Retrospective Chart Analysis of Concussion Discharge Instructions in the Emergency Department

Background

Recognition and diagnosis of concussion is increasing, but current research shows these patients are discharged from the emergency department (ED) with a wide variability of recommendations and instructions.

The Effect Of Mild Exercise Induced Dehydration On Sport Concussion Assessment Tool 3 (SCAT3) Scores: A within-subjects design.

BackgroundSports-related concussions are prevalent in the United States. Various diagnostic tools are utilized in order to monitor deviations from baseline in memory, reaction time, symptoms, and balance. Evidence indicates that dehydration may also alter the results of diagnostic tests.PurposeThe purpose was to determine the effect of exercise-induced dehydration on performance related to concussion examination tools.Study DesignRepeated measures design.MethodsSeventeen recreationally competitive, non-concussed participants (age: 23.1±3.1 years, height:168.93±10.71 cm, mass: 66.16 ± 6.91 kg) performed three thermoneutral, counterbalanced sessions (rested control, euhydrated, dehydrated). Participants were either restricted (0.0 L/hr) or provided fluids (1.0 L/hr) while treadmill running for 60 min at an intensity equal to 65-70% age-predicted maximum heart rate (APMHR). The Sport Concussion Assessment Tool 3 (SCAT3) was utilized to assess symptoms, memory, balance, and coordination.ResultsStatistically significant differences were seen among sessions for symptom severity and symptom total. The rested control session had significantly lower values when compared to the dehydrated session. Additionally, the symptom total in the rested control was significantly lower than the euhydrated condition as well. No statistically significant differences were seen for the BESS or memory scores.ConclusionsMild exercise-induced dehydration results in increased self-reported symptoms associated with concussions. Clinicians tasked with monitoring and accurately diagnosing head trauma should take factors such as hydration status into account when assessing patients for concussion with the SCAT3. Clinicians should proceed with caution and not assume concussion as primary cause for symptom change.Level of evidenceLevel 3     

The Test Re-Test Reliability of A Novel Single Leg Hop Test (T-Drill Hop Test)

BackgroundFunctional training and testing are an important part of a comprehensive rehabilitation program stressing the neuromuscular system in ways that simulate athletic performance to help determine criteria for return to sport. There are numerous single leg hop tests that have been used for these purposes, however, the validity and clinical relevance has been questioned. Many of the functional performance tests assess only the sagittal plane or forward direction and may only partially assess a person’s athletic abilities. There is a need for reliable and valid functional tests to assess in a multi-directional manner.Purpose/HypothesisThe purpose of this study is to determine the test re-test reliability of a novel multi-directional timed single leg hop test (T-Drill Hop Test) for use in rehabilitation and performance assessments.Study DesignCross-sectional reliability study.MethodsFifty healthy recreationally active college age subjects, (23 males and 27 females) between the ages of 18 and 35, (mean age 23.48 with SD 3.82) consented to perform the test. The subjects hopped along a 10ft. x 10ft. “T” shaped course. Subjects performed two timed maximum effort trials of the T-Drill Hop Test on each leg with an interval of 3-7 days between the two testing days. Intraclass Correlation Coefficients (ICC) were calculated to determine intersession reliability.ResultsThe inter-rater reliability (ICC’s) for the entire group of 50 subjects ranged between .98 and 1.00 suggesting excellent reliability. The bilateral comparison, utilizing paired t-tests, of the T-Drill Hop Test demonstrated no significant differences between the time scores for the dominant and non-dominant legs for either males or females (p>.05).ConclusionThis study demonstrates the T-Drill Hop Test has excellent test re-test reliability. These results are important prior to validation and utilization as a clinical functional performance test.Levels of EvidenceLevel 2     

Tetrax平衡测试系统用于老年人平衡功能测试的重测信度

目的检验Tetrax测试系统在老年人平衡功能测试中的重测信度。方法对22名符合入选条件的老年人(66～84岁),应用Tetrax测试系统测定受试者睁眼自然站立状态下的稳定性指数、姿势摆动频谱和体重分布状态。1周后同一时间由同一测试者重复测试1次。采用组内相关系数(ICC)分析两次测试的重测信度。结果平衡功能测试的各个指标ICCs=0.797～0.882(P<0.01)。结论 Tetrax平衡测试系统用于老年人平衡功能评估时具有较高的重测信度。     

Establishing Normative Values for Inter-Limb Kinetic Symmetry During Landing in Uninjured Adolescent Athletes

