Brian Hainline

AOSSM Early Sport Specialization Consensus Statement.

Background: Early sport specialization is not a requirement for success at the highest levels of competition and is believed to be unhealthy physically and mentally for young athletes. It also discourages unstructured free play, which has many benefits. Purpose: To review the available evidence on early sports specialization and identify areas where scientific data are lacking. Study Design: Think tank, roundtable discussion. Results: The primary outcome of this think tank was that there is no evidence that young children will benefit from early sport specialization in the majority of sports. They are subject to overuse injury and burnout from concentrated activity. Early multisport participation will not deter young athletes from long-term competitive athletic success. Conclusion: Youth advocates, parents, clinicians, and coaches need to work together with the sport governing bodies to ensure healthy environments for play and competition that do not create long-term health issues yet support athletic competition at the highest level desired.

Expert consensus document: Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions

Sports-related concussions and repetitive subconcussive exposure are increasingly recognized as potential dangers to paediatric populations, but much remains unknown about the short-term and long-term consequences of these events, including potential cognitive impairment and risk of later-life dementia. This Expert Consensus Document is the result of a 1-day meeting convened by Safe Kids Worldwide, the Alzheimers Drug Discovery Foundation, and the Andrews Institute for Orthopaedics and Sports Medicine. The goal is to highlight knowledge gaps and areas of critically needed research in the areas of concussion science, dementia, genetics, diagnostic and prognostic biomarkers, neuroimaging, sports injury surveillance, and information sharing. For each of these areas, we propose clear and achievable paths to improve the understanding, treatment and prevention of youth sports-related concussions.

Concussion-Related Protocols and Preparticipation Assessments Used for Incoming Student-Athletes in National Collegiate Athletic Association Member Institutions

CONTEXT National Collegiate Athletic Association (NCAA) legislation requires that member institutions have policies to guide the recognition and management of sport-related concussions. Identifying the nature of these policies and the mechanisms of their implementation can help identify areas of needed improvement. OBJECTIVE To estimate the characteristics and prevalence of concussion-related protocols and preparticipation assessments used for incoming NCAA student-athletes. DESIGN Cross-sectional study. SETTING Web-based survey. PATIENTS OR OTHER PARTICIPANTS Head athletic trainers from all 1113 NCAA member institutions were contacted; 327 (29.4%) completed the survey. INTERVENTION(S) Participants received an e-mail link to the Web-based survey. Weekly reminders were sent during the 4-week window. MAIN OUTCOME MEASURE(S) Respondents described concussion-related protocols and preparticipation assessments (eg, concussion history, neurocognitive testing, balance testing, symptom checklists). Descriptive statistics were compared by division and football program status. RESULTS Most universities provided concussion education to student-athletes (95.4%), had return-to-play policies (96.6%), and obtained the number of previous concussions sustained by incoming student-athletes (97.9%). Fewer had return-to-learn policies (63.3%). Other concussion-history-related information (e.g., symptoms, hospitalization) was more often collected by Division I universities. Common preparticipation neurocognitive and balance tests were the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; 77.1%) and Balance Error Scoring System (46.5%). In total, 43.7% complied with recommendations for preparticipation assessments that included concussion history, neurocognitive testing, balance testing, and symptom checklists. This was due to moderate use of balance testing (56.6%); larger proportions used concussion history (99.7%), neurocognitive testing (83.2%), and symptom checklists (91.7%). More Division I universities (55.2%) complied with baseline assessment recommendations than Division II (38.2%, χ2 = 5.49, P = .02) and Division III (36.1%, χ2 = 9.11, P = .002) universities. CONCLUSIONS National Collegiate Athletic Association member institutions implement numerous strategies to monitor student-athletes. Division II and III universities may need additional assistance to collect in-depth concussion histories and conduct balance testing. Universities should continue developing or adapting (or both) return-to-learn policies.

Neuropsychiatric Problems Interfering with Inpatient Stroke Rehabilitation

The current study was designed to assess the frequency of neuropsychiatric behavior problems occurring following stroke and to evaluate the utility of current Diagnostic and Statistical Manual-3 Revised (DSM-3R) criteria to categorize them. Forty-four patients with stroke requiring inpatient rehabilitation were prospectively screened using a behavioral checklist scored at two-week intervals by physical and occupational therapists. Thirty-one patients (70 percent) had behavioral problems noted by their therapists and were referred to the participating psychiatrist. Of these thirty-one patients, seventeen were diagnosed as having an organic mood syndrome with depression, five had multi-infarct dementia, four had post-stroke delirium, one had organic anxiety syndrome, one had an adjustment reaction not otherwise specified, and six had no psychiatric disorder identified. Behavioral signs and symptoms due to post-stroke depression, anxiety, delirium, and dementia appear well categorized by DSM-3R criteria. Five behavioral problems were identified which were inconsistently coded using DSM-3R diagnoses: distractibility (N = 19), neglect of neurologic impairment (N = 14), impulsivity (N = 11), somnolence (N = 6), and irritability (N = 4). Future research concerning the impact of these problems on stroke rehabilitation outcome will be aided by an increased general awareness of their prevalence, development of consistent diagnostic criteria, standardized symptom severity scales, and plausible treatment intervention strategies.

