Context Para sport athletes experience concussions at a similar rate to athletes without disabilities; however, published concussion tools have limited applicability to diverse athlete populations. Objective To understand health care provider (HCP) concussion management across different para sports and athlete classifications to identify facilitators and barriers influencing the delivery of concussion care. Design Cross-sectional study. Setting Online survey and virtual interviews. Patients or Other Participants Para sport HCPs completed online surveys (n = 21) and voluntary follow-up interviews (n = 11). Data Collection and Analysis Researchers designed a survey from an established line of health care evaluation surveys and distributed it via chain-referral sampling following expert review (n = 3) and pilot testing (n = 4). We conducted follow-up interviews via Google Meet using automatic transcription technology and reviewed for accuracy. We used phenomenology to analyze the qualitative data with multianalyst triangulation and peer review as credibility strategies. Results Health care providers most often used the Sport Concussion Assessment Tool 6 (85.7%) to guide examinations, the modified Balance Error Scoring System (66.7%) for balance testing, and the Vestibular/Ocular-Motor Screening (81.0%) for vestibular ocular-motor testing. Health care providers noted 3 themes: (1) the importance of developing purposefully flexible classification- and para sport–specific frameworks to promote individualized concussion care while (2) building personal HCP–athlete relationships to understand individual needs and improve concussion diagnostics and emphasizing (3) a multidisciplinary, team-based approach to care. Health care providers emphasized these themes as critical for successful management across para sports to overcome limited education and resource allocation available to often volunteer-based HCPs. Conclusions Para sport HCPs used current concussion assessment tools but reported a lack of effective adaptive guidelines exemplified by variable athlete-specific modifications for concussion care. Our findings emphasize the need to develop flexible frameworks for para sport concussion management while emphasizing a multidisciplinary, team-based approach to care and HCP–athlete relationships to implement effective para sport concussion care.
Context:In the United States, more than 71 000 college students, many of whom participate in athletic programs, are deaf or hard of hearing (D/HoH). Although recent concussion consensus statements have recommended different management for special populations, critical knowledge gaps remain regarding baseline concussion performance in athletes who are D/HoH. Objective:To compare baseline concussion assessments between athletes who are D/HoH and athletes who are hearing. Design:Cross-sectional study. Setting:Collegiate athletic department. Patients or Other Participants:A total of 128 National Collegiate Athletic Association Division III athletes including 64 athletes who are D/HoH (42 who are deaf, 22 who are hard of hearing; age = 21.64 ± 3.23 years, height = 1.70 ± 0.10 m, mass = 80.83 ± 25.24 kg) and 64 athletes who are hearing (age = 19.73 ± 1.13 years, height = 1.76 ± 0.10 m, mass = 78.55 ± 16.95 kg) matched by sex and sport-contact classification. Main Outcome Measures:Participants completed a comprehensive battery of baseline concussion assessments, including symptom inventories (Sport Concussion Assessment Tool 6 symptom evaluation and Brief Symptom Inventory-18), virtual reality-based smooth pursuits, oculomotor function (Vestibular/Ocular Motor Screening), postural control (modified Balance Error Scoring System), instrumented tandem gait, and neurocognitive testing (Immediate Post-Concussion Assessment and Cognitive Testing). Results:No differences were found for Sport Concussion Assessment Tool 6 symptom severity (z = -1.41, P = .16) or total number of symptoms (z = -1.62, P = .11), but athletes who are D/HoH had a higher Brief Symptom Inventory-18 Global Severity Index (z = -2.37, P = .02) compared with athletes who are hearing. Athletes who are D/HoH demonstrated better oculomotor tracking (eg, higher velocity gain and lower saccade percentage, P < .01) and lower Vestibular/Ocular Motor Screening total symptom scores (z = 2.57, P = .01) compared with athletes who are hearing. Additionally, athletes who are D/HoH demonstrated poorer performance in postural control (more modified Balance Error Scoring System errors, z = -5.24, P < .001; slower tandem gait speed, z = 3.65, P < .001) and lower neurocognitive assessment scores (visual and verbal memory and visual-motor speed, P < .001) compared with athletes who are hearing. Conclusions:Athletes who are D/HoH exhibited distinct performance profiles across multiple baseline concussion domains, likely influenced by sensory adaptations, vestibular differences, and language-related factors. Clinicians should interpret assessment outcomes while considering these unique biopsychosocial characteristics to ensure accurate concussion management for D/HoH populations.
