Healthy Athlete
Conditions
Keywords
Concussion, Football player, Movement assessment, Soccer player
Brief summary
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 and gait. 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.
Detailed description
Experiment 1. High school athletes will complete a battery of tests including the Y-balance test, a version of the Star Excursion Balance Test (SEBT), a divided attention gait task, the Psychomotor Vigilance Task (PVT). 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. 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.
Interventions
Assessment measuring reaction time based on auditory cues.
Computerized assessment that provides information related to visual reaction time and visual memory.
Walking alone and then walking while performing a memory task on a tablet.
Dynamic balance test measuring reaching of the leg to the anterior,postero- lateral, and postero-medial directions.
Sponsors
Study design
Eligibility
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | preseason, postseason, end of the school year, pre-season year 2 | Verbal memory (total % correct from design memory, total correct from memory score from X's and O's) and visual memory (total number correct/4 during module 3) Scores on verbal memory and visual memory range from 70-99 (high scores are better than low scores). Visual motor speed is comprised correct responses/4 for specific modules and the average counted correctly x3 for a specific module. Scores range from 27-39.8 (high scores are better than low scores) |
| Spatiotemporal Gait Parameters- Gait Velocity | Cross-sectional baseline | For the purposes of this study, parameters that were captured by the GAITRite® include: gait velocity (cm/s); Subjects walk on pathway during single task and dual task is walking while performing a visual memory task on a tablet |
| Gait Parameters: Step Length (Cm) | cross-sectional baseline | For the purposes of this study, parameters that were captured by the GAITRite® include:step length (cm); |
| Gait Parameters- Percent of DLS | cross-sectional baseline | DLS, defined as the percent of the gait cycle (%GC) when both feet are on the ground measured in healthy males and female athletes and concussed males and female athletes |
| Gait Parameters- % of Gait Cycle in SLS | cross-sectional baseline | For the purposes of this study, parameters that were captured by the GAITRite® include: SLS, defined as the %GC weight bearing through a single limb. |
| Y Balance Assessment- Anterior Reach Direction | Cross sectional baseline | subset from healthy athlete group and concussed group Measured on YBT in anterior direction |
| Y Balance Assessment- Posterolateral Reach Direction | Cross sectional baseline | subset from healthy athlete group and concussed group Measured on YBT in postero-lateral direction. |
| Y Balance Assessment- Postero-medial Reach Direction | Cross sectional baseline | subset from healthy athlete group and concussed group Measured on YBT in postero-medial direction. |
| Psychomotor Vigilance Task (PVT) | cross-sectional baseline | 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. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Healthy Athletes Healthy Adolescent school athletes 14-18 years old were recruited from central Arkansas schools to complete assessments of gait, balance and computerized cognitive testing through the ImPACT(Immediate post concussion assessment and cognitive testing) baseline assessment. | 281 |
| Concussed Athletes Adolescent males and females (14-19 years of age) with concussion who visited the concussion clinic at a regional Children's Hospital. | 46 |
| Total | 327 |
Baseline characteristics
| Characteristic | Healthy Athletes | Concussed Athletes | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 281 Participants | 46 Participants | 327 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized African American | 108 participants | 1 participants | 109 participants |
| Race/Ethnicity, Customized Caucasian | 132 participants | 44 participants | 176 participants |
| Race/Ethnicity, Customized Not Selected | 41 participants | 0 participants | 41 participants |
| Race/Ethnicity, Customized Two or More Races | 0 participants | 1 participants | 1 participants |
| Sex: Female, Male Female | 116 Participants | 17 Participants | 133 Participants |
| Sex: Female, Male Male | 165 Participants | 29 Participants | 194 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 281 | 0 / 46 |
| other Total, other adverse events | 0 / 281 | 0 / 46 |
| serious Total, serious adverse events | 0 / 281 | 0 / 46 |
Outcome results
Gait Parameters- % of Gait Cycle in SLS
For the purposes of this study, parameters that were captured by the GAITRite® include: SLS, defined as the %GC weight bearing through a single limb.
