Symptom Provocation During Aerobic and Dynamic Supervised Exercise Challenges in Adolescents With Sport-Related Concussion

ContextSupervised exercise challenges (SECs) have been shown to be safe and beneficial in the early symptomatic period after concussion. Thus far, most in-clinic SECs studied have included a form of basic aerobic exercise only. An SEC that also includes dynamic forms of exercise mimics all steps of a standard return-to-play progression and may enhance the detection of concussion symptoms to guide in-clinic management decisions.ObjectiveTo determine whether an SEC that includes a dynamic SEC (DSEC) uncovered symptoms that would not have been identified by an SEC involving an aerobic SEC (ASEC) alone in adolescent patients with sport-related concussion.DesignRetrospective case series.SettingMultidisciplinary sport concussion clinic at a tertiary care center.Patients or Other ParticipantsA total of 65 adolescent athletes (mean age = 14.9 ± 2.0 years, 72.3% males) who underwent an in-clinic SEC within 30 days of concussion.Main Outcome Measure(s)Presence of pre-exercise symptoms and symptom provocation during the SEC were recorded, with exercise-provoked symptoms categorized as occurring during ASEC or DSEC.ResultsOf the total patient sample, 69.2% (n = 45/65) experienced symptom provocation at some point during the SEC. Symptoms were provoked in 20 patients during the ASEC, whereas 25 completed the ASEC without symptom provocation before becoming symptomatic during the subsequent DSEC and 20 completed the SEC without any symptom provocation. Of the 65 patients in the total sample, 46 were asymptomatic immediately before the SEC. Of these previously asymptomatic patients, 23.9% (n = 11/46) experienced symptom provocation during the ASEC, and an additional 37.0% (n = 17/46) remained asymptomatic during the ASEC but then developed symptoms during the DSEC.ConclusionsThe ASEC alone may not detect symptom provocation in a significant proportion of concussion patients who otherwise would develop symptoms during a DSEC.     

Performance After Concussion in National Hockey League Players

ContextConcussions in ice hockey players are an interesting area of study due to the fast-paced and high-impact nature of the sport. Recently, researchers have focused on player performance after return from concussion to evaluate subclinical deficits that were previously missed.ObjectiveTo examine National Hockey League (NHL) player performance from 2013 to 2019 and compare performance before a concussion with performance immediately after recovering to assess the current NHL return-to-play protocol.DesignCross-sectional study.SettingThe NHL Injury Viz and sports reporting websites.Patients or Other ParticipantsPlayers in the NHL who sustained concussions from 2013 to 2019.Main Outcome Measure(s)Goals, assists, points, plus-minus, time on ice (TOI), and hits.ResultsWhen goals, assists, points, plus-minus, TOI, and hits were examined, only TOI was different after the players returned from injury, and this TOI difference was not substantively important.ConclusionsAfter concussion, NHL player performance did not change.     

Usefulness of Permanent Tracheostoma in Chronic Brain Injured Patients: A Case Series

Patients with severe neurological deficit, such as hypoxic ischemic injury, cerebral infarction, and traumatic brain injury, often show comatose mental status and require maintenance of long-term tracheostomy for pulmonary toileting. However, several complications, which are mostly related to the cannula, invariably occur. Permanent tracheostoma is a short, skin-lined, noncollapsing, self-sustaining opening by suturing the denuded skin lining to the margin of the tracheal stoma. This tube-free method is a useful alternative to make long-term airway without tube-related complications in chronic diseases, such as obstructive sleep apnea, and laryngeal cancer, however, it has not yet been reported in chronic brain injured patients. This case report illustrates 3 cases of vegetative patients in our rehabilitation clinic who underwent successful procedure of permanent tracheostoma. Permanent tracheostoma has some benefits associated with the free of tube-related complications, and can be considered as a useful alternative way for chronic brain injured patients with long-term tracheostomy.     