Objectives:To (1) support athletic trainers (ATs) as they help athletes and other active individuals navigate dietary supplement use while prioritizing health, safety, legality, performance, and a food-first but not always food-only approach and (2) ensure that ATs have the reliable resources they need to provide general education and evaluate the use of dietary supplements. Background:While the market continues to expand, the quality of dietary supplements worldwide is poorly regulated. At the same time, many active individuals report consuming multiple dietary supplements to improve health or performance or both. Athletic trainers are well positioned to proactively educate athletes on concerns that arise with taking dietary supplements. In many cases, the AT is the first health care professional asked to review the safety, effectiveness, and legality of a dietary supplement that an athlete is consuming. Our mission with this position statement is to provide ATs with the tools and resources needed to educate tactical operators and tactical athletes and to know when to refer the individual to a Sports Registered Dietitian Nutritionist and Board-Certified Specialist in Sports Dietetics. Recommendations:An individual's overall dietary pattern and habits should be considered first, but we encourage a food-first but not always food-only approach to dietary supplement education and review. The AT should use reliable resources to understand the risks and benefits of using dietary supplements.
Background Psychological and physical factors influence recovery after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the relative contributions of psychological, subjective, and objective recovery measures to psychological readiness for return to sport remain unclear. Objective To identify psychological, subjective, and objective recovery factors associated with psychological readiness to return to sport approximately 6 months after ACLR. Design Cross-sectional study. Setting University laboratory. Patients or Other Participants A total of 58 participants (31 [53%] females; age = 18.95 ± 5.20 years), who completed standardized postoperative rehabilitation and follow-up testing at approximately 6 months after primary unilateral ACLR, were included. Main Outcome Measure(s) We measured psychological readiness using the ACL-Return to Sport after Injury (ACL-RSI) scale and conducted hierarchical regression analyses to examine predictors of psychological readiness across 4 conceptually ordered domains: (1) demographics (age, sex, and time since surgery), (2) generalized anxiety (Patient-Reported Outcomes Measurement Information System Anxiety Scale) and kinesiophobia (Tampa Scale for Kinesiophobia 11), (3) knee-specific patient-reported outcomes (Knee Injury and Osteoarthritis Outcomes Scale [KOOS] subscales of Pain, Symptoms, Quality of Life [QoL], and Sport), and (4) objective functional measures (quadriceps strength and single-legged hop symmetry). We conducted hierarchical linear regression in conceptually ordered blocks. Results Demographic factors explained minimal variance in psychological readiness (1%–4%). Generalized anxiety contributed an additional 18.1%, and kinesiophobia (Tampa Scale for Kinesiophobia 11, 22.3%), QoL (KOOS-QoL, 9.8%), and subjective sport function (KOOS-Sport, 5.3%) emerged as the strongest incremental predictors. Pain, symptoms, and objective function contributed little additional variance. The full model explained 70.5% of the variance in ACL-RSI scores (adjusted R 2 = 0.64, P < .001), and cross-validation produced a comparable R 2 (0.61), indicating good model generalizability and minimal overfitting. Conclusions Fear-related beliefs and perceived function exerted stronger influences on psychological readiness after ACLR than objective functional symmetry. These findings highlight the importance of biopsychosocial assessment models and sport-specific psychological measures to enhance return-to-sport decision-making and long-term recovery outcomes.
Context Unbalanced or uncoordinated activity across either the scapulohumeral or the scapulothoracic muscle may impair scapulohumeral rhythm during arm elevation. Objective To compare the effects of progressive resistance exercises (PREs), integrated with and without facilitatory motor-control exercises (MCEs), on scapulohumeral and scapulothoracic myoelectric activities in overhead athletes diagnosed with secondary subacromial impingement syndrome (SAIS). Design Randomized controlled clinical trial. Setting Neuromuscular Rehabilitation Research Center. Patients or Other Participants Overhead athletes diagnosed with secondary SAIS were assigned randomly to 3 parallel groups: 2 intervention groups and 1 control group. Intervention(s) All groups received contemporary physical therapy modalities every other day for 8 weeks. Intervention groups I and II also completed scapulohumeral and scapulothoracic PREs, integrated, respectively, with and without facilitatory MCEs targeting infraspinatus and lower trapezius muscles. Main Outcome Measure(s) Scapulohumeral and scapulothoracic myoelectric activities were recorded during scapular arm abduction between 80° and 110° before and after the prescribed treatment protocols. Results Scapulohumeral and scapulothoracic PREs reduced the corresponding myoelectric activities during scapular arm abduction within the groups ( P ≤ .02, partial η 2 ≥ 0.127). Facilitatory biofeedback-guided exercises integrated into PREs preserved scapulohumeral and scapulothoracic myoelectric activities ( P ≤ .03), excluding teres minor myoelectric activity ( P > .99). Conclusions Scapulohumeral and scapulothoracic PREs reduced the corresponding muscle activations during scapular arm abduction in overhead athletes with secondary SAIS. Facilitatory MCEs targeting infraspinatus and lower trapezius muscles, integrated into PREs, preserved scapulohumeral and scapulothoracic muscle activations.
