-
A Non-Profit Organization
Review Journal
Launches in 2015 Volume 1 Number 1
ISSN 2376-3825 (online)
ISSN 2378-7910 (print)
-
2A Non-Profit Organization
Review JournalNFP
2 2014 Joshua Rothenberg. All Rights Reserved.
Table of ContentsAdolescent vs. Young Adult Concussion: Should
We Manage Adolescent Concussions Differently? 4Joshua Rothenberg,
DO reviewing David Howell et al. Am J Sports Med 2014; 43(1)
published online ahead of print
Sample 2 5Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
Sample 3 6Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
Sample 4 7Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
Sample 5 8Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
Sample 6 9Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
Sample 7 10Joshua Rothenberg, DO reviewing David Howell et al.
Am J Sports Med 2014; 43(1) published online ahead of print
Sample 8 11Joshua Rothenberg, DO reviewing David Howell et al.
Am J Sports Med 2014; 43(1) published online ahead of print
-
3A Non-Profit Organization
Review JournalNFP
2014 Joshua Rothenberg. All Rights Reserved. 3
About the Editors:
Joshua Rothenberg, DOFounder & Publisher
Resident PhysicianUniversity of Miami
Gerard Malanga, MDCo-Editor-In-Chief
Sports Fellowship TrainedMayo Clinic
Ken Mautner, MDCo-Editor-In-Chief
Sports Fellowship TrainedAmerican Sports Medical
Institute, AL
Jim Ross, MDCo-Editor-In-Chief
Sports Fellowship TrainedUniversity of Michigan
Alberto Panero, DOAlexander Creighton, MDAndrew Gregory,
MDArthur Deluigi, DOBrandee Waite, MDBryson Lesniak, MDBrian Leo,
MDCarolyn Marquardt, MDCassandra Lee, MDCharlie Cox, MDClifton
Page, MD
Editorial Board:David Berkoff, MDEllie Jelsing, MDEvan Peck,
MDIvette Guttman, MDJeffrey Nepple, MDJacob Sellon, MDJason
Zaremski, MDJoanne Borg-Stein, MDJose Ramirez Del Toro, MDJoseph
DeAngelis, MDJoseph Herrera, DO
Matthew Matava, MDMichael Baraga, MDMichael Fredericson, MDOmar
Bhatti, MDRicardo Colberg, MDScott Faucett, MDTracy Ray, MD
Published Reviewers:Sample 1, DOSample 2, MDSample 3, MDSample
4, DOSample 5, MDSample 6, MDSample 7, MDSample 8, MD
Acknowledgements:A special thanks to a great mentor, supporter,
and advisor.
Ricardo Vasquez-Duarte, MD
Administrative Editor
-
4A Non-Profit Organization
Review JournalNFP
4 2014 Joshua Rothenberg. All Rights Reserved.
Adolescent vs. Young Adult Concussion: Should We Manage
Adolescent Concussions Differently? Concussion remains a heavily
debated topic surrounding our young adult and adolescent
populations. David Howell et al. completed a level 2 prospective
longitudinal cohort study on dual task gait analysis, in which he
hypothesized that adolescents may need more time for recovery than
their young adult counterparts after sustaining a concussion. His
research was predicated on looking at gait stability while
performing the Stroop test, a secondary task that has been shown to
engage executive function, namely conflict resolution. The
adolescent and young adult groups were selected using a single
concussion definition published by McCrory. The testing was
performed at 72 hours, 1 week, 2 weeks, 1 month, and 2 months
post-concussion. Matched controls were selected by age, height,
sex, mass, and activity participation. They completed the same
testing at the same time periods. Both groups underwent gait
analysis, in which body motion analysis was conducted using a
10-camera motion analysis system. The gait analysis was done while
performing the Stroop test, which was listening to the words high
or low spoken in a high or low pitch, and determining which pitch
the word was spoken in. Center of mass (COM) position data was then
calculated using the weighted sum of body segments. Statistically
significant results were primarily noted in the adolescent group.
Concussed adolescents demonstrated larger peak COM medial-lateral
velocity (p=0.001) and greater COM medial-lateral displacement
(p=0.001) at 72 hours. They also demonstrated greater total
medial-lateral COM displacement (p=0.001) over the entire 2 months.
