Matti Vartiainen

Paradoxical heat sensations during moderate cooling of the skin

Paradoxical heat sensations during cooling of the skin were examined in two experiments. In Expt. I the number of occurrences of sensation was studied in 19 naive test subjects (Ss) when cooling from thermal indifference both without and with preceding heating. Without preceding heating 13 Ss reported sensations of paradoxical heat (9.8% of all stimulations). Preheating markedly facilitated the occurrence of the sensations (35% of all stimulations). In Expt. II the effects of cooling velocity (velocities 0.4, 0.7 and 2.0 degrees C/s) and the type of skin area stimulated (hairy or glabrous skin of the hand) on the thresholds of paradoxical sensations were studied in 4 Ss without and with preheating. Cooling velocity, type of skin area and preheating had significant effects on the sensation thresholds, the thresholds being the higher (i.e. the sensation appearing at lower stimulation temperatures) the higher the cooling velocity, if the stimuli were applied to the glabrous skin, or if no preheating was used. The results confirm the existence of paradoxical heat sensations during cooling of the skin and suggest that the sensation is mediated by polymodal units supplied by C-fibers.

Sport concussion assessment tool - 3rd edition - normative reference values for professional ice hockey players

OBJECTIVES To determine normative reference values for the Sport Concussion Assessment Tool-3rd Edition (SCAT3) using a large sample of professional male ice hockey players. DESIGN A descriptive cross-sectional study. METHODS Preseason baseline testing was administered individually to 304 professional male ice hockey players. RESULTS The participants were aged between 16 and 40 with a mean (M) age of 25.3 years. Over 60% of the athletes reported previous concussion, almost 20% had been hospitalized or medically imaged following a head trauma. Of the players, 48% reported no symptoms. The symptom score median (Md) was 1.0 (M=1.5) and severity median was 1.0 (M=2.3). The median of the SAC score was 27.0 (M=27.0). The median of the M-BESS was 1.0 (M=2.0). The Tandem gait median was 10.9s (M=10.8s). The most common baseline symptom was neck pain (24%). Delayed recall was the most difficult component of the SAC (Md=4); only 24% performed it flawlessly. All athletes completed the double-leg stance of the M-BESS without errors, but there was performance variability in the tandem stance (Md=0, M=0.6, range=0-10) and single-leg stance (Md=1.0, M=1.4, range=0-10). CONCLUSIONS Representative normative reference values for the SCAT3 among professional male ice hockey players are provided.

King–Devick test normative reference values for professional male ice hockey players

The King–Devick (K‐D) test, a measure of processing speed, visual tracking, and saccadic eye movements, has shown promise as a supplemental screening test following concussion. However, limited normative data for this test have been published.The K‐D test was administered to 185 professional ice hockey players as a preseason baseline test in seasons 2012–2013 and 2013–2014. Their average age was 23.8 years (median = 22.0 years, range = 16–40 years). The average K‐D score was 40.0 s (SD = 6.1 s, range = 24.0–65.7 s). K‐D test performance showed no association with age, education, or the number of self‐reported previous concussions in this sample. The association between trials 1 and 2 of the K‐D test was good (ICC = 0.92, Pearson = 0.93). Normative values of the K‐D test for professional male ice hockey players are reported. K‐D test performance did not vary by age, education, or concussion history in this study.

