Background:Concussion management practices are important for athlete safety. Baseline
testing provides a benchmark to which post-injury assessments are compared.
Yet few neurophysical concussion assessment studies have examined learned
response. The Balance Error Scoring System (BESS) measures postural
stability through 6 conditions by counting the errors committed during each
condition. In a study examining the performance of high school–aged athletes
on the BESS, the learned response extinguished in 3 weeks. However, this
phenomenon has not been studied in the college-aged population.Hypothesis:College-aged adults performing the BESS will have a learned response at 1 and
2 weeks but would have no change from baseline at or after 3 weeks, as found
previously in high school–aged subjects.Study Design:Randomized controlled clinical trial.Methods:Three groups of college-aged adults ages 18 to 26 years were tested using the
BESS at scheduled intervals. Each subject was randomly assigned into 1 of 3
groups to determine learned response at weeks 1, 2, and 4. Changes in
pretest and posttest BESS scores were compared using the paired
t test for each group at week 4 and other intervals.
Differences among groups were compared using analysis of variance for means
or the chi-square test for proportions.Results:After 4 weeks, participants exhibited a mean (95% confidence interval) change
from pretest baseline of −2.30 (−4.75, 0.16) in the control group
(P = 0.065), −3.13 (−4.84, −1.41) in Group 1
(P = 0.001), and −2.57 (−5.28, 0.15) in Group 2
(P = 0.063). There were no statistically significant
differences between the 3 groups for week 4 BESS score (P =
0.291) or changes from baseline to week 4 BESS scores (P =
0.868). Overall, participant score changes from baseline to the 4-week
follow-up still showed a statistically significant or close to significant
reduction across the 3 groups, indicating the learned response did not
extinguish after 4 weeks.Conclusion:Repeated BESS testing results in a learned effect in college-aged adults did
not extinguish after 4 weeks. These results question the ability of the BESS
to assess an athlete’s balance deficits following a concussion.Clinical Relevance:Given learned response did not extinguish in this sample and the BESS has a
minimal detectable change/reliable change index of 7 or greater, the
effectiveness of the BESS to assess balance may be limited.
The purpose of this descriptive study was to determine whether bilateral differences exist in concentric and eccentric shoulder internal and external rotation strength in high school aged baseball pitchers. Thirty-nine high school aged baseball pitchers were bilaterally tested for concentric and eccentric internal and external rotation muscle performance on a Kin-Com 500-H isokinetic dynamometer at 90 degrees .s(-1) and 180 degrees .s(-1). Paired t-tests were used to test for differences among extremities, speed, and ratio of external rotation to internal rotation (ER/IR ratios). Concentric peak torque internal rotation at 90 degrees .s(-1) was significantly greater (p < 0.05) in the dominant arm compared with the nondominant arm. Statistically significant differences (p < 0.001) were found between the nondominant and dominant in concentric 90 degrees .s(-1). The nondominant arm demonstrated significantly greater eccentric strength (p < 0.05) compared with the dominant arm in ER/IR ratios at 90 degrees .s(-1) and 180 degrees .s(-1). The nondominant arm demonstrated significantly greater eccentric strength (p < 0.05) than the dominant arm in ER/IR ratio at 180 degrees .s(-1). Data demonstrated that muscular adaptations are consistent with previous research in this area. Also, muscular adaptations occur in the shoulder in the high school aged population. These data can serve as a guideline to be used by clinicians who rehabilitate shoulders in patients in this population.
Study Design Prospective cohort. Objectives To identify the prevalence of neurocognitive and balance deficits in collegiate football players 48 hours following competition. Background Neurocognitive testing, balance assessments, and subjective report of symptoms are a test battery commonly used to examine athletes suspected of having sustained a concussion. Previous literature suggests that many concussions go unreported. Little research exists examining the prevalence of neurocognitive or balance deficits in athletes who do not report concussion-like symptoms to a healthcare provider. Methods Forty-five Division IA collegiate football players participated in this study. Preseason baseline scores using the Balance Error Scoring System, the Immediate Post-Concussion Assessment and Cognitive Testing, and the Postconcussion Symptom Scale were compared to posttest results obtained 48 hours following a game. Prevalence of symptoms was analyzed and reported. Results Thirty-two (71%) of the 45 athletes tested demonstrated at least 1 deficit in either the Postconcussion Symptom Scale, Balance Error Scoring System, or at least 1 composite score of the Immediate Post-Concussion Assessment and Cognitive Testing. Nineteen of the 32 subjects demonstrated a change in 2 or more categories of neurocognitive and balance function. Conclusion In a cohort of football players tested 48 hours following their last game of the season, who did not seek medical attention related to a concussion, a significant number demonstrated limitations in neurocognitive and balance performance, suggesting that further research may need to be performed to improve recognition of an athlete's deficits and to improve the ability to assess concussion. Level of Evidence Differential diagnosis/symptom prevalence, level 3b. J Orthop Sports Phys Ther 2012;42(7):625–632, Epub 24 April 2012. doi:10.2519/jospt.2012.3798
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