The concussed young adults only demonstrated statistical
significance for less peak COM anterior velocity (p=0.01) at 72
hours. Thus, the authors suggest that that post concussive injuries
may need to be managed more cautiously in the adolescent age group.
The manuscript demonstrated several strengths. The authors
recognized the lack of published data on motor control in
concussion studies. They also found
that dual task assessment of concussion appeared to be the most
sensitive testing done in the past. Thus, they combined the two,
and used the dual task model to include motor control, via gait
analysis, while performing the Stroop test. They were able to do so
while having age, mass, and height-matched controls participate.
Weaknesses were also evident in the study. The total N of the study
was 38, and in future studies, a greater power would be beneficial
to corroborate results. Also, the adolescent group had 17 males and
only 2 females, while the disparity between sexes among young
adults was not evident. We still do not know if there are true
differences in rate and recovery of concussion amongst the two
sexes, but this may have played a role in the results. Also
noteworthy was that the management of the concussed subjects was
done independently of the study, thus, some adolescents and/or
young adults may have received medication and therapies that could
have affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants, which
ultimately may have led to a selection bias. Although weaknesses
exist, the conclusions deduced by the authors are appropriately
reflected in their data. The methods and statistics used were
appropriate, and demonstrate a well thought out study. After
careful review, the findings prove to be valid. The take home point
of this article that I will take into my practice is to allow a
longer time period to elapse in the concussed adolescent population
before consideration of resuming activities. These conclusions were
formed on the basis that this study confirms the presence of motor
control issues in adolescents 2 months post-concussion. Future
studies corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding these
populations. Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
-
5A Non-Profit Organization
Review JournalNFP
2014 Joshua Rothenberg. All Rights Reserved. 5
Sample 2 Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell et al.
completed a level 2 prospective longitudinal cohort study on dual
task gait analysis, in which he hypothesized that adolescents may
need more time for recovery than their young adult counterparts
after sustaining a concussion. His research was predicated on
looking at gait stability while performing the Stroop test, a
secondary task that has been shown to engage executive function,
namely conflict resolution. The adolescent and young adult groups
were selected using a single concussion definition published by
McCrory. The testing was performed at 72 hours, 1 week, 2 weeks, 1
month, and 2 months post-concussion. Matched controls were selected
by age, height, sex, mass, and activity participation. They
completed the same testing at the same time periods. Both groups
underwent gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The gait
analysis was done while performing the Stroop test, which was
listening to the words high or low spoken in a high or low pitch,
and determining which pitch the word was spoken in. Center of mass
(COM) position data was then calculated using the weighted sum of
body segments. Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents demonstrated
larger peak COM medial-lateral velocity (p=0.001) and greater COM
medial-lateral displacement (p=0.001) at 72 hours. They also
demonstrated greater total medial-lateral COM displacement
(p=0.001) over the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM anterior
velocity (p=0.01) at 72 hours. Thus, the authors suggest that that
post concussive injuries may need to be managed more cautiously in
the adolescent age group. The manuscript demonstrated several
strengths. The authors recognized the lack of published data on
motor control in concussion studies. They also found that dual task
assessment of concussion appeared to be
the most sensitive testing done in the past. Thus, they combined
the two, and used the dual task model to include motor control, via
gait analysis, while performing the Stroop test. They were able to
do so while having age, mass, and height-matched controls
participate. Weaknesses were also evident in the study. The total N
of the study was 38, and in future studies, a greater power would
be beneficial to corroborate results. Also, the adolescent group
had 17 males and only 2 females, while the disparity between sexes
among young adults was not evident. We still do not know if there
are true differences in rate and recovery of concussion amongst the
two sexes, but this may have played a role in the results. Also
noteworthy was that the management of the concussed subjects was
done independently of the study, thus, some adolescents and/or
young adults may have received medication and therapies that could
have affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants, which
ultimately may have led to a selection bias. Although weaknesses
exist, the conclusions deduced by the authors are appropriately
reflected in their data. The methods and statistics used were
appropriate, and demonstrate a well thought out study. After
careful review, the findings prove to be valid. The take home point
of this article that I will take into my practice is to allow a
longer time period to elapse in the concussed adolescent population
before consideration of resuming activities. These conclusions were
formed on the basis that this study confirms the presence of motor
control issues in adolescents 2 months post-concussion. Future
studies corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding these
populations. Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
-
6A Non-Profit Organization
Review JournalNFP
6 2014 Joshua Rothenberg. All Rights Reserved.
