VCOM Research Appreciation Day 2012 Stephanie Aldret, DO Sports - - PowerPoint PPT Presentation

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VCOM Research Appreciation Day 2012 Stephanie Aldret, DO Sports Medicine Fellow VCOM/Virginia Tech The speaker for this CME program has affirmed to have no relevant financial relationship with any of the products, manufacturers or provider of

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VCOM Research Appreciation Day 2012

Stephanie Aldret, DO Sports Medicine Fellow VCOM/Virginia Tech

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The speaker for this CME program has affirmed to have no relevant financial relationship with any of the products, manufacturers or provider of services that may be discussed in this presentation.

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¨ Mild traumatic brain injury ¨ Symptoms

¡ Headache ¡ Confusion ¡ Dizziness ¡ Nausea ¡ Emotional irritability ¡ Balance deficits

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¨ Very common in

contact sports1

¡ Football ú Highest number of

concussions

ú Highest number of

participants at all levels

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¨ National Collegiate Association for Athletics

(NCAA) requires baseline assessment for athletes who participate in sports at risk for concussion2,3,4,5

¡ Symptom checklist ¡ Standardized cognitive

assessment

¡ Balance assessment

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¨ Balance assessment

¡ Balance Error Scoring System

(BESS)

¡ Force plate technology ¡ Nintendo Wii ¡ Sensory Organization Testing

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¨ Methods

¡ Baseline balance testing ¡ Two 30-second trials

ú Eyes open ú Eyes closed

¡ Measurements

ú Center of Pressure (COP) ú Total travel time (COPTT) ú Anterior-posterior travel (COPTTY) ú Lateral travel (COPTTX)

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¨ Division I college football players at VT evaluated using

IsoBALANCE 2.0 Force Plate prior to start of contact drills

¨ Conclusions

1) Postural control was influenced by the variables of

height, weight, and position of play

2) Heel to toe travel was significant for weight and position;

therefore anterior-posterior travel could be used in the evaluation of balance

3) ONL players have better postural control that OL players

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¨ Evaluate history of concussion compared to balance ¨ Larger sample size than 2009 study

¡ Football, swimming/diving, soccer, wrestling

¨ Conclusions

1) Height/weight statistically significant between football

positions of play

2) COPTTY appropriate criterion for assessment of balance 3) Soccer had best postural control 4) Statistical significance COPTTY in eyes closed

experiments in history of concussion vs no history of concussion

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¨ Comparison of balance among Division I college

football players from VT over 2009-2011 seasons using IsoBALANCE 2.0 force plate technology

¡ History of concussion ¡ New concussion ¡ No history of concussion

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Eyes Closed Experiment Mean ± SD Mean ± SD Mean ± SD Mean ± SD p-value§ Total Travel (COPTT) 11.63 ± 4.77 11.15 ± 5.32 12.81 ± 5.37 12.49 ± 5.43 <0.0001 *** Lateral side to side travel (COPTTx) 4.80 ± 2.64 5.02 ± 2.97 5.09 ± 2.56 4.88 ± 2.54 0.0071 ** Anterior-posterior travel (COPTTy) 6.83 ± 2.64 6.14 ± 2.74 7.72 ± 3.39 7.61 ± 3.71 <0.0001 *** Percent time staying in the center of pressure within 0.6 inches (%COP60) 93.17 ± 9.89 94.30 ± 8.95 91.62 ± 7.27 91.12 ± 12.17 0.3401 Eyes Opened Experiment Mean ± SD Mean ± SD Mean ± SD Mean ± SD p-value§ Total Travel (COPTT) 8.50 ± 5.03 7.37 ± 2.84 9.85 ± 3.99 7.71 ± 4.35 0.0210 ** Lateral side to side travel (COPTTx) 3.88 ± 2.77 3.54 ± 1.65 4.72 ± 2.52 3.68 ± 2.47 0.3493 Anterior-posterior travel (COPTTy) 4.62 ± 2.67 3.83 ± 1.47 5.13 ± 2.07 4.03 ± 2.29 0.0003 ** Percent time staying in the center of pressure within 0.6 inches (%COP60) 93.52 ± 11.92 96.85 ± 4.32 95.80 ± 5.78 96.38 ± 6.11 0.0754 *

§ p-value is the result from Analysis of Covariance adjusted for the football players' weights and heights * p-value ≤ 0.10; ** p-value ≤ 0.05; *** p-value <0.0001 ** p-value ≤ 0.01

No history of concussion and no new concussion (NHxNNC) History of concussion and no new concussion (HxNNC) History of concussion and new concussion (HxNC) No history of concussion and new concussion (NHxNC) (n = 154) (n = 31) (n = 6) (n = 4)

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10.17 9.26 11.92 10.13 4.47 4.27 4.78 4.36 5.7 5 7.14 5.77

