Mick G. Mack

A descriptive analysis of children's playground injuries in the United States 1990-4.

OBJECTIVES: To review playground injury statistics over a five year period in order to develop an awareness of how and where children in the United States are being injured. METHODS: All data are based on the United States Consumer Product Safety Commissions National Electronic Injury Surveillance System (NEISS) for playground related injuries during 1990-4. The surveillance data includes injuries recorded in more than 90 hospital emergency departments located throughout the United States. RESULTS: Each year there are roughly 211,000 preschool or elementary school-children in the United States who receive emergency department care for injuries associated with playground equipment. On average, 17 of these cases result in death. 70% of all injuries occur on public playgrounds, with nearly one third classified as severe. Swings, climbers, and slides are the pieces of playground equipment associated with 88% of all NEISS reported injuries. Falls to the surface are responsible for 70%. CONCLUSIONS: NEISS playground injury statistics contribute to our understanding of playground injuries. By identifying where and how children are injured, suggestions can be made in an attempt to make playgrounds safer.

Testing the impact attenuation of loose-fill playground surfaces

Objectives—Our objective was to measure the impact attenuation performance of five types of loose-fill playground surfaces at a variety of drop heights, material depths, and conditions. Methods—In a laboratory setting, an instrumented head form was dropped on varying depths of loose-fill materials at one foot height increments until critical deceleration values were exceeded. The effects of test box size, material temperature, and compression were also studied. Results—Data suggest that a larger test box size influences test results. Uncompressed materials performed quite unexpectedly, that is, resilience did not necessarily increase with increasing depth of material and temperature did not have uniform effects. Compression before testing improved consistency of results. Conclusion—The current standard test procedure (ASTM F1292) appears problematic for loose-fill materials. Our results indicate that (1) shredded rubber was the best performer; (2) there was little difference between sand, wood fibers, and wood chips; and (3) pea gravel had the worst performance, making it a poor choice for playground surfacing.

Development and Validation of a Movement and Activity in Physical Space Score as a Functional Outcome Measure

OBJECTIVE To develop and validate a functional measure, the Movement and Activity in Physical Space (MAPS) score, that encompasses both physical activity and environmental interaction. DESIGN Observational matched-pair cohort with 2-month follow-up. SETTING General community under free-living conditions. PARTICIPANTS Adult participants (N=18; n=9 postsurgical, n=9 matched control; mean age ± SD, 28.9 ± 12.0y) were monitored by an accelerometer and global positioning system receiver for 3 days within 1 week (4.1 ± 2.8d) after knee surgery (T=0) and 2 months later (T+2). The healthy controls were matched for age, sex, smoking, perceived physical activity level, and occupation of a postsurgical participant. Correlation, t test (with Bonferroni adjustment: α=.05/2), analysis of variance, and intraclass correlation coefficient were used to establish validity and reliability evidence. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE MAPS scores. RESULTS MAPS scores were moderately correlated with the Knee Injury and Osteoarthritis Outcome Score (P<.05). There was a significant group difference at T = 0 for MAPS (t(9.9)=-3.60; P=.01). Analysis of variance results for the MAPS indicated a time and group interaction (F(1,12)=4.60, P=.05). Reliability of 3 days of MAPS scores ranged from 0.75 to 0.81 (postsurgical and control), and 2-month test-retest reliability in the control group was 0.94. CONCLUSIONS The results provide a foundation of convergent and known-group difference validity evidence along with reliability evidence for the use of MAPS as a functional outcome measure.

Effects of Time and Movements of the Preshot Routine on Free Throw Shooting

This study examined the effects of length and movements of preshot routines on free throw shooting in basketball. 17 members of an intercollegiate mens basketball team attempted 20 free throws in each of four different conditions: (1) normal routine and time, (2) normal routine with altered time, (3) altered routine with normal time, and (4) altered routine with altered time. Free throw performance was measured using an objective 5-poinr scoring system. A multivariate analysis of variance indicated a significant effect for routine. Neither time nor routine by time was significant. Results indicated that altering the movements in the routine had a significant effect on performance while lengthening the time did not.

