difference between the skin and the water. Other cold exposure and conditions, such as during Alpine skiing, biathlon and other sliding sports, facilitate body heat transfer to the environment, potentially leading to hypothermia and/or frostbite; although metabolic heat production during these activities usually increases well above the rate of body heat loss, and protective clothing and limited exposure time in certain events reduces these clinical risks as well. Most athletic events are held at altitudes that pose little to no health risks; and training exposures are typically brief and well-tolerated. While these and other environment-related threats to performance and safety can be lessened or averted by implementing a variety of individual and event preventative measures, more research and evidence-based guidelines and recommendations are needed. In the mean time, the IOC Medical Commission and International Sport Federations have implemented new guidelines and taken additional steps to mitigate risk even further.     

Poor cervical proprioception as a risk factor for concussion in professional male rugby union players

BackgroundConcussion is one of the most common injuries in male professional Rugby Union (‘rugby’) and accounts for significant time loss from training and competition. Despite the most recent Concussion in Sport Group consensus statement recommending a focus on the identification of modifiable risk factors, limited evidence for their existence is available.ObjectiveTo investigate the association between cervical proprioception and concussion incidence in a group of professional male rugby players over the course of a full season.Methods165 players were assessed at pre-, mid- and end of season time points using the Cervical Joint Position Error Test (CJPET). Associations with diagnosed concussion injuries are presented as incidence rate ratios with 95% confidence intervals. We present the Incidence Rate Ratios (IRR) for a 10% increase in each variable and compared results against concussion using match minutes to account for risk exposure.ResultsDuring the study period, 45 concussions were incurred by 44 players [or 19.7 concussions per 1000 player-match hours]. There was a significant association between right rotation repositioning error and concussion, with a 5% increase in concussion rate for each 10% increase in gross right rotation error (P = 0.021).ConclusionPoor gross right rotation repositioning error is a modifiable intrinsic risk factor for concussion in professional male rugby players. Interventions to improve proprioceptive function may act as an effective method for reducing concussion incidence in this population.     

Auger processes in the 21st century

Purpose: The extreme radiotoxicity of Auger electrons and their exquisite capacity to irradiate specific molecular sites has prompted scientists to extensively investigate their radiobiological effects. Their efforts have been punctuated by quadrennial international symposia that have focused on biophysical aspects of Auger processes. The latest meeting, the 6th International Symposium on Physical, Molecular, Cellular, and Medical Aspects of Auger Processes, was held 5–6 July 2007 at Harvard Medical School in Boston, Massachusetts, USA. This article provides a review of the research in this field that was published during the years 2004–2007, the period that has elapsed since the previous meeting.

Conclusion: The field has advanced considerably. A glimpse of the potential of this unique form of ionizing radiation to contribute to future progress in a variety of fields of study is proffered.     

Déclaration de consensus sur l’entraînement de l’enfant au sport d’élite

Protecting the health of the athlete is the primary goal of the International Olympic Committee's Medical Commission. One of its main objectives is the promotion of safe practices in the training of the elite child athlete. The elite child athlete is one who has superior athletic talent, undergoes specialised training, receives expert coaching and is exposed to early competition. Sport provides a positive environment that may enhance the physical growth and psychological development of children. This unique athlete population has distinct social, emotional and physical needs, which vary depending on the athlete's particular stage of maturation. The elite child athlete requires appropriate training, coaching and competition that ensure a safe and healthy athletic career and promote future well-being. This document reviews the scientific basis of sports training in the child, the special challenges and unique features of training elite children and provides recommendations to parents, coaches, health care providers, sports governing bodies and significant other parties.     

Health-related and sociodemographic correlates of meeting the muscle strengthening exercise recommendations in middle-aged and older adults with and without disabilities

Sport Sciences for Health - To identify sociodemographic and health correlates of meeting the muscle strengthening (MS) exercise recommendations in middle-aged and older adults by disability...     

Abstract of the Fourth Annual Symposium of the International Research Group in Immunoscintigraphy and Immunotherapy

Abstract of the Fourth Annual Symposium of the International Research Group in Immunoscintigraphy and ImmunotherapyIn association with the Task Force on Immunocintigraphy of the EANM     

Fundamental movement skill proficiency in juvenile Gaelic games

Sport Sciences for Health - Fundamental movement skills (FMS) are basic observable patterns of movement and prerequisites to successful performance of sports specific skills. International research...     

