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Stephan Moll, Joshua N Berkowitz, Christopher W Miars
Traditionally, the athlete who requires long-term anticoagulation has been told to forgo participation in contact and collision sports. However, a strategy of short-term interruption of anticoagulant therapy may be designed for some athletes, allowing them return to full athletic activity. A personalized pharmacokinetic/pharmacodynamic study of a direct oral anticoagulant (DOAC) may allow athletic participation when plasma drug concentration is minimal and resumption of treatment after the risk of bleeding sufficiently normalizes...
November 30, 2018: Hematology—the Education Program of the American Society of Hematology
Grant T Baldwin, Matthew J Breiding, R Dawn Comstock
Sports and recreation-related (SRR) activities are common in the United States. Beyond the benefits to health, SRR activities can create new friendships, give people a sense of belonging, foster teamwork and other leadership skills, and develop sportsmanship and a respect for rules that govern play. Public awareness about the risk of concussion has grown as the long-term consequences of traumatic brain injury (TBI) have become better known, and likely explains the increasing concussion incidence rates. Currently, surveillance systems capture SRR concussions among high school and college athletes participating in sanctioned sports...
2018: Handbook of Clinical Neurology
Athena M Lolis, Susan Falsone, Aleksandar Beric
Peripheral nerve injuries are unusual in sport but impact an athlete's safe return to play. Nerve injuries result from either acute trauma (most commonly in contact/collision sports) or from repetitive microtrauma and overuse. Diagnosis of overuse nerve injuries includes nerve localization and surrounding soft-tissue anatomy, and must account for possible causes of repetitive microtrauma, including biomechanics, equipment, training schedule, and recovery. Prognosis is related to the type of nerve injury. Management should not simply be rest and gradual return to sport but should address biomechanical and training predispositions to injury...
2018: Handbook of Clinical Neurology
Clara Karton, T Blaine Hoshizaki
Head impacts that transfer mechanical energy to the skull and create brain injuries have unique dynamic responses and brain tissue trauma characteristics. The magnitude of the impact energy and how it is transmitted creates three-dimensional linear and rotational accelerations of the head, resulting in unique strains on brain tissue. Biomechanical investigations of head injuries in contact sports have historically focused on attenuating energy transfer to the skull and brain. Typically, severe life-threatening events are caused by high-energy impact events that result in anatomic damage...
2018: Handbook of Clinical Neurology
Henrik Zetterberg, Kaj Blennow
Chronic traumatic encephalopathy (CTE) is a neuropathologic condition that has been described in individuals who have been exposed to repetitive head impacts, including concussions and subconcussive trauma. CTE cannot currently be diagnosed during life. Clinical symptoms of CTE (including changes in mood, behavior, and cognition) are nonspecific and may develop after a latency phase following the injuries. Differential diagnosis based solely on clinical features is, therefore, difficult. For example, some younger patients who do not experience the latency phase (i...
2018: Handbook of Clinical Neurology
Alexander Lin, Molly Charney, Martha E Shenton, Inga Katharina Koerte
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impact exposure, such as that resulting from sports-related concussive and subconcussive brain trauma. Currently, the only way to diagnose CTE is by using neuropathologic markers obtained postmortem. To diagnose CTE earlier, so that possible treatment interventions may be employed, there is a need to develop noninvasive in vivo biomarkers of CTE. Neuroimaging provides promising biomarkers for the diagnosis of CTE and may also help elucidate pathophysiologic changes that occur with chronic sports-related brain injury...
2018: Handbook of Clinical Neurology
Ian J Wallace, Clotilde Hainline, Daniel E Lieberman
An evolutionary perspective helps explain a conundrum faced by sports neurologists: why is the human brain dependent on physical activity to function optimally, yet simultaneously susceptible to harm from particular types of athletics? For millions of years, human bodies and brains co-evolved to meet the physical and cognitive demands of the uniquely human subsistence strategy of hunting and gathering. Natural selection favored bodies with adaptations for endurance-based physical activity patterns, whereas brains were selected to be big and powerful to navigate the complex cultural and ecologic landscapes of hunter-gatherers...