The prevention of playground injuries

The second in a series of three articles devoted to the development, maintenance, and implementation of the National Association of School Nurses 1998-2001 Strategic Plan and how it relates to the practice of school nurses. Information about the development of a mission/vision statement for the organization is given along with strategies for developing a local school district school health program strategic plan. A previous Nursing Practice Management section article discussed the development of the Associations strategic plan considering the changing health care climate, the shifting needs of school children, and the economic climate for school funding. A future Nursing Practice Management section article will discuss the implementation of the seven goal areas in the National Association of School Nurses 1998-2001 Strategic Plan.: The second in a series of three articles devoted to the development, maintenance, and implementation of the National Association of School Nurses 1998-2001 Strategic Plan and how it relates to the practice of school nurses. Information about the development of a mission/vision statement for the organization is given along with strategies for developing a local school district school health program strategic plan. A previous Nursing Practice Management section article discussed the development of the Associations strategic plan considering the changing health care climate, the shifting needs of school children, and the economic climate for school funding. A future Nursing Practice Management section article will discuss the implementation of the seven goal areas in the National Association of School Nurses 1998-2001 Strategic Plan.

Psychometric Evaluation of the Standardized Assessment of ConcussionEvaluation of Baseline Score Validity Using Item Analysis

The Standardized Assessment of Concussion (SAC) is a concussion screening tool used in identifying concussions by measuring performance decreases compared with baseline scores. This places great importance on valid baseline and postinjury scores. The objective was to examine baseline psychometric properties of SAC items using item analysis. One hundred fortyseven healthy adults (n = 72 men, n = 75 women; age =18-59 years) completed all 3 SAC versions in random block order. Item analysis examined item difficulty (.1 > P .1). Acceptable items met both criteria. All 3 SAC versions had few acceptable items (A = 33%, B = 30%, C = 27%). Most items were too easy (76%). No orientation, 7% of immediate memory, and 60% of concentration were acceptable. Most SAC items have unacceptable psychometric properties when used to establish baseline cognitive abilities, which questions the validity for postinjury score comparisons. Mild traumatic brain injuries (MTBI), also known as concussions, are a serious concern that affect athletes and the general public.1 A traumatic brain injury is defined as a blow or penetrating force to the head, which leads to a disruption of normal brain function.2 Mild traumatic brain injuries account for 85% of the 1.5 million head injuries that occur annually throughout the United States; approximately 300,000 of these occur in sport-related activities.3,4 Langlois et al5 have reported that sport-related traumatic brain injuries are severely underestimated. They estimated that approximately 1.6 to 3.8 million sport-related traumatic brain injuries occur each year. Memory, attention, and information processing are some of the cognitive functions that are affected by MTBI.6-9 The accurate measurement of these functions is vital for health care professionals to identify and manage MTBI. It is important to use standardized tests for the assessment of an individual’s cognitive status and severity after sustaining an MTBI. Several brief diagnostic screening tools have been developed that can be used to evaluate changes in an individual’s cognitive status. For example, the Mini-Mental Status Examination (MMSE)10 is commonly used with older adults and other cognitively impaired populations. In sports medicine, the Standardized Assessment of Concussion (SAC) was created to provide team physicians, athletic trainers, and other medical professionals involved in the care of sport-related MTBI with a quick standardized, objective, screening tool for use on the field.11-13 Unlike the MMSE, which uses a criterion-referenced standard14 (ie, cut-score) for identification of cognitive dysfunction, the SAC uses an individual-centered standard. This approach is used in sport-related MTBI assessment protocols and is recommended by the National Athletic Trainers’ Association.15,16 The individual-centered standard requires testing to document the athlete’s baseDr Ragan is from the Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio; Mr Herrmann is from the Healthy Lifestyles Research Center Program in Exercise & Wellness, Arizona State University, Mesa, Ariz; Dr Kang is from the Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, Tenn; and Dr Mack is from the School of Health, Physical Education & Leisure Services, University of Northern Iowa, Cedar Falls, Iowa. Originally submitted February 18, 2009. Accepted for publication May 18, 2009. The authors have no financial or proprietary interest in the materials presented herein. Presented in part at the National Athletic Trainers’ Association Annual Meeting; June 2007; Anaheim, California. The authors thank Karen Kirkwood, Whitney Harris, and Ranae Abel for their help with the data collection. Address correspondence to Brian G. Ragan, PhD, ATC, Department of Family Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-7136; e-mail: brian.ragan@case.edu. doi:10.3928/19425864-20090625-07

