Challenges and Research Opportunities for Integrating Quantitative Electroencephalography Into Sports Concussion Rehabilitation.

Although concussion management and return to play/learn decision making focuses on reducing symptoms, there is growing interest in objective physiological approaches to treatment. Clinical and technological advancements have aided concussion management; however, the scientific study of the neurophysiology of concussion has not translated into its standard of care. This expert commentary is motivated by novel clinical applications of electroencephalographic-based neurofeedback approaches (eg, quantitative electroencephalography [QEEG]) for treating traumatic brain injury and emerging research interest in its translation for treating concussion.

Association between days for concussion recovery and initial specialty clinic evaluation within 48 hours.

Background: Researchers have highlighted the importance of early access to concussion care within one week of injury in reducing recovery times. However, a persisting question for concussion researchers is "just how early is important?" The purpose of this study was to examine differences in recovery time as predicted by the number of days elapsed since injury (DSI) to initial evaluation among patients who had access to a specialty concussion clinic within seven days. We hypothesized that DSI group membership, even within seven days, would significantly predict risk of protracted recovery (i.

Prospective evaluation of 24-hour movement behaviors among adolescents recovering from a sport-related concussion.

This study aimed to describe the 24-hour composition of movement behaviors, including sleep, sedentary behavior, and physical activity (PA), among pediatric sports-related concussion (SRC) patients over their recovery period, assess the association between movement compositions and recovery time, and understand feasibility of 24-hour accelerometry in the study population. A cohort of 50 pediatric SRC patients were asked to wear a wrist-worn accelerometer continuously for the duration of their recovery. Among all enrolled participants, the sample was primarily 14 or 15 years of age (65%), female (55%), and recovered in under 28 days (88%).

Comparison of Prescribed Physical Therapy to a Home Exercise Program for Pediatric Sports-Related Concussion Patients.

The purpose of this retrospective chart review was to compare sports-related concussion (SRC) recovery time in protracted recovery (≥28 days) patients who were prescribed physical therapy (PPT) with those who were only provided a home exercise program (HEP). We hypothesized PPT would be associated with shorter recovery times relative to HEP. Associations were evaluated with multivariable zero-truncated negative binomial regressions.

The acute, systemic effects of aerobic exercise in recently concussed adolescent student-athletes: preliminary findings.

Objectives: Examine the acute effects (pre-, during, post-intervention) of two different intensities of aerobic exercise or rest on autonomic, oculomotor, and vestibular function and symptom burden in patients with a recent sport-related concussion (SRC) and compare their responses to sex-matched, age-stratified, non-concussed (HEALTHY) student-athletes.

Methods: Student-athletes between the ages of 13 and 18 that presented to the sports medicine clinic within Day 3-7 post-SRC and from local schools were recruited for a randomized controlled trial (RCT). The participants were administered the Vestibular/Ocular Motor Screening (VOMS), King-Devick (K-D), and Post-Concussion Symptom Scale (PCSS) before and after the intervention.

Machine learning to predict sports-related concussion recovery using clinical data.

Objectives: Sport-related concussions (SRCs) are a concern for high school athletes. Understanding factors contributing to SRC recovery time may improve clinical management. However, the complexity of the many clinical measures of concussion data precludes many traditional methods.

Exploring Vestibular/Ocular and Cognitive Dysfunction as Prognostic Factors for Protracted Recovery in Sports-Related Concussion Patients Aged 8 to 12 Years.

Objective: To explore the prognostic ability of the vestibular/ocular motor screening (VOMS), King-Devick (K-D) Test, and C3 Logix Trails A and B to identify protracted recovery from sports-related concussion (SRC) in patients aged 8 to 12 years.

Design: Retrospective cohort analysis.

Setting: Specialty pediatric sports concussion clinic.

Evaluation of the vestibular and ocular motor screening (VOMS) as a prognostic tool for protracted recovery following paediatric sports-related concussion.

Objective: To understand the relationship between initial vestibular and ocular motor screening (VOMS) and recovery time, and the utility of VOMS to screen for protracted recovery in youth/adolescent patients with sport-related concussion (SRC).