2018: Handbook of Clinical Neurology
Ann C Mckee, Bobak Abdolmohammadi, Thor D Stein
Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head trauma, including concussion and subconcussion. CTE was first recognized in boxers nearly a century ago as "dementia pugilistica" or "punch drunk," but has been recently identified in contact sports athletes (including American football, ice hockey, soccer, baseball, rugby, boxing, and wrestling) and military veterans exposed to blast. Similar to many other neurodegenerative diseases, CTE is diagnosed conclusively only by neuropathologic examination of brain tissue...
2018: Handbook of Clinical Neurology
Steven D'Ascanio, Michael L Alosco, Robert A Stern
Exposure to repetitive head impacts from contact sport participation (e.g., American football, boxing, soccer) is associated with the neurodegenerative disorder known as chronic traumatic encephalopathy (CTE). The neuropathology of CTE is becoming well defined, and diagnostic criteria have been developed and are being refined. The critical next step in this emerging field is the diagnosis of CTE during life. The objective of this chapter is to describe what is currently known about the clinical presentation and in vivo diagnosis of CTE...
2018: Handbook of Clinical Neurology
Breton M Asken, Dallas C Hack, Michael A McCrea
The study of contact and collision sport athletes at risk for concussion began approximately three decades ago. Since then, sport-related concussion (SRC) research across several medical specialties has helped to develop consensus guidelines for clinical management through interdisciplinary efforts. The modern landscape of SRC research includes large-scale investigations to define the natural history of concussion and identify factors that should guide prevention, diagnosis, and treatment specific to the individual patient...
2018: Handbook of Clinical Neurology
Catherine S Wolff, Robert C Cantu, Kristen L Kucera
Tens of millions of children and adults participate in organized sport in the United States each year. Although uncommon, fatal and severe nonfatal brain and spine injuries can occur during these activities. These "catastrophic" injuries have been noted in contact sports such as football, rugby, and ice hockey, as well as in noncontact sports including baseball, cheerleading, swimming and diving, equestrian, gymnastics, pole vault, rodeo, snow skiing, snowboarding, and wrestling. They happen at all levels of play, from youth to professional...
2018: Handbook of Clinical Neurology
Bethany Rowson, Abigail Tyson, Steven Rowson, Stefan Duma
Understanding the biomechanics of head injuries is essential for the development of preventive strategies and protective equipment design. However, there are many challenges associated with determining the forces that cause injury. Acceleration of the skull is often measured because it is relatively easy to quantify and relates to severity of impact, but it is difficult to relate those measurements to the type and extent of injury that occurs. Experimental work in the laboratory has used either human cadavers or volunteers...
2018: Handbook of Clinical Neurology
Henrik Zetterberg, Bengt Winblad, Charles Bernick, Kristine Yaffe, Marek Majdan, Gunilla Johansson, Virginia Newcombe, Lars Nyberg, David Sharp, Olli Tenovuo, Kaj Blennow
Traumatic brain injury (TBI) is clinically divided into a spectrum of severities, with mild TBI being the least severe form and a frequent occurrence in contact sports, such as ice hockey, American football, rugby, horse riding and boxing. Mild TBI is caused by blunt non-penetrating head trauma that causes movement of the brain and stretching and tearing of axons, with diffuse axonal injury being a central pathogenic mechanism. Mild TBI is in principle synonymous with concussion; both have similar criteria in which the most important elements are acute alteration or loss of consciousness and/or post-traumatic amnesia following head trauma and no apparent brain changes on standard neuroimaging...
November 27, 2018: Journal of Internal Medicine
Francesco Della Villa, Bert R Mandelbaum, Lawrence J Lemak
Soccer (football) is a complex contact sport with a substantial risk of injury. As injury surveillance is the first step of the injury prevention paradigm, soccer epidemiology is well reported in the existing literature, but less is known about the actual role of player position on the general injury risk. The goal of this study is to present the existing evidence regarding the influence of player's position on general injury risk in male soccer. A systematic review of the Medline database was carried out. Only English written studies on male soccer and citing playing position as a possible determinant of injury risk were included...