BackgroundAssessment of inter-limb kinetic symmetry during landing could provide valuable insights when working with athletes who have undergone anterior cruciate ligament reconstruction. However, it is difficult to determine if the asymmetry exhibited by an injured athlete is excessive or within a range that is similar to uninjured athletes, until normative values are established.PurposeThe purpose of this study was to establish normative values for inter-limb impact force symmetry in uninjured adolescent athletes. In addition, an example is provided of how these normative values could be used to identify athletes who exhibit atypically high levels of asymmetry following anterior cruciate ligament reconstruction.Study DesignCross-sectional studyMethodsOne hundred and thirty-six uninjured athletes completed drop vertical jumps and countermovement jumps while force plates recorded ground reaction forces. Symmetry indices captured inter-limb symmetry in impact forces during landing for both tasks. These symmetry indices were also combined to create an index that captured symmetry across both tasks. Normative values were established using the uninjured athletes’ data. Eleven athletes who had undergone anterior cruciate ligament reconstruction and been cleared to return to landing and jumping performed the same tasks and their data were compared to the results for the uninjured group.ResultsMeasures of central tendency, variability, percentiles, and outliers were calculated/identified based on the uninjured athletes’ symmetry indices. Six of the 11 injured athletes exhibited atypically high symmetry index values.ConclusionThe normative values established as part of this study may serve as a basis for identifying athletes who exhibit atypically high levels of inter-limb impact force asymmetry during jumping tasks following anterior cruciate ligament reconstruction.Level of Evidence3b     

An inter-rater reliability study of the Functional Assessment Measure (FIM + FAM)

There is an increasing demand for measures of outcome to evaluate the effects of rehabilitation interventions for brain injury from clinicians, research workers and healthcare providers and purchasers. The Functional Assessment Measure (FIM + FAM), an expanded derivative of the Functional Independence Measure (FIM), is designed specifically for this purpose for this patient group. This study examined the inter-rater reliability of the FIM + FAM between two independent raters, a physician and a nurse, the subjects being 30 in-patients in a neurological rehabilitation unit. The results show that the inter-rater reliability was good (kappa values 0·50 to 0·95) for all but one of the 30 items rated on the FIM + FAM. The exception (with a kappa value of 0·35) was ‘adjustment to limits’. Higher agreement was found for rating of physical activities than for cognitive, communication and behavioural items.     

The Non-injured Leg Can Be Used as a Reference for the Injured Leg in Single-legged Hop Tests

BackgroundSingle-legged hop tests are frequently used in substantiating return to sport decisions following lower extremity injury. Evidence for using the non-injured leg as a reference for the injured leg in the return to sport decision-making at the criterion-based point of return to sport following lower extremity injury is lacking.PurposeTo compare absolute values in single-legged hop tests between the non-injured leg of athletes returning to high-impact sports after lower extremity injury and the matched leg of healthy athletes.Study DesignCross-sectional study.MethodsOne hundred and sixty-nine athletes returning to high-impact sports after lower extremity injury and 169 matched healthy athletes executed five single-legged hop tests. Differences between athletes returning to high-impact sports after lower extremity injury and matched healthy athletes on five single-legged hop tests were analyzed using paired t-tests.ResultsThere were no statistically significant differences between the non-injured leg of athletes returning to sport and the matched leg of healthy athletes. Effect sizes ranged from 0.05 to 0.14 indicating negligible effects.ConclusionClinicians can use the non-injured leg as a reference for the injured leg in single-legged hop tests for deciding on return to high-impact sports after lower extremity injuries.Level of Evidence3b     

脊髓震荡的诊治(附11例报告)

目的 探讨脊柱外伤后脊髓震荡(SCC)的诊治方法。方法 报告脊髓震荡11例，对其致伤原因、受力部位、临床表现及治疗恢复经过进行回顾性分析。结果 11例经治疗后全部恢复正常。结论 脊髓震荡是闭合性脊髓损伤后造成最轻的原发性脊髓损伤，具有短暂性的脊髓功能障碍。正确诊治对于伤情的解释及预后的判断以及外伤的处理具有重要意义。     

平衡训练在脑血管病康复中的机制及问题

平衡功能是脑卒中患者需要康复的几项受损功能之一，也是评测运动功能恢复的重要指标，一直受到康复界的重视，在某些方面，平衡功能的恢复与步态一样不可替代。作者通过神经补偿机制探讨目前的平衡训练方法提高脑卒中慢性期患者平衡功能的可能机制和存在的问题。     

Assessment of Sleep Quantity and Sleep Disturbances During Recovery From Sports-Related Concussion in Youth Athletes

Objective

To determine the relation between sleep quantity and sleep disturbances on symptoms and neurocognitive ability during the acute phase (<7d) and after sports-related concussion (SRC; >21d).