Methods: Participants (8-18 years) who were diagnosed with an SRC within 7 days of the injury were administered the VOMS test by certified medical personnel. Recovery time (days) and protracted recovery (>30 days) were the primary outcomes.

Microhemorrhages in Professional Motocross Athletes: A Case Series.

Introduction: Motocross is a sport in which riders race 250-450 cc four-stroke dirt bikes and are potentially subjected to a high frequency of head injuries starting at a very young age. The objective of this case series is to present the findings following gradient echo T2-weighted MRI (SWI) upon clinical evaluation after a concussion in 4 young professional motocross racers.

Clinical Findings: Microhemorrhages were found in 2 of 4 riders.

Association Between Concussion History and Factors Relating to Cognitive, Behavioral, and Emotional Health Among American High School Athletes: A Cross-sectional Analysis.

Background: The cognitive, behavioral, and emotional deficits that may be associated with sports-related concussions among adolescents are unclear.

Purpose: To examine the association between reported concussion history and factors relating to cognitive, behavioral, and emotional health among a population-based sample of US high school-aged adolescents.

Study Design: Cross-sectional study; Level of evidence, 3.

Management and Treatment of Concussions via Tele-Concussion in a Pediatric Setting: Methodological Approach and Descriptive Analysis.

Background: Approximately 2 million children in the United States sustain a concussion annually, resulting in an economic impact as high as US $20 billion. Patients who receive treatment at concussion specialty clinics, versus primary care, experience faster recovery, thereby reducing patient burden and subsequent medical-related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits.

A Physiologically Based Approach to Prescribing Exercise Following a Sport-Related Concussion.

Clinical management of concussion has evolved over the last 20 years, and complete cognitive and physical rest remains a common clinical recommendation. The duration of rest may vary widely, from 24-48 h to several weeks or until the patient's symptoms have resolved or returned to near baseline levels. Following a period of rest, a stepwise progression of exercise is used for gradual return to play or to work.

Test Performance and Test-Retest Reliability of the Vestibular/Ocular Motor Screening and King-Devick Test in Adolescent Athletes During a Competitive Sport Season.

Background: The Vestibular/Ocular Motor Screening (VOMS) and King-Devick (K-D) test are tools designed to assess ocular or vestibular function after a sport-related concussion.

Purpose: To determine the test-retest reliability and rate of false-positive results of the VOMS and K-D test in a healthy athlete sample.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Synchronous volcanic eruptions and abrupt climate change ∼17.7 ka plausibly linked by stratospheric ozone depletion.

Glacial-state greenhouse gas concentrations and Southern Hemisphere climate conditions persisted until ∼17.7 ka, when a nearly synchronous acceleration in deglaciation was recorded in paleoclimate proxies in large parts of the Southern Hemisphere, with many changes ascribed to a sudden poleward shift in the Southern Hemisphere westerlies and subsequent climate impacts. We used high-resolution chemical measurements in the West Antarctic Ice Sheet Divide, Byrd, and other ice cores to document a unique, ∼192-y series of halogen-rich volcanic eruptions exactly at the start of accelerated deglaciation, with tephra identifying the nearby Mount Takahe volcano as the source.

Reliability of Head, Neck, and Trunk Anthropometric Measurements Used for Predicting Segment Tissue Masses in Living Humans.

Soft and rigid tissue mass prediction equations have been previously developed and validated for the segments of the upper and lower extremities in living humans using simple anthropometric measurements. The reliability of these measurements has been found to be good to excellent for all measurement types (segment lengths, circumferences, breadths, skinfolds). However, the reliability of the measurements needed to develop corresponding equations for the head, neck, and trunk has yet to be determined.

YcaO-Dependent Posttranslational Amide Activation: Biosynthesis, Structure, and Function.