Peripheral nerve injury in sports.

ABSTRACTPurpose of Review: The purpose of this review is to discuss peripheral nerve injuries in sport and to discuss such injuries within the context of their mechanisms of action.Recent Findings: This review is based on the author’s personal experience combined with analysis of pertinent articles and reviews. Peripheral nerve injuries are uncommon in sport, but represent a potentially serious cause of morbidity to the athlete. Although making a diagnosis of the involved peripheral nerve is not necessarily difficult for the practicing neurologist, it is critical to always place peripheral nerve injury in sport within the context of sports medicine. Nerve injuries do not occur in isolation, but rather are intertwined with the conditioning of the athlete, the biomechanics of the sport, and the use of protective equipment.Summary: In assessing peripheral nerve injuries in sport, it is not enough to simply make a diagnosis of the involved nerve; the physician must also assess whether the nerve became injured through a process of direct acute compression or stretching, repetitive compression and stretching over time, or another mechanism such as ischemia or laceration. Diagnosing sports-related peripheral nerve injuries within the context of their mechanism of action better allows for the possibility of functional rehabilitation.

Debunking early single sport specialisation and reshaping the youth sport experience: an NBA perspective

Among many parents and coaches, it is believed that early single sport specialisation is essential for future competitive sport success and, further, that a high level of achievement in youth sports predicts future success. Owing to these misconceptions, youth sport has become focused on results at young ages rather than the overall development process, including physical and psychosocial health and well-being. The emphasis on competitive success in youth sports has been driven by a variety of factors including efforts to make elite travel or club teams, attend exclusive camps or showcase events, secure high school roster spots, garner collegiate scholarships and achieve professional careers. In addition, in the USA, the college recruiting process itself is a significant issue, with those as young as the eighth grade committing to a college programme.1 All of this has led to pressure to begin high-intensity training and single sport specialisation in childhood. As a consequence, many parents and young athletes are concerned that not specialising early will place them at a disadvantage in achieving their sport-related goals. In the sport of basketball, a recent National Collegiate Athletic Association (NCAA) survey found that ∼49% of men and 55% of women at the Division 1 level …

The Need for Accountability and Transparency in Intercollegiate Athletic Medicine

Over the years, intercollegiate athletics has exertedinfluences that have sometimes had adverse effects on thehealth and welfare of student–athletes. Even individualswho routinely uphold high ethical standards are notimmune to intense situational pressures for compromise.Conflicts of interest generally arise from a sense of duty toan organization or concern that one’s employment is injeopardy. Team physicians and athletic trainers share inthe challenges associated with the efforts to achieve teamand organizational success, but their first priority is toprovide optimal health care for each student–athlete. TheAmerican Medical Association Opinion 3.06–SportsMedicine,

Neuropathic Pain: Mind-body Considerations

Emerging research in neuroscience is bridging the gap between mind and body. Thought is brain based and influences brain function. The continuum and bidirectionality of mind and body, thought and brain, emotions and physiology forms the basis of understanding neuropathic pain, a neuropsychiatric condition with myriad clinical manifestations.

The NBA and Youth Basketball: Recommendations for Promoting a Healthy and Positive Experience

Participation in sports offers both short-term and long-term physical and psychosocial benefits for children and adolescents. However, an overemphasis on competitive success in youth sports may limit the benefits of participation, and could increase the risk of injury, burnout, and disengagement from physical activity. The National Basketball Association and USA Basketball recently assembled a group of leading experts to share their applied research and practices to address these issues. This review includes the group’s analysis of the existing body of research regarding youth sports participation and the related health, performance, and psychosocial outcomes. Based upon this, age-specific recommendations for basketball participation are provided that aim to promote a healthy and positive experience for youth basketball players.

A cross-species approach to disorders affecting brain and behaviour

Structural and functional elements of biological systems are highly conserved across vertebrates. Many neurological and psychiatric conditions affect both humans and animals. A cross-species approach to the study of brain and behaviour can advance our understanding of human disorders via the identification of unrecognized natural models of spontaneous disorders, thus revealing novel factors that increase vulnerability or resilience, and via the assessment of potential therapies. Moreover, diagnostic and therapeutic advances in human neurology and psychiatry can often be adapted for veterinary patients. However, clinical and research collaborations between physicians and veterinarians remain limited, leaving this wealth of comparative information largely untapped. Here, we review pain, cognitive decline syndromes, epilepsy, anxiety and compulsions, autoimmune and infectious encephalitides and mismatch disorders across a range of animal species, looking for novel insights with translational potential. This comparative perspective can help generate novel hypotheses, expand and improve clinical trials and identify natural animal models of disease resistance and vulnerability.Many disorders of brain and behaviour affect human and veterinary patients. In this Perspectives, Orrin Devinsky and colleagues outline a cross-species approach to understanding neurological and psychiatric conditions, including pain, cognitive decline, epilepsy, anxiety and CNS infections, and propose that collaborations between physicians and veterinarians will generate new insights for therapy development.