Time frame: cross-sectional baseline
Population: Data are not mutually exclusive. Reported for single task and dual task and divided into male and female groups as well as healthy and concussed athletes.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Athlete IMPACT Score | Gait Parameters- % of Gait Cycle in SLS | Single task % GC in SLS Male | 35.290 percentage of gait cycle spent on 1 limb | Standard Deviation 1.504 |
| Healthy Athlete IMPACT Score | Gait Parameters- % of Gait Cycle in SLS | Single task % GC in SLS Female | 36.522 percentage of gait cycle spent on 1 limb | Standard Deviation 1.352 |
| Healthy Athlete IMPACT Score | Gait Parameters- % of Gait Cycle in SLS | Dual task % GC in SLS Male | 34.05 percentage of gait cycle spent on 1 limb | Standard Deviation 1.901 |
| Healthy Athlete IMPACT Score | Gait Parameters- % of Gait Cycle in SLS | Dual task % GC in SLS Females | 35.112 percentage of gait cycle spent on 1 limb | Standard Deviation 1.549 |
| Healthy Athlete IMPACT Score | Gait Parameters- % of Gait Cycle in SLS | Single Task % GC Female Concussed | 35.85 percentage of gait cycle spent on 1 limb | Standard Deviation 1.796 |
| Healthy Athlete IMPACT Score | Gait Parameters- % of Gait Cycle in SLS | Dual Task % GC Female Concussed | 34.407 percentage of gait cycle spent on 1 limb | Standard Deviation 1.974 |
| Healthy Athlete IMPACT Score | Gait Parameters- % of Gait Cycle in SLS | Single task % of GC in SLS male concussed | 34.62 percentage of gait cycle spent on 1 limb | Standard Deviation 1.03 |
| Healthy Athlete IMPACT Score | Gait Parameters- % of Gait Cycle in SLS | Dual Task % GC in SLS Male Concussed | 33.58 percentage of gait cycle spent on 1 limb | Standard Deviation 1.26 |
Gait Parameters- Percent of DLS
DLS, defined as the percent of the gait cycle (%GC) when both feet are on the ground measured in healthy males and female athletes and concussed males and female athletes
Time frame: cross-sectional baseline
Population: Data are not mutually exclusive. Reported for single task and dual task and divided into male and female groups and healthy and concussed athletes.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Athlete IMPACT Score | Gait Parameters- Percent of DLS | Single task % GC in DLS Male | 29.077 percentage of GC spent on 2 limbs | Standard Deviation 2.631 |
| Healthy Athlete IMPACT Score | Gait Parameters- Percent of DLS | Single task % GC in DLS Female | 26.922 percentage of GC spent on 2 limbs | Standard Deviation 2.648 |
| Healthy Athlete IMPACT Score | Gait Parameters- Percent of DLS | Dual task % GC in DLS Male | 31.92 percentage of GC spent on 2 limbs | Standard Deviation 3.461 |
| Healthy Athlete IMPACT Score | Gait Parameters- Percent of DLS | Dual task % GC in DLS Females | 29.542 percentage of GC spent on 2 limbs | Standard Deviation 3.085 |
| Healthy Athlete IMPACT Score | Gait Parameters- Percent of DLS | Single Task % GC in DLS Female Concussed | 28.09 percentage of GC spent on 2 limbs | Standard Deviation 3.66 |
| Healthy Athlete IMPACT Score | Gait Parameters- Percent of DLS | Dual Task % of GC in DLS Female | 30.45 percentage of GC spent on 2 limbs | Standard Deviation 5.29 |
| Healthy Athlete IMPACT Score | Gait Parameters- Percent of DLS | Single task % of GC in DLS male concussed | 30.33 percentage of GC spent on 2 limbs | Standard Deviation 2.13 |
| Healthy Athlete IMPACT Score | Gait Parameters- Percent of DLS | Dual Task % GC in DLS Male Concussed | 32.32 percentage of GC spent on 2 limbs | Standard Deviation 2.66 |
Gait Parameters: Step Length (Cm)
For the purposes of this study, parameters that were captured by the GAITRite® include:step length (cm);
Time frame: cross-sectional baseline
Population: Data are not mutually exclusive. Reported for single task and dual task and divided into male and female groups and healthy and concussed athletes
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Athlete IMPACT Score | Gait Parameters: Step Length (Cm) | Single task step length males | 68.031 cm | Standard Deviation 6.779 |
| Healthy Athlete IMPACT Score | Gait Parameters: Step Length (Cm) | Single task step length female | 65.483 cm | Standard Deviation 6.021 |
| Healthy Athlete IMPACT Score | Gait Parameters: Step Length (Cm) | Dual Task Step Length Male | 60.073 cm | Standard Deviation 7.858 |