The impact attenuation performance of materials used under indoor playground equipment at child care centers

Each year, thousands of children receive emergency medical treatment for playground-related fall injuries. In the United States, over 64,000 of these playground injuries involve children under the age of 5, many occurring in child care centers. More specifically, playground injuries were estimated to annually involve 1.64% of children in a child care center, with playground fall-injury rates estimated at 0.25/100,000 child-hours in day care. Thus, selecting an appropriate surface material for use under and around playground equipment is a concern for many child care center professionals. Information concerning a range of acceptable surface materials (such as sand, wood chips, gravel, and rubber products) is readily available. However, the advent and popularity of portable playground equipment has complicated the issue of providing safe undersurfacing, especially when used indoors where loose-fill surfacing is not practical. This equipment is designed to meet public playground equipment standards (ASTM F1487 in the United States, for example), but because it does not require concrete footings, this equipment is often used indoors. We believe that outdoor testing standards and procedures (i.e., ASTM F1487 and ASTM F1292) are most applicable to this equipment even if it is used indoors. Child care center operators frequently ask whether rest mats, exercise mats, tumbling mats, and carpet provide adequate fall protection for the portable plastic equipment used indoors in their centers. It appears that the common practice is to place whatever mats are on hand around the equipment. Because data on the safety of this approach are unavailable, the National Program for Playground Safety, located at the University of Northern Iowa, investigated the impact attenuation of products commonly used by child care centers under and around indoor playground equipment. While certainly not exhaustive, the data in this report are intended to highlight a potential safety concern from this practice.

ROLE MODELS IN SELF-ESTEEM OF COLLEGE WOMEN '

This study examined the relationship between self-esteem and the existence of role models among a sample of 36 female college students. Participants completed a questionnaire which included demographic questions, the Self-esteem Inventory, and questions concerning use of childhood and contemporary role models. Independent t-test results indicated that participants who reported having current role models had higher self-esteem scores than participants who did not, suggesting that role models may contribute to higher self-esteem in college-age women No significant differences in self-esteem were by sex of the role model.

Differential item functioning analysis of the mental, emotional, and bodily toughness inventory

In this study the authors used differential item functioning analysis to examine if there were items in the Mental, Emotional, and Bodily Toughness Inventory functioning differently across gender and athletic membership. A total of 444 male (56.3%) and female (43.7%) participants (30.9% athletes and 69.1% non-athletes) responded to the Mental, Emotional, and Bodily Toughness Inventory items. Using Mantel–Haenszel and simultaneous item bias test methods, 43 items were analyzed for differential item functioning. Four Mental, Emotional, and Bodily Toughness Inventory items were identified as large differential item functioning items by both Mantel–Haenszel and simultaneous item bias test methods, where item 21 favored non-athletes, item 40 favored athletes, item 2 favored males, and item 17 favored females. Athletic membership differential item functioning disappeared, whereas gender differential item functioning still existed at the scale level. Overall, there are gender and athletic membership differential item functioning items in the Mental, Emotional, and Bodily Toughness Inventory, but only gender differential item functioning still exists at the scale level. Thus, conclusions regarding gender differences in mental toughness should be made with caution when using total Mental, Emotional, and Bodily Toughness Inventory scores.

Playground Safety: Using Research to Guide Community Policy

Abstract Each year over 200,000 children in the United States require emergency medical treatment for playground-related injuries, costing an estimated