Fehler und Streuungen des Widmark-Verfahrens beim Nachweis von Äthylalkohol

Ohne ZusammenfassungAuszugsweise vorgetragen und diskutiert in dem Symposium über Blutalkoholfragen in Eberbach a. Neckar im Anschluß an die Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin Juni 1957 in Heidelberg und auf einem Symposium über das gleiche Thema in Frankfurt a. M. im November 1957.     

Trends in activities of ICRP

International Commission for Radiological Protection (ICRP) consists of main commission (MC) and 4 committees. Committee 3 (C3) deals with radiological protection in medicine, which is chaired by Prof. Fred Mettler. The C3 has been actively producing reports and recommendations applying ICRP recommendation 1990 (Pub.90) to daily practices of radiology. Those publications include "pregnancy and medical radiation", "avoidance of radiation injuries in IVR", etc.. The main commission has been dealing with two important subjects. The one is "new recommendation at the start of the 21st century" the other is "protection of environments and ecology". Two task groups are preparing drafts recommendations for those subjects, which will be discussed in MC to be held in October 2002.     

Standardization of I by the coincidence method and practical applications

A new coincidence system, based on two thin NaI(Tl) crystals, 50×2 mm², with beryllium windows, 1.5 mg cm⁻², positioned approximately symmetrically from the source holder (at various distances) was constructed. The electronic chains of a classical 4πPC–γ system were utilized. A multichannel analyzer was employed for energy calibration, and an oscilloscope for visualization of the pulses. After calibration, the system was used for the standardization of an ¹²⁵I solution. An energy window of 12–95 keV containing the entire spectrum (single and sum peak) was employed, and a simple demonstration of Taylor's equation [1967. X-ray–X-ray coincidence counting methods for the standardization of ¹²⁵I and ¹⁹⁷Hg. In: Standardization of Radionuclides: Proceedings of a International Atomic Energy Agency Symposium, Vienna, 1966, pp. 341–353, SM-79/65] for whole spectrum counting, was developed. The method and system were tested during the calibration of a LKB 2104 multi-gamma counter, by comparing the detection efficiency values obtained for this prepared standard solution and that utilized in the CIPM-CCRI(II) key comparison. The efficiency of the equipment was calculated as the mean of the two individual values. The result validates the method and demonstrates the accomplishment of the national traceability assurance in nuclear medicine for ¹²⁵I.     

Availability and content of concussion guidelines in Australian combat sports

ObjectivesTo examine the availability and content of publicly available concussion information published by peak amateur and professional combat sport governing bodies in Australia.DesignCross-sectional study; document analysis.MethodsPublicly available concussion information was retrieved from the websites of eleven peak Australian amateur and professional combat sport governing bodies. Data on type of source material, concussion definition, provision of medical services, concussion evaluation, and return-to-sport information were extracted. The quality of the information was assessed using a modified version of the Global Rating Scale.ResultsEight out of eleven combat sport governing bodies provided concussion information in source documents ranging from competition rules to position statements to specific policies. Five governing bodies provided information on post-contest concussion evaluation or testing, four of which mentioned the Sport Concussion Assessment Tool. Eight governing bodies provided information on return-to-sport, of which six stipulated mandatory minimum rest periods and four indicated that athletes should complete a graduated return-to-sport protocol. The provided concussion information was generally of low quality, with a median score of 3 out of 9 (range: 1–4).ConclusionsThere is substantial scope and an urgent need for improving concussion guidelines across peak combat sport governing bodies in Australia to improve the health and safety of their athletes.     

First European regional symposium of international physicians for the prevention of nuclear war

This well–organized Symposium took place on 9–10 November 1985 in an air of optimism commensurate with the recent Nobel Peace Prize announcement. Some 250 participants gathered in well‐appointed surroundings of the Free University of Brussels for a day of lectures followed by a day of workshops. Amongst an impressive array of dignitaries Kevin Craig (Medical Campaign Against Nuclear Weapons, UK) proved an adroit chairman—supervising the delivery of the Symposium with appropriate obstetric puns.