The anatomy of concussion and chronic traumatic encephalopathy: A comprehensive review

Concussion is defined as a complex pathophysiological process that affects the brain as a result of traumatic biomechanical forces. Repeated unrecovered concussions can result in chronic brain injury syndrome which is referred to in the literature today as chronic traumatic encephalopathy.” There is an exponential increase in public and political interest in this condition in the recent times resulting in a significant investment in research to improve the current understanding of the disease, ways to decrease its incidence and determine its prognosis. Broadly the research involves three main disciplines of medicine including neuropathology, neuroradiology and biological markers. Although progress has been made, to date there is no definite pathological, radiological or neurobiological marker which has shown consistent promise to make the diagnosis and prognosticate the disease. Possible reasons are multiple such as inconsistencies in the methods studies have used, different time periods in which the tests were conducted, the small numbers of subjects included in the studies, and inconsistencies in the definitions of concussion or mild traumatic brain injury. Herein, we present a comprehensive review of the current literature on this topic. Positron emission tomography scans with radioactive ligands such as T807 as an imaging biomarker, and neurofilament light and ubiquitin C‐terminal hydrolase as serum biomarkers have shown some promise lately in diagnosing concussion and chronic traumatic encephalopathy and also determining their prognosis. Clin. Anat. 32:310–318, 2019. © 2018 Wiley Periodicals, Inc.     

Increased QT interval variability in 3 recently concussed athletes: an exploratory observation

Context:

The QT interval variability index (QTVI) is a noninvasive measure of beat-to-beat fluctuations of the QT interval as seen from a single electrocardiographic lead. It represents the relationship between the respective variabilities of the QT and R-R intervals. Recently, the QTVI was demonstrated to be an index of vagal cardiac autonomic modulation in resting conditions.

Objective:

To determine whether QTVI varied in athletes at 48 hours, 1 week, and 2 weeks after a concussive head injury.

Design:

Case series.

Setting:

Testing facility.

Patients or Other Participants:

Three athletes with recent concussions and 3 uninjured athletes with similar demographic factors.

Main Outcome Measure(s):

Continuous 3-lead electrocardiograms were obtained in a seated, resting position over 2 successive weeks. Separate, unpaired t tests were performed to determine whether group-visit differences were present in the QTVI at 48 hours, 1 week, or 2 weeks.

Results:

No demographic differences were present between groups. At 48 hours, the QTVI was greater in the concussion group than in the matched controls. At weeks 1 and 2, the QTVI in the concussion group was lower than at 48 hours and not different from that of the control group.

Conclusions:

Vagal cardiac autonomic modulation, as quantified by the QTVI, appeared to be negatively affected in concussed athletes within 48 hours of injury, resolved within 1 week, and remained at control group levels 2 weeks later. Serial assessments of QTVI may be of clinical utility in identifying suspected cases of acute concussion and may provide helpful information for determining when an athlete can return to play safely.     

Explosive Quadriceps Strength Symmetry and Landing Mechanics Limb Symmetry After Anterior Cruciate Ligament Reconstruction in Females

ContextEmerging evidence suggests that a lower quadriceps rate of torque development (RTD) after anterior cruciate ligament (ACL) reconstruction (ACLR) may be associated with altered landing mechanics. However, the influence of quadriceps RTD magnitude and limb symmetry on landing mechanics limb symmetry remains unknown.ObjectiveTo assess the influence of quadriceps RTD magnitude and limb symmetry on limb symmetry in sagittal-plane landing mechanics during functional landing tasks in females with or without ACLR.DesignCross-sectional study.SettingLaboratory.Patients or Other ParticipantsA total of 19 females with ACLR (age = 19.21 ± 1.81 years, height = 164.12 ± 6.97 cm, mass = 63.79 ± 7.59 kg, time after surgery = 20.05 ± 9.50 months) and 19 females serving as controls (age = 21.11 ± 3.28 years, height = 167.26 ± 7.26 cm, mass = 67.28 ± 9.25 kg).Main Outcome Measure(s)Landing mechanics were assessed during a double-legged (DL) jump-landing task, a single-legged jump-landing task, and a side-cutting task. Quadriceps RTD was collected during isometric muscle contractions. Separate stepwise multiple linear regression models were used to determine the variance in limb symmetry in the sagittal-plane knee moment at initial contact, peak vertical ground reaction force, and loading rate that could be explained by quadriceps RTD magnitude or limb symmetry, group (ACLR or control), and their interaction.ResultsIn the ACLR group, greater limb symmetry in quadriceps RTD was associated with greater symmetry in sagittal-plane knee moment at initial contact during the DL task (P = .004). Peak vertical ground reaction force and loading rate could not be predicted by quadriceps RTD magnitude or limb symmetry, group, or their interaction during any task.ConclusionsDeveloping greater symmetry but not magnitude in quadriceps RTD likely enabled more symmetric sagittal-plane knee landing mechanics during the DL task in the ACLR group and thus may reduce the risk of a second ACL injury. Such a protective effect was not found during the single-legged or side-cutting tasks, which may indicate that these tasks do not allow for the compensatory landing mechanism of shifting load to the uninvolved limb that was possible during the DL task.     

