Movement Assessment for Concussion Management
| Status: | Enrolling by invitation |
|---|---|
| Healthy: | No |
| Age Range: | 14 - 18 |
| Updated: | 3/9/2019 |
| Start Date: | June 2016 |
| End Date: | June 2019 |
Comprehensive Dynamic Movement Assessment for Concussion Management
Previous work in the area of concussion management has focused heavily on neuro-cognitive
testing. In addition to routine neuro-cognitive testing through Immediate Post-Concussion
Assessment and Cognitive Testing (ImPACT),this pilot study is designed to establish a
comprehensive battery of clinical assessment through the utilization of functional movement
and dynamic postural control assessments. The immediate application of these assessments will
be focused on the male high school football player (who is at risk for concussion) and both
female and male soccer players. Our pilot study aims determine the stability of ImPACT
testing in youth athletes in light of ongoing neurodevelopment in this population. In
addition, this pilot work will implement additional tools focused on assessment of dynamic
balance, reaction time, and agility. This approach will significantly enhance predictions of
subsequent musculoskeletal injuries that have been shown to occur in concussed collegiate and
professional athletes and that we believe are also occurring in our high school athletes.
This battery of tests will provide clinicians with invaluable information to guide both
rehabilitation of and return to play (RTP) decisions for concussed high school athletes. This
pilot study will further track those athletes who sustain a concussion and assess increased
risks for musculoskeletal injury.
testing. In addition to routine neuro-cognitive testing through Immediate Post-Concussion
Assessment and Cognitive Testing (ImPACT),this pilot study is designed to establish a
comprehensive battery of clinical assessment through the utilization of functional movement
and dynamic postural control assessments. The immediate application of these assessments will
be focused on the male high school football player (who is at risk for concussion) and both
female and male soccer players. Our pilot study aims determine the stability of ImPACT
testing in youth athletes in light of ongoing neurodevelopment in this population. In
addition, this pilot work will implement additional tools focused on assessment of dynamic
balance, reaction time, and agility. This approach will significantly enhance predictions of
subsequent musculoskeletal injuries that have been shown to occur in concussed collegiate and
professional athletes and that we believe are also occurring in our high school athletes.
This battery of tests will provide clinicians with invaluable information to guide both
rehabilitation of and return to play (RTP) decisions for concussed high school athletes. This
pilot study will further track those athletes who sustain a concussion and assess increased
risks for musculoskeletal injury.
Experiment 1. High school athletes will complete a battery of tests including the Star
Excursion Balance Test (SEBT), a divided attention gait task, the Psychomotor Vigilance Task
(PVT), and the Change of Direction (COD) Illinois agility test (IAGT). The SEBT is an
established, reliable outcome measure of dynamic postural stability through measurement of
lower extremity reach distance. Our study will also utilize a force plate during SEBT testing
to allow the investigators to sensitively measure center of mass in all planes. To test gait
balance control and adaptation of gait strategy which have been shown to be impaired in
concussed individuals acutely and chronically, athletes will walk at self-selected speed on
the GAITRite® portable gait analysis walkway for three undivided attention trials and three
divided attention trials during which a cognitive task, will be imposed.The GaitRite® will
calculate spatio-temporal parameters during gait and has been used in the concussion
literature. The PVT is a reliable and valid measurement of simple reaction time to an
auditory cue. The outcome measure will be the mean reaction time. The COD IAGT is a valid and
reliable protocol to assess agility in male team athletes. This test yields a completion time
in seconds. These tests were administered by licensed physical therapists, assisted by
students from both the Doctorate of Physical Therapy (DPT) and PhD physical therapy programs
at UCA, before the initiation of summer 2016 football practices for all athletes in the
program. The total testing time per athlete will not exceed 1.5 hours. The battery will be
administered again to all athletes in the football program after the season has ended and
prior to the end of the school year in the spring 2017. The 2017-2019 season will test both
football and soccer (male and female athletes) and will include functional testing for
athletes who have had a concussion through concussion clinic.
Experiment 2. Qualified athletic trainers or Physical Therapists, with oversight by Dr.