2 4 6 8 10 12 14 NHxNNC HxNNC HxNC NHxNC Inches COP (TT) COP (TTX) COP (TTY)

93.9 95.6 93.2 93.3 92.0 92.5 93.0 93.5 94.0 94.5 95.0 95.5 96.0 Percentage

%COP (0.6)

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COP (TT) COP (TTX) COP (TTY) NHxNNC 11.63 4.8 6.83 HxNNC 11.15 5.02 6.14 HxNC 12.81 5.09 7.72 NHxNC 12.49 4.88 7.61

2 4 6 8 10 12 14

Inches p = <0.0001 p = 0.0071 p = <0.0001

COP (TT) COP (TTX) COP (TTY) NHxNNC 8.5 3.88 4.62 HxNNC 7.37 3.54 3.83 HxNC 9.85 4.72 5.13 NHxNC 7.71 3.68 4.03

2 4 6 8 10 12

Inches p = 0.0210 p = 0.3493 p = 0.0003

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%COP (0.6) NHxNNC 93.17 HxNNC 94.3 HxNC 91.62 NHxNC 91.12

89 90 91 92 93 94 95

Percentage

NHxNNC HxNNC HxNC NHxNC

p = 0.3401

%COP (0.6) NHxNNC 93.52 HxNNC 96.85 HxNC 95.8 NHxNC 96.38

91 92 93 94 95 96 97 98

Percentage

NHxNNC HxNNC HxNC NHxNC

p = 0.0754

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¨ Concussions acutely effect balance

¡ COPTT, COPTTX, COP TTY

¨ COPTTY most affected by concussion ¨ History of concussion with new incidence of

concussion largest COPTTY

¨ History of concussion had no effect on balance

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¨

P. Gunnar Brolinson, DO

¨

Suporn Sukpraprut, PhD

¨

John Schifflett, ATC

¨

Mike Goforth, ATC

¨

Crystal Dyer, MD

¨

Jonathan D. Tait, DO

¨

Quinton J. Nottingham, PhD

¨

Terrence Vardy, DO

¨

Jarrod Harrall, DO

¨

Dave Dietter, ATC

¨

Kieth Doolan, ATC

¨

Stefan Duma, PhD

¨

Steve Rowson, MS

¨

Elaine Powers, MSLS

¨

Veera Motashaw, OMSIII

¨

Ryan Wennell, OMSIII

¨

Simbex

¨

IsoTechnology

¨

Virginia Tech Football Athletes

¨

Edward Via Virginia College of Osteopathic Medicine

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1. McCrea, M, Guskiewicz, KM, Marshall, SW, Barr, W, Randolph, C, Cantu, RC, Onate, JA, Yang, J, Kelly, JP.

Acute Effects and Recovery Time Following Concussion in Collegiate Football Players: The NCAA Concussion

Study. JAMA, November 19, 2003;290(19):2556-2563
2. Runkle, D. Memorandum: Concussion Management Plan to NCAA Head Athletic Trainers. NCAA

Committee on Competitive Safeguards and Medical Aspects of Sports, April 29, 2010

3. Clark, RA, Bryant, AL, Pua, Y, McCrory, P, Bennell, K, Hung, M. Validity and reliability of the Nintendo Wii

Balance Board for assessment of standing balance. Gait & Posture 2009; doi:10.1016/j.gaitpost.2009.11.012

4. Nitz, JC, Kuys, S, Isles, R., Fu, S. Is the Wii FitTM a new-generation tool for improving balance, health and

well-being? A pilot study. Climacteric 2009; Early Online, 1-6

5. Dyer, Cs, Brolinson, PG, Tait, JD, Hall, J, Sukpraprut, S, Nottingham, QJ, Vardy, T, Shifflett, J, Dietter, D,

Goforth, M, Wennell, R. Evaluation of Postural Stability among NCAA Division I College Athletes using IsoBALANCE 2.0 Force Plate Technology: An Analysis of VT Football Players over the 2009 and 2010 Seasons. Abstract submission for American Osteopathic Academy of Sports Medicine Conference 2011.

6. Guskiewicz, KM, Perrin, DH, Bansneder, BM. Effect of Mild Head Injury on Postural Stability in Athletes.

Journal of Athletic Training 1996;31(4):300-306

7. Parker, TM, Osternig, LR, van Donkelaar, P, Chou, L. Recovery of cognitive and dynamic motor function

following concussion. Br J Sports Med 2007;41:868-873. Doi:10.1136/bjsm.2006.033761

8. Sosnoff, JJ, Broglio, SP, Shin, S, Ferrara, MS. Previous Mild Traumatic Brain Injury and Postural-Control
Dynamics. Journal of Athletic Training 2011;46(1):85-91

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