成年Graves病患者焦虑状态的相关因素分析

目的:研究成年格雷夫斯病(Graves病,GD)患者的焦虑水平及相关危险因素.方法:收集我院2000.7～2003.4期间在门诊就诊或住院的948名成年GD患者流行病学一般资料,同时对患者进行家庭功能、生活应激事件及焦虑评定,SPSS10.0建立数据库,并用描述性统计分析对GD患者焦虑水平进行分析;Logistic回归分析确定GD焦虑发生的危险因素.结果:GD患者伴焦虑状态者占61.1%,男性51.9%,女性64.1%,性别之间比较差异有统计学显著性(X2=6.4,P＜0.01),焦虑患者多在30～45岁之间.受教育程度低、低经济收入的GD人群是GD患者焦虑的高发人群;农民、机关干部、医务人员相对其他职业的检出率为高.年龄、甲亢性眼病(GO)、甲状腺体积、游离T3(FT3)及生活应激事件为GD患者并焦虑的危险因素;促甲状腺素(TSH)、经济情况和家庭功能为GD患者并焦虑的保护因素.结论:GD患者并焦虑的发病率较正常人群检出率高且有性别差异,中年人、低受教育程度、低经济收入GD人群是焦虑的高发人群,年龄、GO、甲状腺体积、FT3及生活应激事件是GD患者焦虑状态的危险因素,TSH、经济情况和家庭功能是GD并焦虑的保护因素.     

运动员应激反应性焦虑预测与生理心理指标的关系

目的预测优秀射击射箭运动员应激反应性焦虑发生概率,分析其认知加工的差异,为评估运动员心理能力提供参考。方法用《SMMU军事应激反应性焦虑预测量表》对上海市射击射箭中心18名一线运动员进行分组,观察焦虑预测低分组与高分组皮温、皮电、心率、P300潜伏期、P300波幅、反应时和正确率指标,分析两组差异。结果焦虑预测高分组应激前后皮电显著升高（2.3200±1.66906,5.3080±3.14961;P〈0.05）,反应时明显缩短（0.33136±0.04098,0.29748±0.03951;P〈0.05）,其余指标应激前后无显著差异;焦虑预测低分组应激前后各项指标均无显著性差异。结论《SMMU军事应激反应性焦虑预测量表》筛选出的焦虑高危人群应激前后所测生理心理指标有明显区分。     

Anxiety in the workplace: A comprehensive occupational health evaluation of anxiety disorder in public school teachers