Interpreting change on the SCAT3 in professional ice hockey players

OBJECTIVES To examine test-retest reliability of the SCAT3 for two consecutive seasons using a large sample of professional male ice hockey players, and to make recommendations for interpreting change on the test. DESIGN A cross-sectional descriptive study. METHODS Preseason baseline testing was administered in the beginning of the seasons 2013-2014 and 2014-2015 to 179 professional male hockey players in rink side settings. RESULTS The test-retest reliabilities of the SCAT3 components were uniformly low. However, the majority of athletes remained grossly within their own individual performance range when two pre-season SCAT3 baseline scores were compared to published normative reference values. Being tested by the same person or a different person did not influence the results. It was uncommon for the Symptom score to worsen by ≥3 points, the Symptom Severity score to worsen by ≥5 points, SAC total score to worsen by ≥3 points, M-BESS total error points to increase by ≥3, or the time to complete Tandem Gait to increase by ≥4s; each occurred in less than 10% of the sample. CONCLUSIONS The SCAT3 has low test-retest reliability. Change scores should be interpreted with caution, and more research is needed to determine the clinical usefulness of the SCAT3 for diagnosing concussion and monitoring recovery. Careful examination of the natural distributions of difference scores provides clinicians with useful information on how to interpret change on the test.

The feasibility of romberg quotient in assessment of balance after sport concussion

Objective To evaluate the feasibility of a computerised balance test and a calculated Romberg Quotient in acute recognition of concussion Design Prospective pilot study. Setting Finnish national ice hockey league. Participants Four teams participated in the study (n=113, male). Nine athletes who sustained a head/neck-related injury and control group of seven non-concussed volunteer players were followed. Study procedure All participants underwent the baseline assessment before season. The study period was one hockey season 2009- 2010. All game related concussions during this time were recorded. Post-concussion assessment was administered within 36 hours after injury. Outcome measures Balance was measured using a portable computerised platform. Romberg test stances were used on hard surface and soft foam. The participants stood still for 30 seconds with a closed stance. A relative balance change, Romberg Quotient (RQ), was assessed by calculating the ratio between eyes open, and eyes closed parameters. RQ was computed for sway length, area and velocity in each condition Main results Concussed and control group did not differ in balance measures at baseline. At post-injury, soft foam measures showed a difference between groups in sway length (U=5.0, p=0.005) and velocity (U=5.0, p=0.005). Among the concussed, RQ mean in sway velocity was 2.02 (1.7–2.3, 95% confidence limits) at baseline and 2.14 (1.9–2.4) post-injury Conclusions Alternating between different visual and/or somatosensory conditions in balance testing brings out the effect of concussions. RQ is easy to calculate regardless of the measurement systems or scales and can be used as valid tool in sport concussion measurement Competing interests None.

A novel approach to sports concussion assessment: computerized multilimb reaction times and balance control testing

Abstract Introduction: Mild traumatic brain injuries (MTBI) or concussions often result in problems with attention, executive functions, and motor control. For better identification of these diverse problems, novel approaches integrating tests of cognitive and motor functioning are needed. The aim was to characterize minor changes in motor and cognitive performance after sports-related concussions with a novel test battery, including balance tests and a computerized multilimb reaction time test. The cognitive demands of the battery gradually increase from a simple stimulus response to a complex task requiring executive attention. Method: A total of 113 male ice hockey players (mean age = 24.6 years, SD = 5.7) were assessed before a season. During the season, nine concussed players were retested within 36 hours, four to six days after the concussion, and after the season. A control group of seven nonconcussed players from the same pool of players with comparable demographics were retested after the season. Performance was measured using a balance test and the Motor Cognitive Test battery (MotCoTe) with multilimb responses in simple reaction, choice reaction, inhibition, and conflict resolution conditions. Results: The performance of the concussed group declined at the postconcussion assessment compared to both the baseline measurement and the nonconcussed controls. Significant changes were observed in the concussed group for the multilimb choice reaction and inhibition tests. Tapping and balance showed a similar trend, but no statistically significant difference in performance. Conclusion: In sports-related concussions, complex motor tests can be valuable additions in assessing the outcome and recovery. In the current study, using subtasks with varying cognitive demands, it was shown that while simple motor performance was largely unaffected, the more complex tasks induced impaired reaction times for the concussed subjects. The increased reaction times may reflect the disruption of complex and integrative cognitive function in concussions.