| Healthy Athlete IMPACT Score | Gait Parameters: Step Length (Cm) | Dual Task Step Length Female | 58.650 cm | Standard Deviation 5.885 |
| Healthy Athlete IMPACT Score | Gait Parameters: Step Length (Cm) | Single Task Step Length Female concussed | 61.26 cm | Standard Deviation 7.94 |
| Healthy Athlete IMPACT Score | Gait Parameters: Step Length (Cm) | Dual Task Gait step length Female Concussed | 57.22 cm | Standard Deviation 12.79 |
| Healthy Athlete IMPACT Score | Gait Parameters: Step Length (Cm) | Single Task Step length Male Concussed | 65.63 cm | Standard Deviation 5.11 |
| Healthy Athlete IMPACT Score | Gait Parameters: Step Length (Cm) | Dual Task Step length Male Concussed | 57.71 cm | Standard Deviation 6.37 |
Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete
Verbal memory (total % correct from design memory, total correct from memory score from X's and O's) and visual memory (total number correct/4 during module 3) Scores on verbal memory and visual memory range from 70-99 (high scores are better than low scores). Visual motor speed is comprised correct responses/4 for specific modules and the average counted correctly x3 for a specific module. Scores range from 27-39.8 (high scores are better than low scores)
Time frame: preseason, postseason, end of the school year, pre-season year 2
Population: subset from healthy athlete group
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | pre season verbal memory | 86.33 score on Immediate post concussion scale | Standard Error 1.47 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | post season year verbal memory | 84.0 score on Immediate post concussion scale | Standard Error 2.379 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | end of school verbal memory | 90.73 score on Immediate post concussion scale | Standard Error 2.095 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | pre-season year 2 verbal memory | 89.1436 score on Immediate post concussion scale | Standard Error 2.707 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | pre-season visual memory | 69.8361 score on Immediate post concussion scale | Standard Error 3.54 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | post season visual memory | 81.2 score on Immediate post concussion scale | Standard Error 2.5824 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | end of the school year visual memory | 81.4659 score on Immediate post concussion scale | Standard Error 2.98 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | pre-season year 2 visual memory | 82.2006 score on Immediate post concussion scale | Standard Error 2.26 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | preseason visual motor composite | 36.371 score on Immediate post concussion scale | Standard Error 2.007 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | post season visual motor | 36.727 score on Immediate post concussion scale | Standard Error 2.05 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | end of school visual motor | 38.897 score on Immediate post concussion scale | Standard Error 2.215 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | pre-season year 2 visual motor | 39.3035 score on Immediate post concussion scale | Standard Error 1.665 |
Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete
Reaction time Composite is the average correct reaction time of 3 skills Scores range from 0.5 to 0.7 Lower scores are better.
Time frame: preseason, postseason and end of the school year and preseason the following year
Population: subset from healthy athlete group Measured on Reaction time composite score (Immediate Post Concussion Assessment)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | Preseason | 0.5797 seconds | Standard Error 0.016 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | Post Season | 0.5780 seconds | Standard Error 0.01615 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | End of the school year | 0.5902 seconds | Standard Error 0.0166 |
| Healthy Athlete IMPACT Score | Impact ( Immediate Post-concussion Assessment and Cognitive Testing) Healthy Athlete | Pre-season year 2 | 0.6089 seconds | Standard Error 0.01792 |
Psychomotor Vigilance Task (PVT)
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.
