Nick Reed

Measurement of Head Impacts in Youth Ice Hockey Players

Despite growing interest in the biomechanical mechanisms of sports-related concussion, ice hockey and the youth sport population has not been studied extensively. The purpose of this pilot study was: 1) to describe the biomechanical measures of head impacts in youth minor ice hockey players; and, 2) to investigate the influence of player and game characteristics on the number and magnitude of head impacts. Data was collected from 13 players from a single competitive Bantam boys (ages 13-14 years) AAA ice hockey team using telemetric accelerometers implanted within the players helmets at 27 ice hockey games. The average linear acceleration, rotational acceleration, Gadd Severity Index and Head Injury Criterion of head impacts were recorded. A significantly higher number of head impacts per player per game were found for wingers when compared to centre and defense player positions (df=355, t=3.087, p=0.00218) and for tournament games when compared to regular season and playoff games (df=355, t=2.641, p=0.086). A significant difference in rotational acceleration according to player position (F2,1812=4.9551, p=0.0071) was found. This study is an initial step towards a greater understanding of head impacts in youth ice hockey.

Oculomotor-Based Vision Assessment in Mild Traumatic Brain Injury: A Systematic Review.

Objective:The purpose of this article is to synthesize and appraise the evidence regarding the use of oculomotor-based vision assessment to identify and monitor recovery from mild traumatic brain injury (mTBI). Specific objectives are to (1) identify changes in oculomotor-based vision following mTBI; (2) distinguish methods of assessment; (3) appraise the level and quality of evidence; and, if warranted, (4) determine clinical recommendations for assessment. Methods:A systematic review was undertaken to identify and appraise relevant literature. A search was conducted of 7 databases of peer-reviewed literature from January 1990 to January 2015. Articles were included if study populations were clearly identified as having mTBI and used an assessment of oculomotor-based vision. Articles with pooled data (eg, mTBI and stroke), addressing afferent visual function (eg, visual field deficits) or using single case designs, were excluded. Results:Twenty articles were selected for inclusion. Exploratory findings suggest that measurements of saccades, smooth pursuit, and vergence are useful in detecting changes associated with mTBI. Assessment methods included eye tracker protocols, optometric assessment, and the King-Devick test. Conclusion:The strength of this evidence is not yet sufficient to warrant clinical recommendations. Research using rigorous methods is required to develop reliable, valid, and clinically useful assessment protocols.

A systematic review of hospital-to-school reintegration interventions for children and youth with acquired brain injury

Objectives We reviewed the literature on interventions that aimed to improve hospital-to-school reintegration for children and youth with acquired brain injury (ABI). ABI is the leading cause of disability among children and youth. A successful hospital-to-school reintegration process is essential to the rehabilitative process. However, little is known about the effective components of of such interventions. Methods and findings Our research team conducted a systematic review, completing comprehensive searches of seven databases and selected reference lists for relevant articles published in a peer-reviewed journal between 1989 and June 2014. We selected articles for inclusion that report on studies involving: a clinical population with ABI; sample had an average age of 20 years or younger; an intentional structured intervention affecting hospital-to-school transitions or related components; an experimental design; and a statistically evaluated health outcome. Two independent reviewers applied our inclusion criteria, extracted data, and rated study quality. A meta-analysis was not feasible due to the heterogeneity of the studies reported. Of the 6933 articles identified in our initial search, 17 articles (reporting on 350 preadolescents and adolescents, aged 4–19, (average age 11.5 years, SD: 2.21) met our inclusion criteria. They reported on interventions varying in number of sessions (one to 119) and session length (20 minutes to 4 hours). The majority of interventions involved multiple one-to-one sessions conducted by a trained clinician or educator, homework activities, and parental involvement. The interventions were delivered through different settings and media, including hospitals, schools, and online. Although outcomes varied (with effect sizes ranging from small to large), 14 of the articles reported at least one significant improvement in cognitive, social, psychological, or behavioral functioning or knowledge of ABI. Conclusions Cognitive, behavioral, and problem-solving interventions have the potential to improve school reintegration for youth with ABI. However, more comprehensive interventions are needed to help link rehabilitation clinicians, educators, adolescents, and families.

Concussion-Like Symptoms in Child and Youth Athletes at Baseline: What Is “Typical”?