Sample 3 Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell et al.
completed a level 2 prospective longitudinal cohort study on dual
task gait analysis, in which he hypothesized that adolescents may
need more time for recovery than their young adult counterparts
after sustaining a concussion. His research was predicated on
looking at gait stability while performing the Stroop test, a
secondary task that has been shown to engage executive function,
namely conflict resolution. The adolescent and young adult groups
were selected using a single concussion definition published by
McCrory. The testing was performed at 72 hours, 1 week, 2 weeks, 1
month, and 2 months post-concussion. Matched controls were selected
by age, height, sex, mass, and activity participation. They
completed the same testing at the same time periods. Both groups
underwent gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The gait
analysis was done while performing the Stroop test, which was
listening to the words high or low spoken in a high or low pitch,
and determining which pitch the word was spoken in. Center of mass
(COM) position data was then calculated using the weighted sum of
body segments. Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents demonstrated
larger peak COM medial-lateral velocity (p=0.001) and greater COM
medial-lateral displacement (p=0.001) at 72 hours. They also
demonstrated greater total medial-lateral COM displacement
(p=0.001) over the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM anterior
velocity (p=0.01) at 72 hours. Thus, the authors suggest that that
post concussive injuries may need to be managed more cautiously in
the adolescent age group. The manuscript demonstrated several
strengths. The authors recognized the lack of published data on
motor control in concussion studies. They also found that dual task
assessment of concussion appeared to be
the most sensitive testing done in the past. Thus, they combined
the two, and used the dual task model to include motor control, via
gait analysis, while performing the Stroop test. They were able to
do so while having age, mass, and height-matched controls
participate. Weaknesses were also evident in the study. The total N
of the study was 38, and in future studies, a greater power would
be beneficial to corroborate results. Also, the adolescent group
had 17 males and only 2 females, while the disparity between sexes
among young adults was not evident. We still do not know if there
are true differences in rate and recovery of concussion amongst the
two sexes, but this may have played a role in the results. Also
noteworthy was that the management of the concussed subjects was
done independently of the study, thus, some adolescents and/or
young adults may have received medication and therapies that could
have affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants, which
ultimately may have led to a selection bias. Although weaknesses
exist, the conclusions deduced by the authors are appropriately
reflected in their data. The methods and statistics used were
appropriate, and demonstrate a well thought out study. After
careful review, the findings prove to be valid. The take home point
of this article that I will take into my practice is to allow a
longer time period to elapse in the concussed adolescent population
before consideration of resuming activities. These conclusions were
formed on the basis that this study confirms the presence of motor
control issues in adolescents 2 months post-concussion. Future
studies corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding these
populations. Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
-
7A Non-Profit Organization
Review JournalNFP
2014 Joshua Rothenberg. All Rights Reserved. 7
Sample 4Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell et al.