Time frame: cross-sectional baseline
Population: Subset of healthy athletes. The Concussed athlete data for the PVT (as was the ImPACT concussed data) was used clinically to assess individual auditory reaction time and for clinical decision making by the medical team. The concussed PVT data will not be used as aggregate data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Healthy Athlete IMPACT Score | Psychomotor Vigilance Task (PVT) | 218.57 ms | Standard Deviation 62.78 |
Spatiotemporal Gait Parameters- Gait Velocity
For the purposes of this study, parameters that were captured by the GAITRite® include: gait velocity (cm/s); Subjects walk on pathway during single task and dual task is walking while performing a visual memory task on a tablet
Time frame: Cross-sectional baseline
Population: Data are not mutually exclusive. Reported for single task and dual task and divided into male and female groups.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Athlete IMPACT Score | Spatiotemporal Gait Parameters- Gait Velocity | Single Task Gait Velocity Male | 1.236 cm/sec | Standard Deviation 0.163 |
| Healthy Athlete IMPACT Score | Spatiotemporal Gait Parameters- Gait Velocity | Single Task Gait Velocity Female | 1.449 cm/sec | Standard Deviation 0.199 |
| Healthy Athlete IMPACT Score | Spatiotemporal Gait Parameters- Gait Velocity | Dual Task Gait Velocity Male | 1.030 cm/sec | Standard Deviation 0.185 |
| Healthy Athlete IMPACT Score | Spatiotemporal Gait Parameters- Gait Velocity | Dual Task Gait Velocity Female | 1.232 cm/sec | Standard Deviation 0.196 |
| Healthy Athlete IMPACT Score | Spatiotemporal Gait Parameters- Gait Velocity | Single Task Gait Velocity Female Concussed | 1.207 cm/sec | Standard Deviation 0.238 |
| Healthy Athlete IMPACT Score | Spatiotemporal Gait Parameters- Gait Velocity | Dual Task Gait Velocity Female Concussed | 0.974 cm/sec | Standard Deviation 0.18 |
| Healthy Athlete IMPACT Score | Spatiotemporal Gait Parameters- Gait Velocity | Single Task Gait Velocity Male Concussed | 1.125 cm/sec | Standard Deviation 0.14 |
| Healthy Athlete IMPACT Score | Spatiotemporal Gait Parameters- Gait Velocity | Dual Task Gait Velocity Male Concussed | 0.922 cm/sec | Standard Deviation 0.18 |
Y Balance Assessment- Anterior Reach Direction
subset from healthy athlete group and concussed group Measured on YBT in anterior direction
Time frame: Cross sectional baseline
Population: Data are not mutually exclusive. Reported for Y balance test divided into male and female groups. Data for concussed subjects is reported in the acute phase and divided into male and female groups.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Athlete IMPACT Score | Y Balance Assessment- Anterior Reach Direction | Male healthy athletes | 95.34 Index | Standard Deviation 10.814 |
| Healthy Athlete IMPACT Score | Y Balance Assessment- Anterior Reach Direction | Female healthy athletes | 94.45 Index | Standard Deviation 14.52 |
| Healthy Athlete IMPACT Score | Y Balance Assessment- Anterior Reach Direction | male acute concussed | 95.13 Index | Standard Deviation 9.8 |
| Healthy Athlete IMPACT Score | Y Balance Assessment- Anterior Reach Direction | female acute concussed | 95.14 Index | Standard Deviation 12.48 |
Y Balance Assessment- Posterolateral Reach Direction
subset from healthy athlete group and concussed group Measured on YBT in postero-lateral direction.
Time frame: Cross sectional baseline
Population: Data are not mutually exclusive. Reported for Y balance test divided into male and female groups and healthy and concussed athletes. Data for concussed subjects is reported in the acute phase and divided into male and female groups.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Athlete IMPACT Score | Y Balance Assessment- Posterolateral Reach Direction | Male healthy athletes | 78.08 Index | Standard Deviation 10.697 |
| Healthy Athlete IMPACT Score | Y Balance Assessment- Posterolateral Reach Direction | Female healthy athletes | 70.138 Index | Standard Deviation 10.12 |
| Healthy Athlete IMPACT Score | Y Balance Assessment- Posterolateral Reach Direction | Male acute concussed | 74.21 Index | Standard Deviation 10.44 |
| Healthy Athlete IMPACT Score | Y Balance Assessment- Posterolateral Reach Direction | female acute concussed | 83.89 Index | Standard Deviation 14.14 |
Y Balance Assessment- Postero-medial Reach Direction
subset from healthy athlete group and concussed group Measured on YBT in postero-medial direction.
Time frame: Cross sectional baseline
Population: Data are not mutually exclusive. Reported for Y balance test divided into male and female groups and healthy and concussed athletes. Data for concussed subjects is reported in the acute phase and divided into male and female groups.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Athlete IMPACT Score | Y Balance Assessment- Postero-medial Reach Direction | Male healthy athletes | 69.750 Index | Standard Deviation 12.59 |
| Healthy Athlete IMPACT Score | Y Balance Assessment- Postero-medial Reach Direction | Female healthy athletes | 65.860 Index | Standard Deviation 8.768 |
| Healthy Athlete IMPACT Score | Y Balance Assessment- Postero-medial Reach Direction | male acute concussed | 68.80 Index | Standard Deviation 11.13 |
| Healthy Athlete IMPACT Score | Y Balance Assessment- Postero-medial Reach Direction | female acute concussed | 69.17 Index | Standard Deviation 12.66 |