CONTEXTnAfter a concussion, guidelines emphasize that an athlete should be asymptomatic before starting a return-to-play protocol. However, many concussion symptoms are nonspecific and may be present in individuals without concussion. Limited evidence exists regarding the presence of typical or preinjury (baseline) symptoms in child and youth athletes.nnnOBJECTIVEnTo describe the frequency of symptoms reported at baseline by child and youth athletes and identify how age, sex, history of concussion, and learning factors influence the presence of baseline symptoms.nnnDESIGNnCross-sectional cohort study.nnnSETTINGnBaseline testing was conducted at a hospital research laboratory or in a sport or school setting (eg, gym or arena).nnnPATIENTS OR OTHER PARTICIPANTSnA total of 888 child (9-12 years old, n = 333) and youth (13-17 years old, n = 555) athletes participated (46.4% boys and 53.6% girls, average age = 13.09 ± 1.83 years).nnnMAIN OUTCOME MEASURE(S)nDemographic and symptom data were collected as part of a baseline protocol. Age-appropriate versions of the Post-Concussion Symptom Inventory (a self-report concussion-symptoms measure with strong psychometric properties for pediatric populations) were administered. Demographic data (age, sex, concussion history, learning factors) were also collected.nnnRESULTSnCommon baseline symptoms for children were feeling sleepier than usual (30% boys, 24% girls) and feeling nervous or worried (17% boys, 25% girls). Fatigue was reported by more than half of the youth group (50% boys, 67% girls). Nervousness was reported by 32% of youth girls. Headaches, drowsiness, and difficulty concentrating were each reported by 25% of youth boys and girls. For youths, a higher total symptom score was associated with increasing age and number of previous concussions, although these effects were small (age rs = 0.143, number of concussions rs = .084). No significant relationships were found in the child group.nnnCONCLUSIONSnChildren and youths commonly experienced symptoms at baseline, including fatigue and nervousness. Whether clinicians should expect complete symptom resolution after concussion is not clear.

Increasing Task Complexity and ICE Hockey Skills of Youth Athletes

The objective of this pilot study was to investigate the effects on cognitive performance of progressively adding tasks specific to ice hockey (skating, stick handling, and obstacle avoidance) during a visual interference task (Stroop Color Word Test–interference condition). In addition, the effects on locomotor performance of progressively adding tasks of stickhandling, visual interference, and obstacle avoidance related to maximal skating speed and minimal obstacle clearance were investigated in eight male athletes ages 10 to 12 years. Results revealed decreased performance on both cognitive and physical measures with increased task complexity, suggesting that adding complexity to an environment influences hockey skill performance.

Developmental and gender influences on executive function following concussion in youth hockey players

Abstract Background: Concussion is the most common athletic injury in youth who are simultaneously undergoing rapid developmental changes in the brain, specifically the development of executive functions (EF). The developing brain is more vulnerable to concussive injury with a protracted and different trajectory of recovery than that of adults. Thus, there is a critical need to enhance understanding of how concussion affects EF in youth. Objective: To investigate the effects of age, gender and concussion history (i.e. concussion incidence, recency, severity) on EF in youth hockey players. Methods: This 3-year cross-sectional and longitudinal multiple cohort study examined data from 211 hockey players of 8–15 years of age. Mixed-effects modelling was used to examine the influence of age, gender and concussion on EF in youth athletes. Findings: Baseline analyses revealed significant age and gender effects on measures of EF. Multiple effects of concussion history on measures of cognitive flexibility (Fu2009=u20092.48, pu2009=u20090.03) and psychomotor speed (Fu2009=u20092.59, pu2009=u20090.04) were found. Implications: This study highlights the impact of age, gender and concussion on EF in youth. These findings provide foundational knowledge to better manage cognitive sequelae following sports-related concussion.

Age and competition level on injuries in female ice hockey.

The objective of this study was to describe the number, types and locations of known injuries occurring across different age categories and levels of competition in female ice hockey within the Ontario Womens Hockey Association from 2004/05 to 2007/08. We further examined under which aforementioned factors and combination of factors an unusually high or low number of injuries was recorded. Secondary analysis of anonymized injury data was conducted. The most common known injury type was strain/sprain, followed by concussion while the most frequent injury location was head/face/mouth. Analysis of deviance indicated that a significantly higher than expected number of sprain/strain, concussion and laceration injuries were recorded compared to all other injury types. In addition, there were a higher number of injuries recorded at the AA level compared to all other levels of competition. Finally, the age categories of Peewee, Midget and Intermediate within the AA level of competition, as well as Senior/Adult within the Houseleague level of competition also recorded a significantly higher number of injuries compared to other combinations of descriptive factors. Further research with female youth is needed to better understand the high number of injuries, including concussions, reported overall.