October 2018: American Journal of Orthopedics
Amy R Lewis, David S Haydon, Elissa J Phillips, Paul N Grimshaw, Ross A Pinder, Joseph Winter, William S P Robertson, Marc R Portus
Inertial measurement units (IMUs) provide a practical solution for attaining key performance data for wheelchair sports. The effects of IMU placement position on the identification of propulsion characteristics are unknown. The aim of this study was to determine the variability in the reliability of cycle time measurements (time between hand contacts) across IMU locations on the chair frame (axle housings), and wheels (axle, push rim, outer rim), on both the left and right sides (n = 8). Contacts were defined by spikes in the resultant acceleration data, corresponding to impact between the hands and push rim, and verified against motion capture...
November 27, 2018: Sports Biomechanics
Steffen Paul Hacker, Florian Schall, Frank Niemeyer, Nicolas Wolf, Anita Ignatius, Lutz Dürselen
Background: Knee braces are prescribed by physicians to protect the knee from various loading conditions during sports or after surgery, even though the effect of bracing for various loading scenarios remains unclear. Purpose: To extensively investigate whether bracing protects the knee against impacts from the lateral, medial, anterior, or posterior directions at different heights as well as against tibial moments. Study Design: Controlled laboratory study...
November 2018: Orthopaedic Journal of Sports Medicine
Philip L Wilson, Charles W Wyatt, Jose Romero, Meagan J Sabatino, Henry B Ellis
Background: Despite the increasing incidence of sports-related knee injuries in youth athletes, few studies have reported on the diagnosis and treatment of pediatric and adolescent meniscal root injuries. Purpose: To describe traumatic posterior meniscal root injuries in a pediatric and adolescent population and compare the presentation of meniscal root injuries versus that of nonroot injuries. Study Design: Cohort study; Level of evidence, 3...
November 2018: Orthopaedic Journal of Sports Medicine
Kamal M Yakoub, Patrick O'Halloran, David J Davies, Conor Bentley, Callum N Watson, Mario Forcione, Ugo Scarpa, Jonathan R B Bishop, Emma Toman, Douglas Hammond, Matthew J Cross, Keith A Stokes, Simon P T Kemp, David K Menon, Valentina Di Pietro, Antonio Belli
INTRODUCTION: The diagnosis of mild traumatic brain injury or sports-related concussion is a challenge for all clinicians, players, coaches and parents involved in contact sports. Currently, there is no validated objective biomarker available to assess the presence or severity of concussion in sport, and so it is necessary to rely on subjective measures like self-reporting of symptoms which depend on the cooperation of the athlete. There is a significant health risk associated with repetitive injury if the diagnosis is missed, and so there is great value in an objective biomarker to assist diagnostic and prognostic decisions...
November 25, 2018: BMJ Open
Timothy B Hartwig, Tim J Gabbett, Geraldine Naughton, Craig Duncan, Simon Harries, Nicholas Perry
Training and competition loads have emerged as valuable injury risk factors but very few studies have explored injury outcomes in adolescent athletes. The aims of this study were to describe injuries and to explore the relationship between training and match load volumes and injury in adolescent athletes participating in multiple contact team sports. One hundred and three male youth rugby athletes aged 14 to 16 years from 8 rugby union teams were prospectively monitored during a season for weekly training and match volumes and injuries...
November 23, 2018: Scandinavian Journal of Medicine & Science in Sports
Grace Hernandez, Kimberly Baumann, Susan Knight, Heidi Purrington, Marc Gilgannon, Jennifer Newman, Patricia Tobase, Sheba Mathew, David L Cooper
INTRODUCTION: Limited evidence describes physical activity-associated bleeding risks for people with haemophilia, and risks are usually described only generically. AIM: To assess activity-specific ranges of risk for joint, soft tissue and head bleeds by identifying inherent and modifiable risk factors associated with each activity, based on opinions of expert physical therapists (PTs). METHODS: Physical therapists from US haemophilia treatment centres (HTCs) participated in a survey of 101 physical activities...
November 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
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