Israel, will administer the ImPACT using the same schedule as described in Experiment 1. The
ImPACT is a widely used neurocognitive testing component of the standard three-prong approach
to concussion management which also includes symptom inventories and static balance
assessment. The computerized test evaluates concentration, attention, memory, visual motor
speed, and reaction time. High sensitivity and specificity for concussion using the ImPACT
has been shown. The test also has been shown to be a valid and reliable measure in the high
school and collegiate populations. Composite scores for each of the non-injured athletes will
be stratified by age to examine changes across the three assessments. Hunt and Ferrara have
shown significant change in baseline assessments between 9th grade and 11th and 12th grade
age groups driven by 9th grade test scores indicating that biennial testing for young
adolescents may not be sufficient.The current recommendation for this younger age group is
annual testing, though recent studies call for the investigation of even more frequent
testing, thus our plan to test at six months. ImPACT testing will not exceed 1 hour. The
2017-2018 season will test both football and soccer (male and female athletes) for ImPACT
testing.
Excursion Balance Test (SEBT), a divided attention gait task, the Psychomotor Vigilance Task
(PVT), and the Change of Direction (COD) Illinois agility test (IAGT). The SEBT is an
established, reliable outcome measure of dynamic postural stability through measurement of
lower extremity reach distance. Our study will also utilize a force plate during SEBT testing
to allow the investigators to sensitively measure center of mass in all planes. To test gait
balance control and adaptation of gait strategy which have been shown to be impaired in
concussed individuals acutely and chronically, athletes will walk at self-selected speed on
the GAITRite® portable gait analysis walkway for three undivided attention trials and three
divided attention trials during which a cognitive task, will be imposed.The GaitRite® will
calculate spatio-temporal parameters during gait and has been used in the concussion
literature. The PVT is a reliable and valid measurement of simple reaction time to an
auditory cue. The outcome measure will be the mean reaction time. The COD IAGT is a valid and
reliable protocol to assess agility in male team athletes. This test yields a completion time
in seconds. These tests were administered by licensed physical therapists, assisted by
students from both the Doctorate of Physical Therapy (DPT) and PhD physical therapy programs
at UCA, before the initiation of summer 2016 football practices for all athletes in the
program. The total testing time per athlete will not exceed 1.5 hours. The battery will be
administered again to all athletes in the football program after the season has ended and
prior to the end of the school year in the spring 2017. The 2017-2019 season will test both
football and soccer (male and female athletes) and will include functional testing for
athletes who have had a concussion through concussion clinic.
Experiment 2. Qualified athletic trainers or Physical Therapists, with oversight by Dr.
Israel, will administer the ImPACT using the same schedule as described in Experiment 1. The
ImPACT is a widely used neurocognitive testing component of the standard three-prong approach
to concussion management which also includes symptom inventories and static balance
assessment. The computerized test evaluates concentration, attention, memory, visual motor
speed, and reaction time. High sensitivity and specificity for concussion using the ImPACT
has been shown. The test also has been shown to be a valid and reliable measure in the high
school and collegiate populations. Composite scores for each of the non-injured athletes will
be stratified by age to examine changes across the three assessments. Hunt and Ferrara have
shown significant change in baseline assessments between 9th grade and 11th and 12th grade
age groups driven by 9th grade test scores indicating that biennial testing for young
adolescents may not be sufficient.The current recommendation for this younger age group is
annual testing, though recent studies call for the investigation of even more frequent
testing, thus our plan to test at six months. ImPACT testing will not exceed 1 hour. The
2017-2018 season will test both football and soccer (male and female athletes) for ImPACT
testing.
Inclusion Criteria:
- Male football players (2016 and 2017 season)
- Male and female soccer players (2017-2018 and 2018-2019 season) OR Athletes who have
been diagnosed with a sports related concussion during the season of their assigned
sport and is being seen through concussion clinic at Arkansas children's hospital
- Age 14-18
- Written informed consent from the parent
Exclusion Criteria:
- Athletes who have not completed pre-participation physicals
- Any condition that the investigator determines would put the subject at risk if
participating in the study.
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