Adolescent athletes with learning disability display atypical maturational trajectories on concussion baseline testing: Implications based on a Finnish sample

ABSTRACT Previous research has reported lower cognitive test scores on baseline testing in athletes reporting multiple previous concussions or a history of learning disability (LD). Age also has an important influence on cognitive performance. While these factors have been considered individually in previous studies, the present study is the first to explore the interaction of age, self-reported LD, and history of concussion on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) in a nationwide study of adolescent athletes. ImPACT® was administered to 1823 Finnish male ice hockey players (aged 12–21 years old) prior to the 2015–2016 or 2016–2017 playing seasons. Linear regressions and simple slopes analyses were used for clarifying the impact of LD and previous concussion history on maturational trajectories. In comparison to typically developing athletes, athletes with LD had lower neurocognitive scores in all composites and differing maturational trajectory in verbal memory and visual motor speed. The number of previous concussions did not impair neurocognitive performance at baseline assessment. Application of standard age-based norms to adolescent athletes with a history of LD has the potential to negatively skew clinical decision-making. Separate reference values for LD athletes are warranted due to their unique developmental cognitive trajectories. The reference values for the Finnish participants in this study are presented.

The effects of age and learning disabilities in the king-devick test in adolescent ice-hockey players

Objective King-Devick (K-D) is becoming a popular screening test for sport concussion. Rapid number naming may be impaired in developmental dyslexia and other learning disabilities (LD). The aim was to study the interaction of age and LD in K-D in adolescence. The hypothesis was that those with LD perform more poorly on the test regardless of age. Design A case-control, cross-sectional nation-wide study. Setting Pre-season 2015–16 baseline tests in all junior teams in the Finnish ice hockey League. Participants A total of 805 male adolescents aged 12–21 (divided in 7 age groups), 75 of them reported LD. Outcome measures The K-D performance was measured twice. Time in the three subtests was combined to produce a sum score. Sum scores, and their difference, were used as outcome measures. Main Results In the youngest age group the mean of the K-D second trial was 49.7 (48.3–51.0, 95% confidence intervals) and in the oldest age group 44.7 (42.9–46.5). In a two-way ANOVA those with LD performed poorer (p=0.014, ηp²=0.008) but there was no interaction between age and LD. Similarly, a repeated analysis of covariance yielded a significant main effect for the trial (p<0.001, ηp²=0.042) and for LD (p<0.001, ηp²=0.026) but not for their interaction when the effect of age was controlled. Conclusions Adolescent players improve their performance in K-D with age, but those with learning disabilities remain slower despite maturation. If K-D is used as a single test for screening, and no baseline data is available, this needs to be recognised. Competing interests None.

156 The effect of age on cognitive performance in finnish sport-related concussion assessment

Background Consensus guidelines for managing sport-related concussion in adults are being implemented in Europe, but for adolescents they are still limited. While cognitive function in adults is relatively stable over time, cognition in adolescence continues to develop. Changes in adolescents’ cognitive performance have been reported to be of comparable magnitude to impairments observed on cognitive post-injury assessment in adults. Maturational improvement between baseline and post-concussion assessment may compensate any injury related cognitive impairment in adolescents, and can lead to misdiagnosis if not taken into account. The aim was to study the effect of age on cognitive performance in the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in Finnish adolescent ice hockey players. Methods The ImPACT test was administered to 1311 Finnish ice hockey players at baseline for the season 2015–2016, mean age 16.31 years (standard deviation 1.79, median 16 y, range 12–21 y). Players were divided in seven equal sized groups (12–14, 15, 16, 17, 18, 19, and 20–21 years olds) and cognitive test results were compared between groups. Results There was a statistically significant difference in cognitive test performance between age groups (Wilks’ Lambda p < 0.001). The effect appeared in all composite scores, but especially in Visual Motor Speed and Reaction Time the four first age groups showed a significant yearly change. Conclusions Age-specific national test norms and concussion assessment guidelines are needed. Longitudinal data would enable a more reliable comparison.