completed a level 2 prospective longitudinal cohort study on dual
task gait analysis, in which he hypothesized that adolescents may
need more time for recovery than their young adult counterparts
after sustaining a concussion. His research was predicated on
looking at gait stability while performing the Stroop test, a
secondary task that has been shown to engage executive function,
namely conflict resolution. The adolescent and young adult groups
were selected using a single concussion definition published by
McCrory. The testing was performed at 72 hours, 1 week, 2 weeks, 1
month, and 2 months post-concussion. Matched controls were selected
by age, height, sex, mass, and activity participation. They
completed the same testing at the same time periods. Both groups
underwent gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The gait
analysis was done while performing the Stroop test, which was
listening to the words high or low spoken in a high or low pitch,
and determining which pitch the word was spoken in. Center of mass
(COM) position data was then calculated using the weighted sum of
body segments. Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents demonstrated
larger peak COM medial-lateral velocity (p=0.001) and greater COM
medial-lateral displacement (p=0.001) at 72 hours. They also
demonstrated greater total medial-lateral COM displacement
(p=0.001) over the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM anterior
velocity (p=0.01) at 72 hours. Thus, the authors suggest that that
post concussive injuries may need to be managed more cautiously in
the adolescent age group. The manuscript demonstrated several
strengths. The authors recognized the lack of published data on
motor control in concussion studies. They also found that dual task
assessment of concussion appeared to be
the most sensitive testing done in the past. Thus, they combined
the two, and used the dual task model to include motor control, via
gait analysis, while performing the Stroop test. They were able to
do so while having age, mass, and height-matched controls
participate. Weaknesses were also evident in the study. The total N
of the study was 38, and in future studies, a greater power would
be beneficial to corroborate results. Also, the adolescent group
had 17 males and only 2 females, while the disparity between sexes
among young adults was not evident. We still do not know if there
are true differences in rate and recovery of concussion amongst the
two sexes, but this may have played a role in the results. Also
noteworthy was that the management of the concussed subjects was
done independently of the study, thus, some adolescents and/or
young adults may have received medication and therapies that could
have affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants, which
ultimately may have led to a selection bias. Although weaknesses
exist, the conclusions deduced by the authors are appropriately
reflected in their data. The methods and statistics used were
appropriate, and demonstrate a well thought out study. After
careful review, the findings prove to be valid. The take home point
of this article that I will take into my practice is to allow a
longer time period to elapse in the concussed adolescent population
before consideration of resuming activities. These conclusions were
formed on the basis that this study confirms the presence of motor
control issues in adolescents 2 months post-concussion. Future
studies corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding these
populations. Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
-
8A Non-Profit Organization
Review JournalNFP
8 2014 Joshua Rothenberg. All Rights Reserved.
Sample 5 Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell et al.
completed a level 2 prospective longitudinal cohort study on dual
task gait analysis, in which he hypothesized that adolescents may
need more time for recovery than their young adult counterparts
after sustaining a concussion. His research was predicated on
looking at gait stability while performing the Stroop test, a
secondary task that has been shown to engage executive function,
namely conflict resolution. The adolescent and young adult groups
were selected using a single concussion definition published by
McCrory. The testing was performed at 72 hours, 1 week, 2 weeks, 1
month, and 2 months post-concussion. Matched controls were selected
by age, height, sex, mass, and activity participation. They
completed the same testing at the same time periods. Both groups
underwent gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The gait
analysis was done while performing the Stroop test, which was
listening to the words high or low spoken in a high or low pitch,
and determining which pitch the word was spoken in. Center of mass
(COM) position data was then calculated using the weighted sum of
body segments. Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents demonstrated
larger peak COM medial-lateral velocity (p=0.001) and greater COM
medial-lateral displacement (p=0.001) at 72 hours. They also
demonstrated greater total medial-lateral COM displacement
(p=0.001) over the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM anterior
velocity (p=0.01) at 72 hours. Thus, the authors suggest that that
post concussive injuries may need to be managed more cautiously in
the adolescent age group. The manuscript demonstrated several
strengths. The authors recognized the lack of published data on
motor control in concussion studies. They also found that dual task
assessment of concussion appeared to be
the most sensitive testing done in the past. Thus, they combined
the two, and used the dual task model to include motor control, via
gait analysis, while performing the Stroop test. They were able to
do so while having age, mass, and height-matched controls
participate. Weaknesses were also evident in the study. The total N
of the study was 38, and in future studies, a greater power would
be beneficial to corroborate results. Also, the adolescent group
had 17 males and only 2 females, while the disparity between sexes
among young adults was not evident. We still do not know if there
are true differences in rate and recovery of concussion amongst the
two sexes, but this may have played a role in the results. Also
noteworthy was that the management of the concussed subjects was
done independently of the study, thus, some adolescents and/or
young adults may have received medication and therapies that could
have affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants, which
ultimately may have led to a selection bias. Although weaknesses
exist, the conclusions deduced by the authors are appropriately
reflected in their data. The methods and statistics used were
appropriate, and demonstrate a well thought out study. After
careful review, the findings prove to be valid. The take home point
of this article that I will take into my practice is to allow a
longer time period to elapse in the concussed adolescent population
before consideration of resuming activities. These conclusions were
formed on the basis that this study confirms the presence of motor
control issues in adolescents 2 months post-concussion. Future
studies corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding these
populations. Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
-
9A Non-Profit Organization
Review JournalNFP
2014 Joshua Rothenberg. All Rights Reserved. 9
Sample 6 Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell et al.
