Robert E. Mangine

Serial assessments to determine normalization of gait following anterior cruciate ligament reconstruction

There is an increased emphasis to identify clinically applicable methods that quantify gait deficits following anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to perform serial gait assessments in a clinical setting to determine whether and when clinical gait parameters normalize in patients following ACLR. The hypothesis was that a clinically available gait treadmill would quantify gait deficits measured at 4 weeks post‐reconstruction. The secondary hypothesis was that patients would demonstrate incremental improvements in these gait parameters measured at each interval up to 12 weeks post‐reconstruction, and that the objectively measured improvements would correlate to the patients subjective rating of function. Fifteen subjects, five male and 10 female, who had initial unilateral anterior cruciate ligament injury were selected for this study on the basis of operative data. All subjects were evaluated in a physical therapy clinic within 3 days following ACLR and were enrolled in a standardized rehabilitation program. The dependent gait variables of step length, stance time and gait velocity were measured at 4, 6, 8 and 12 weeks post‐ACLR on a commercially available gait treadmill. A 2 × 4 multivariate analysis of variance (2 within factors) with measures for limb involvement (uninvolved and involved) and repeated measures for time (4, 6, 8 and 12 weeks) was used to assess the interactions and the main effects on the gait variables of stance time and step length. The results of this study supported the hypothesis that gait deficits and serial improvements can be objectively quantified in a clinical setting (P<0.001). Specifically, stance time, step length and gait velocity deficits evaluated at 4 weeks showed significant improvements at the measured intervals. Step length normalized at week 8. Stance time and gait velocity reached normal levels at the 12‐week time interval. Subjective activity of daily living scores (ADLS) also improved following the 12‐week rehabilitation, from 53±17% to a mean score of 88±11% (P<0.001). ADLS scores significantly correlated to step length (R=0.63) and stance time (R=0.53) in the involved limb. Self‐selected gait velocity also correlated to ADLS scores and significantly predicted 49% of the variance in the subjective outcome measure. A clinically available gait treadmill can be used to quantify gait deficits and improvements following ACLR. Serial assessments of walking gait may aid clinicians to identify and target deficits in their patients during rehabilitation.

Vision training methods for sports concussion mitigation and management.

There is emerging evidence supporting the use vision training, including light board training tools, as a concussion baseline and neuro-diagnostic tool and potentially as a supportive component to concussion prevention strategies. This paper is focused on providing detailed methods for select vision training tools and reporting normative data for comparison when vision training is a part of a sports management program. The overall program includes standard vision training methods including tachistoscope, Brocks string, and strobe glasses, as well as specialized light board training algorithms. Stereopsis is measured as a means to monitor vision training affects. In addition, quantitative results for vision training methods as well as baseline and post-testing *A and Reaction Test measures with progressive scores are reported. Collegiate athletes consistently improve after six weeks of training in their stereopsis, *A and Reaction Test scores. When vision training is initiated as a team wide exercise, the incidence of concussion decreases in players who participate in training compared to players who do not receive the vision training. Vision training produces functional and performance changes that, when monitored, can be used to assess the success of the vision training and can be initiated as part of a sports medical intervention for concussion prevention.

Retinal and Balance Changes Based on Concussion History: A Study of Division 1 Football Players

Background: The long term effects of a sports concussion or mild traumatic brain injury (mTBI) is poorly understood. The term chronic traumatic encephalopathy (CTE) is associated with protein deposition observed post mortem; thus the diagnosis of CTE in living subjects is impracticable using protein deposition as a diagnostic criterion. To date, there is no validated, objective method to observe and document pathologic changes post mTBI. The brain, optic-nerve, retina axes is closely linked; it is believed that some aspects of mTBI may be reflected in the retinal nerve fiber layer (RNFL) and that optical coherence tomography (OCT) could be a means to observe and document these changes. In this paper we show an association between a history of concussion and RNFL changes in college athletes. Methods: Each member of the University of Cincinnati football team was surveyed for a history of diagnosed concussion during pre-season camp. All players participating in camp were consented and were subjected to both a retinal exam using the Optovue iVue OCT retinal imaging system and a balance challenge by performing a visual motor task (Dynavision D2) on a BOSU Pro Balance Trainer (BOSU ball) and on a firm surface. Eye-hand coordination, balance and RNFL thickness measurements for the athletes with a history of concussion were compared to those the athletes with no history of concussion. Results: A total of 34 athletes reported having at least one previously diagnosed concussion that occurred up to 10 years prior to data collection; 73 reported no history of diagnosed concussion. Data analysis of the OCT retinal images demonstrated significant thickening of the RNFL in those athletes with a remote history of concussion when compared to athletes with no history of concussion, 106.8 μm vs 103.7 μm (p = 0.009), respectively. With the BOSU ball challenge there was no change in performance with or without a balance challenge 4.57 vs 4.63 hits per minute (p=0.93) for those with history of concussion versus no history. The performance task on the Dynavision D2 is an eye hand coordination task and a balance task, so eye hand coordination was not impacted by the RNFL changes. Discussion: In this paper we report significant sustained chronic RNFL thickness changes occurring in athletes with a remote history of concussion when compared to similar athletes without a reported history of concussion. However, there were no statistically significant sustained changes in eye hand coordination or balance challenge performance tasks. We suggest that RNFL changes may be an indicator of a structural brain injury following a postconcussive eve