Movement Assessment for Concussion Management
Condition: Healthy Athlete
Study type: Interventional

Summary: 
      Previous work in the area of concussion management has focused heavily on neuro-cognitive
      testing. In addition to routine neuro-cognitive testing through Immediate Post-Concussion
      Assessment and Cognitive Testing (ImPACT),this pilot study is designed to establish a
      comprehensive battery of clinical assessment through the utilization of functional movement
      and dynamic postural control assessments. The immediate application of these assessments will
      be focused on the male high school football player (who is at risk for concussion) and both
      female and male soccer players. Our pilot study aims determine the stability of ImPACT
      testing in youth athletes in light of ongoing neurodevelopment in this population. In
      addition, this pilot work will implement additional tools focused on assessment of dynamic
      balance and gait. This approach will significantly enhance predictions of subsequent
      musculoskeletal injuries that have been shown to occur in concussed collegiate and
      professional athletes and that we believe are also occurring in our high school athletes.
      This battery of tests will provide clinicians with invaluable information to guide both
      rehabilitation of and return to play (RTP) decisions for concussed high school athletes.
    

Detailed description: 
      Experiment 1. High school athletes will complete a battery of tests including the Y-balance
      test, a version of the Star Excursion Balance Test (SEBT), a divided attention gait task, the
      Psychomotor Vigilance Task (PVT). The SEBT is an established, reliable outcome measure of
      dynamic postural stability through measurement of lower extremity reach distance. Our study
      will also utilize a force plate during SEBT testing to allow the investigators to sensitively
      measure center of mass in all planes. To test gait balance control and adaptation of gait
      strategy which have been shown to be impaired in concussed individuals acutely and
      chronically, athletes will walk at self-selected speed on the GAITRite® portable gait
      analysis walkway for three undivided attention trials and three divided attention trials
      during which a cognitive task, will be imposed.The GaitRite® will calculate spatio-temporal
      parameters during gait and has been used in the concussion literature. The PVT is a reliable
      and valid measurement of simple reaction time to an auditory cue. The outcome measure will be
      the mean reaction time. These tests were administered by licensed physical therapists,
      assisted by students from both the Doctorate of Physical Therapy (DPT) and PhD physical
      therapy programs at UCA, before the initiation of summer 2016 football practices for all
      athletes in the program. The total testing time per athlete will not exceed 1.5 hours. The
      battery will be administered again to all athletes in the football program after the season
      has ended and prior to the end of the school year in the spring 2017. The 2017-2019 season
      will test both football and soccer (male and female athletes) and will include functional
      testing for athletes who have had a concussion through concussion clinic.

      Experiment 2. Qualified athletic trainers or Physical Therapists, with oversight by Dr.
      Israel, will administer the ImPACT using the same schedule as described in Experiment 1. The
      ImPACT is a widely used neurocognitive testing component of the standard three-prong approach
      to concussion management which also includes symptom inventories and static balance
      assessment. The computerized test evaluates concentration, attention, memory, visual motor
      speed, and reaction time. High sensitivity and specificity for concussion using the ImPACT
      has been shown. The test also has been shown to be a valid and reliable measure in the high
      school and collegiate populations. Composite scores for each of the non-injured athletes will
      be stratified by age to examine changes across the three assessments. Hunt and Ferrara have
      shown significant change in baseline assessments between 9th grade and 11th and 12th grade
      age groups driven by 9th grade test scores indicating that biennial testing for young
      adolescents may not be sufficient.The current recommendation for this younger age group is
      annual testing, though recent studies call for the investigation of even more frequent
      testing, thus our plan to test at six months. ImPACT testing will not exceed 1 hour. The
      2017-2018 season will test both football and soccer (male and female athletes) for ImPACT
      testing.
    

Intervention name(s): Immediate Post-concussion Assessment and Cognitive Testing; Gait with single and dual task; Y-Balance test; Psychomotor Vigilance Task
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Computerized assessment that provides information related to visual reaction time and visual memory.; Walking alone and then walking while performing a memory task on a tablet.; Dynamic balance test measuring reaching of the leg to the anterior,postero- lateral, and postero-medial directions.; Assessment measuring reaction time based on auditory cues.
Other intervention name(s): ImPACT; Star Excursion Balance Test (SEBT); PVT
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Screening
Keywords: Concussion; Football player; Movement assessment; Soccer player