With advances in sequencing technology, uncharacterized proteins and domains of unknown function (DUFs) are rapidly accumulating in sequence databases and offer an opportunity to discover new protein chemistry and reaction mechanisms. The focus of this review, the formerly enigmatic YcaO superfamily (DUF181), has been found to catalyze a unique phosphorylation of a ribosomal peptide backbone amide upon attack by different nucleophiles. Established nucleophiles are the side chains of Cys, Ser, and Thr which gives rise to azoline/azole biosynthesis in ribosomally synthesized and posttranslationally modified peptide (RiPP) natural products.

The effect of asymmetrical body orientation during simulated forward falls on the distal upper extremity impact response of healthy people.

The occurrence of distal upper extremity injuries resulting from forward falls (approximately 165,000 per year) has remained relatively constant for over 20years. Previous work has provided valuable insight into fall arrest strategies, but only symmetric falls in body postures that do not represent actual fall scenarios closely have been evaluated. This study quantified the effect of asymmetric loading and body postures on distal upper extremity response to simulated forward falls.

Leg soft tissue position and velocity data from skin markers can be obtained with good to acceptable reliability following heel impacts.

Quantifying soft tissue motion following impact is important in human motion analysis as soft tissues attenuate potentially injurious forces resulting from activities such as running and jumping. This study determined the reliability of leg soft tissue position and velocity following heel impacts. A grid of black dots was applied to the skin of the right leg and foot (n = 20).

Safety and feasibility for pediatric cardiac regeneration using epicardial delivery of autologous umbilical cord blood-derived mononuclear cells established in a porcine model system.

Congenital heart diseases (CHDs) requiring surgical palliation mandate new treatment strategies to optimize long-term outcomes. Despite the mounting evidence of cardiac regeneration, there are no long-term safety studies of autologous cell-based transplantation in the pediatric setting. We aimed to establish a porcine pipeline to evaluate the feasibility and long-term safety of autologous umbilical cord blood mononuclear cells (UCB-MNCs) transplanted into the right ventricle (RV) of juvenile porcine hearts.

Development and validation of a distal radius finite element model to simulate impact loading indicative of a forward fall.

The purpose of this work was to develop and validate a finite element model of the distal radius to simulate impact loading. Eight-node hexahedral meshes of the bone and impactor components were created. Three separate impact events were simulated by altering the impact velocity assigned to the model projectile (pre-fracture, crack and fracture).

Differences in distal lower extremity tissue masses and mass ratios exist in athletes of sports involving repetitive impacts.

This study aimed to examine the effects of sex and sport on the tissue composition of the distal lower extremity of varsity athletes, in sports that involve repetitive-impact loading patterns. Fat mass, lean mass, bone mineral content and wobbling mass were predicted for the leg and leg + foot segments of varsity basketball, cross-country, soccer and volleyball athletes. The absolute masses were normalised to body mass, and also expressed relative to each other as ratios.

Finite element modeling mesh quality, energy balance and validation methods: a review with recommendations associated with the modeling of bone tissue.

The use of finite element models as research tools in biomechanics and orthopedics has grown exponentially over the last 20 years. However, the attention to mesh quality, model validation and appropriate energy balance methods and the reporting of these metrics has not kept pace with the general use of finite element modeling. Therefore, the purpose of this review was to summarize the current state of finite element modeling validation practices from the literature in biomechanics and orthopedics and to present specific methods and criteria limits that can be used as guidelines to assess mesh quality, validate simulation results and address energy balance issues.

Kinematics, kinetics and muscle activation patterns of the upper extremity during simulated forward falls.

The purpose of this study was to explore the effects of fall type and fall height on the kinematics, kinetics, and muscle activation of the upper extremity during simulated forward falls using a novel fall simulation method. Twenty participants were released in a prone position from a Propelled Upper Limb Fall ARrest Impact System. Impacts occurred to the hands from two fall heights (0.

Multivariate injury risk criteria and injury probability scores for fractures to the distal radius.

The purpose of this study was to develop a multivariate distal radius injury risk prediction model that incorporates dynamic loading variables in multiple directions, and interpret the distal radius failure data in order to establish injury probability thresholds. Repeated impacts with increasing intensity were applied to the distal third of eight human cadaveric radius specimens (mean (SD) age=61.9 (9.