Feasibility and Reliability of a Novel Game-Based Test of Neurological Function in Youth: The Equilibrium Test Battery

BackgroundAn estimated 11% of Canadian adolescents will sustain a sport-related concussion each year. However, diagnostic tools to detect and monitor concussive outcomes are limited.PurposeTo evaluate the feasibility and test-retest reliability of the Highmark Interactive Equilibrium (HIEQ) test battery in uninjured adolescents.Study DesignObservational study with repeated measurements.MethodsParticipants completed the HIEQ test battery, a game-based platform on an iPad application, that assesses balance, cognitive function, and visual function, for up to 15 consecutive school days in a group classroom setting. Feasibility for use of the HIEQ was evaluated by (1) recruitment rates; (2) retention rates; (3) test completion without assistance; and (4) adverse events. Test-retest reliability was examined using Bland Altman 95% limits of agreement and intraclass correlation coefficients comparing the first and second and second and third obtained scores. Reliability across multiple baseline assessments was also analyzed using intraclass correlations for the second to sixth and seventh to eleventh obtained scores.ResultsFifty-five uninjured high school students (31 females and 24 males, mean age = 16.24 [1.09]) from three high schools participated in the study. Three participants (5%) completed all 15 days of testing, and 73% completed at least 10 of 15 test days. No adverse events were reported. Although the test was feasible, all subtests showed wide limits of agreement from first to second and from second to third testing occasions. Results indicate poor-to-moderate reliability (<0.50 to 0.75) across those intervals, as well as across the second to sixth and seventh to eleventh testing occasions.ConclusionThe HIEQ is feasible in high school students; however, performance was characterized by wide limits of agreement and poor-to-moderate reliability across test occasions. Future evaluation of the HIEQ in visual and auditory distraction free individual testing settings is warranted.Level of EvidenceLevel 3.     

Reaction Time and Joint Kinematics During Functional Movement in Recently Concussed Individuals

Objective

To compare movement reaction time and joint kinematics between athletes with recent concussion and matched control recreational athletes during 3 functional tasks.

脑卒中后遗症患者的日常生活活动指导

我们需要仔细思考日常生活活动和国际功能、残疾与健康分类之间的关系.日常生活活动训练是任务导向性训练内容之一,患者在维持抗重力姿势的同时主动进行选择性运动,并与治疗师一起选取有效的系统处理感觉信息输入,选择最有效的姿势及运动控制方式.本文介绍2个病例.病例1除不能独立洗浴外已达到独立生活,并已学习自我控制.病例2还不能达到生活自理的程度,其治疗目标为减少日常生活活动中的外界辅助量,并使患者能在其他家庭成员和治疗人员的辅助下正常的进行感觉-运动学习.小组治疗和24小时管理非常重要.     

The Role of Fatigue in Return to Sport Testing Following Anterior Cruciate Ligament Reconstruction

BackgroundFatigue may play a role in anterior cruciate ligament (ACL) injury, but has not been incorporated into objective test batteries for return to sport decisions following ACL reconstruction (ACLR) surgery. The effect of fatigue on muscle function and performance following surgery and rehabilitation has been poorly studied.Purpose/HypothesisThe purpose of this study was to assess the effect of fatigue on performance of various hop tests used in clinical rehabilitation settings by examining LSI scores. The authors hypothesized that participants will have worse limb symmetry index scores following the fatigue protocol and that the operative limb (ACLR) will have a greater decline in function than the non-operative limb (CON).Study DesignCross-Sectional Study.MethodsParticipants (n=21 [Male = 15, Female = 6]; AGE = 24.6 ± 9.3) were at least six months post ACLR and in rehabilitation. Testing was performed over two separate sessions in either a non-fatigued (NFS) or fatigued state (FS). In the FS, individuals performed a series of exercises to exhaust muscular endurance, strength, and power systems, after which they performed as battery of seven hop tests (single hop for distance, triple hop for distance, crossover hop for distance, 6-meter timed hop, lateral rotation hop for distance, medial rotation hop for distance, and vertical jump for height). A 2(limb) x 2(time) ANOVA was used to compare limbs between each state.ResultsDifferences between limbs (CON vs ACLR) were observed for all hop tests in the NFS whereby the ACLR limb was observed to have reduced performance (↓5.4-9.1%, p <0.05). When tested in the FS, significant differences in performance between limbs remained for only the crossover (↓4.9%), medial rotation (↓7.1%), lateral rotation (↓5.5%), and vertical hop (↓10.0%)(p<0.05). When comparing the NFS and FS states, only the CON limb was observed to have significant decreases in performance of the Triple Hop (↓7.4%), Crossover (↓8.7%), and Lateral Rotation (↓5.2%)(p<0.05).ConclusionsFollowing ACL reconstruction, there appears to be a greater loss in jump performance in the CON limb in the FS. These findings suggest it may be crucial to consider and assess the endurance of both limbs rather than just the ACLR limb when determining readiness for return to play.Level of EvidenceLevel 3