The purpose of the study was to systematically assess demographic, occupational, and psychosocial factors associated with Anxiety Disorder in public school teachers. A sample of 3,361 public school teachers was given an online questionnaire, including questions about demographic, occupational, and psychosocial factors. Anxiety Disorder was based on the Patient Health Questionnaire. Univariate analyses and a hierarchical logistic regression were used to determine the key demographic, occupational, and psychosocial factors associated with Anxiety Disorder. Individuals with Anxiety Disorder were significantly more likely to report absenteeism and higher intent to quit (p < .001). The hierarchical logistic regression showed that the factors most associated with the Anxiety Disorder included being Hispanic (p < .01), taught fewer years (p < .05), teaching elementary school (p < .01), higher job involvement (p < .01), higher perceived stress (p < .01), lower physical quality of life (p < .01), major depression (p < .001), and somatization disorder (p < .01). The results from this study identify specific demographic, occupational, and psychosocial factors associated with the presence of anxiety disorder in public school teachers. Future research should examine how implementing changes in the workplace may improve occupational factors such as job control, satisfaction, absenteeism, and intent to quit, which, in turn, may be associated with a reduction in the presence of anxiety disorders.     

Imagery in cognitive-behavior therapy: Research and application

This paper explores the uses of imagery within behavioral and cognitive-behavioral clinical interventions. The nature of imagery as a central human phenomenon is first examined and then recent theoretical models of the role of imagery in therapy are reviewed and evaluated critically. A trend towards broader conceptualizations of the role of imagery in treatment is highlighted. The notion of self-efficacy and its role in imagery methods is discussed. The specific kinds of imagery techniques that have been practiced, including systematic desensitization, positive imagery, covert conditioning, implosive imagery and others, are briefly described and research results bearing on their effectiveness are presented. The assessment of imagery for clinical purposes is outlined and the possibilities for enhancing imagery capabilities are explored. The paper concludes on a note of cautious optimism about the potential of imagery therapies, acknowledging the limitations of imagery. Finally, it is proposed that clinicians should adopt a “research perspective” to collect information on the effectiveness of their procedures and provide data which could be used to correct the course of therapy as needed.     

Dental Injuries in Intermediate and High School Athletes: A 15-Year Study at Punahou School

OBJECTIVE: To determine the rate, type, and severity of dental injuries recorded for intermediate and high school interscholastic athletic participants. DESIGN AND SETTING: A longitudinal study (1988-2003) of intermediate and high school athletes utilizing the same certified athletic trainers to evaluate and record all injury data. SUBJECTS: Sports participation included 123 teams in 19 female, 18 male, and 2 coed sports. Of 2445 Punahou School intermediate and high school students, on average, 1340 students (623 females, 717 males) annually participated in interscholastic athletics. MEASUREMENTS: Dental injuries were defined as injuries to the jaw, teeth, and oral soft tissue (lip, mouth, cheek, and tongue). Soft tissue injuries requiring physician or dentist referral were recorded. Other soft tissue injuries were treated as skin abrasions and were not recorded. Actual days lost from activity were recorded. The estimated injury rate was determined (injuries/1000 athlete-sessions). Mouth-guard use was recorded. RESULTS: During the 15-year study, 19 492 injuries were reported, with 56 (0.2%) recorded as dental injuries (23 tooth, 20 jaw, and 13 soft tissue). Injury rates were highest for girls' wrestling (0.243, confidence interval = 0-2.3), boys' judo (0.189, confidence interval = 0-3.6), and boys' soccer (0.127, confidence interval = 0.4-1.4). The football injury rate was 0.029 (confidence interval = 0.04-0.29), with no tooth injuries. CONCLUSIONS: The incidence and injury rate of dental injuries was extremely low for all reported sports. A universal definition of dental injuries must be established to facilitate injury data collection and analysis.     

Assessing the Effects of the Acting White Accusation Among Black Girls: Social Anxiety and Bullying Victimization

One of the most harmful accusations one Black adolescent can hurl at another is the acting White accusation (AWA). The AWA is an attack against an individual's ethnic/racial identity and many have described it as a bullying experience. Those who experience the AWA frequently and are bothered by it might perceive the accusation as bullying for these reasons, and peer victimization has been associated with several negative outcomes including social anxiety. The present study examines the relationship between the acting White accusation, bullying victimization, and social anxiety. Thirty-one Black females between the ages of 10 and 18 years served as participants in the study. The findings indicated that all participants reported receiving the accusation at least once in their lifetime. The results also indicated that bother experienced when receiving the accusation was positively associated with social anxiety, while both bother and frequency of the accusation were positively associated with bullying victimization. These findings suggest that adolescents interpret the accusation as a negative evaluation. Additionally, the more an adolescent experiences the accusation and the more bothered he or she is by it, the more victimized they feel.     