Management of persistent postconcussion symptoms in youth: a randomised control trial protocol

Introduction Current management of concussion consists of early education, rest until symptom free, with gradual return to school and physical activity protocols. Although this management strategy is effective for most youth who sustain a concussion, it is not an appropriate strategy for youth with persistent postconcussion symptoms. Prolonged rest and periods of restricted activity may place youth at risk for secondary issues and contribute to the chronicity of postconcussion symptoms. The purpose of this study is to evaluate the efficacy of an active rehabilitation protocol for youth who are slow to recover from concussion. It is hypothesised that an active rehabilitation intervention can reduce persistent postconcussion symptoms, improve function and facilitate return to activity. This article describes the research protocol. Methods and analysis This is a randomised clinical trial with blinded outcome measurement. Participants will be recruited and randomly assigned to 1 of 2 treatment groups, an active rehabilitation intervention or a standard care education group. Both groups will receive standard care education. However, the active rehabilitation group will participate in an additional low-intensity exercise programme consisting of aerobic, coordination and visualisation exercises. Both the active rehabilitation and the standard care education interventions will be 6u2005weeks in duration. The primary outcome measure is postconcussion symptoms. Secondary outcome measures include functional recovery (cognitive, motor, psychosocial and emotional functioning) and return to activity. Outcome measures will be administered preintervention and postintervention. The primary outcome measure will also be repeated 2u2005weeks into the intervention period. Ethics and dissemination This study has been approved by the Holland Bloorview Kids Rehabilitation Hospital research ethics board (REB # 13-459). The findings from this study will be shared with the general public, sport associations, relevant brain injury organisations and healthcare professionals. Trial registration number NCT02257749.

A multi-modal approach to assessing recovery in youth athletes following concussion.

Concussion is one of the most commonly reported injuries amongst children and youth involved in sport participation. Following a concussion, youth can experience a range of short and long term neurobehavioral symptoms (somatic, cognitive and emotional/behavioral) that can have a significant impact on ones participation in daily activities and pursuits of interest (e.g., school, sports, work, family/social life, etc.). Despite this, there remains a paucity in clinically driven research aimed specifically at exploring concussion within the youth sport population, and more specifically, multi-modal approaches to measuring recovery. This article provides an overview of a novel and multi-modal approach to measuring recovery amongst youth athletes following concussion. The presented approach involves the use of both pre-injury/baseline testing and post-injury/follow-up testing to assess performance across a wide variety of domains (post-concussion symptoms, cognition, balance, strength, agility/motor skills and resting state heart rate variability). The goal of this research is to gain a more objective and accurate understanding of recovery following concussion in youth athletes (ages 10-18 years). Findings from this research can help to inform the development and use of improved approaches to concussion management and rehabilitation specific to the youth sport community.

Clinical and non-clinical depression and anxiety in young people: A scoping review on heart rate variability

BACKGROUNDnHeart rate variability (HRV), a measure of cardiac autonomic nervous system functioning, has emerged as a physiological indicator for emotional regulation and psychological well-being. HRV is understudied in the context of depression and anxiety in young people (10-24years old). Main objectives: (1) describe the nature and breadth of reviewed studies; and (2) synthesize main findings in the context of clinical and non-clinical populations of young people with depression and/or anxiety.nnnMETHODSnThe Arksey and OMalley methodology was utilized for this scoping review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched. Two reviewers screened titles, abstracts and full papers for inclusion. A total of 20 citations were included in the final review (19 citations peer-reviewed journal articles, 1 journal abstract). Numerical and thematic analysis was used to summarize study findings.nnnRESULTSnIn clinical populations of either depression or anxiety, HRV was lower compared to controls. In non-clinical populations of either depression or anxiety, HRV was found to be lower in those who reported more depression or anxiety symptoms.nnnLIMITATIONSnThe quality of the reviewed articles was not assessed which limits the ability to generate conclusions regarding study findings.nnnCONCLUSIONnChanges in HRV were found across the spectrum of clinical and non-clinical populations of young people with depression or anxiety. Neurophysiological research on depression and anxiety in young people can act as a first step to understanding how physiological flexibility (i.e. HRV) is related to psychological flexibility (i.e. adaptive or maladaptive responses to life events).