患者信任医生与焦虑、健康相关生命质量的关系

目的探讨患者对医生的信任、焦虑状况和健康相关生命质量之间的关系,旨在研究医患关系及改善对患者健康的作用。方法通过对住院患者的调查,编制患者对医生的信任量表,并结合SF-36健康状况问卷和状态-特质焦虑问卷展开研究。结果①患者信任医生量表包括"患者中心"和"职业素养"2个维度,具有良好的信度和效度;②市级医院患者对医生的信任程度显著高于县级医院患者(t=3.62,P<0.001);③患者对医生的信任程度对其状态焦虑有预测作用(β=-0.248,P<0.01),对生命质量的活力(β=0.278,P<0.01)、社会功能(β=0.322,P<0.001)、情感职能(β=0.197,P<0.05)、精神健康(β=0.223,P<0.05)有预测作用;④焦虑在患者对医生的信任与生命质量之间有中介作用。当焦虑进入回归方程时,信任对活力的预测效应由0.278降至0.148、对社会功能的预测效应由0.322降至0.233、对情感职能的预测效应由0.197降至0.147、对精神健康的预测效应由0.223降至0.096。结论患者的信任可通过降低焦虑等途径间接影响患者治疗和康复。     

Pain, Anxiety, and Cooperativeness in Children with Cerebral Palsy After Rhizotomy: Changes Throughout Rehabilitation

Assessed pain, anxiety, physical functioning, and cooperativenessin 32 childrenn with spastic cerebral palsy. This is the firststudy to assess children throughout rehabilitation followingselective posterior rhizotomy. Results of the ObservationalScale of Behavioral Distress and observer Likert ratings confirmedthe hypothesis that children's pain and anxiety decrease overtime. Children's physical functioning and cooperativeness improveover time. No significant correlation was found between painand changes in physical functioning. Cognitive impairment, parentalinvolvement, and children's pain behaviors explained 77% and56% of the variance in two forms of cooperativeness. Researchand clinical implications are discussed, and special considerationsregarding pain assessment and management in this populationare addressed     

赔偿性颅脑外伤患者伪装智力低下的评估

近些年来 ,精神医学领域中涉及精神损伤或精神伤残的民事案件或工伤、职业病、交通事故伤残鉴定案例有连年增多的趋势 ,本科室每年仅交通事故后的精神伤残鉴定案例就达两百余例 ,今年这类案件比去年增长了 110 %。在这类案件中 ,有相当一部分是要求对被鉴定人的智力损伤或智力伤残的性质和程度进行评定。由于这类案件一般都涉及到经济赔偿、或工种变更、或获得某种社会福利等问题 ,鉴定结论将直接影响到当事人的切身利益 ,因而 ,有相当一部分被鉴定人在心理测量和精神检查的过程中表现出掩饰、夸大症状或伪装 ,尤其是轻微脑损伤的患者出现这…     

Functional electrical stimulation for the upper limb in tetraplegic spinal cord injury: a systematic review

Abstract

Technological advances have helped to improve functional ability in spinal cord injury survivors. The aim of this study is to systematically review the evidence for functional electrical stimulation (FES) on functional tasks involving the upper limb in people with spinal cord injuries. The authors systematically searched from September 2009 to September 2014 in relevant databases using a combination of keywords covering spinal cord injury and FES. Studies were selected using pre-determined criteria. The search yielded 144 studies. Only five studies met the inclusion criteria. All five reported improvements immediately and at follow-up in functional ability as a result of FES or FES combined with conventional therapy. There is some preliminary evidence that FES may reduce disability due to upper limb-related activity limitations in tetraplegic spinal cord injury. Further work needs to examine the role of FES in more detail and in combination with other treatments.