completed a level 2 prospective longitudinal cohort study on dual
task gait analysis, in which he hypothesized that adolescents may
need more time for recovery than their young adult counterparts
after sustaining a concussion. His research was predicated on
looking at gait stability while performing the Stroop test, a
secondary task that has been shown to engage executive function,
namely conflict resolution. The adolescent and young adult groups
were selected using a single concussion definition published by
McCrory. The testing was performed at 72 hours, 1 week, 2 weeks, 1
month, and 2 months post-concussion. Matched controls were selected
by age, height, sex, mass, and activity participation. They
completed the same testing at the same time periods. Both groups
underwent gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The gait
analysis was done while performing the Stroop test, which was
listening to the words high or low spoken in a high or low pitch,
and determining which pitch the word was spoken in. Center of mass
(COM) position data was then calculated using the weighted sum of
body segments. Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents demonstrated
larger peak COM medial-lateral velocity (p=0.001) and greater COM
medial-lateral displacement (p=0.001) at 72 hours. They also
demonstrated greater total medial-lateral COM displacement
(p=0.001) over the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM anterior
velocity (p=0.01) at 72 hours. Thus, the authors suggest that that
post concussive injuries may need to be managed more cautiously in
the adolescent age group. The manuscript demonstrated several
strengths. The authors recognized the lack of published data on
motor control in concussion studies. They also found that dual task
assessment of concussion appeared to be
the most sensitive testing done in the past. Thus, they combined
the two, and used the dual task model to include motor control, via
gait analysis, while performing the Stroop test. They were able to
do so while having age, mass, and height-matched controls
participate. Weaknesses were also evident in the study. The total N
of the study was 38, and in future studies, a greater power would
be beneficial to corroborate results. Also, the adolescent group
had 17 males and only 2 females, while the disparity between sexes
among young adults was not evident. We still do not know if there
are true differences in rate and recovery of concussion amongst the
two sexes, but this may have played a role in the results. Also
noteworthy was that the management of the concussed subjects was
done independently of the study, thus, some adolescents and/or
young adults may have received medication and therapies that could
have affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants, which
ultimately may have led to a selection bias. Although weaknesses
exist, the conclusions deduced by the authors are appropriately
reflected in their data. The methods and statistics used were
appropriate, and demonstrate a well thought out study. After
careful review, the findings prove to be valid. The take home point
of this article that I will take into my practice is to allow a
longer time period to elapse in the concussed adolescent population
before consideration of resuming activities. These conclusions were
formed on the basis that this study confirms the presence of motor
control issues in adolescents 2 months post-concussion. Future
studies corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding these
populations. Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
-
10
A Non-Profit Organization
Review JournalNFP
10 2014 Joshua Rothenberg. All Rights Reserved.
Sample 7 Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell et al.
completed a level 2 prospective longitudinal cohort study on dual
task gait analysis, in which he hypothesized that adolescents may
need more time for recovery than their young adult counterparts
after sustaining a concussion. His research was predicated on
looking at gait stability while performing the Stroop test, a
secondary task that has been shown to engage executive function,
namely conflict resolution. The adolescent and young adult groups
were selected using a single concussion definition published by
McCrory. The testing was performed at 72 hours, 1 week, 2 weeks, 1
month, and 2 months post-concussion. Matched controls were selected
by age, height, sex, mass, and activity participation. They
completed the same testing at the same time periods. Both groups
underwent gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The gait
analysis was done while performing the Stroop test, which was
listening to the words high or low spoken in a high or low pitch,
and determining which pitch the word was spoken in. Center of mass
(COM) position data was then calculated using the weighted sum of
body segments. Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents demonstrated
larger peak COM medial-lateral velocity (p=0.001) and greater COM
medial-lateral displacement (p=0.001) at 72 hours. They also
demonstrated greater total medial-lateral COM displacement
(p=0.001) over the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM anterior
velocity (p=0.01) at 72 hours. Thus, the authors suggest that that
post concussive injuries may need to be managed more cautiously in
the adolescent age group. The manuscript demonstrated several
strengths. The authors recognized the lack of published data on
motor control in concussion studies. They also found that dual task
assessment of concussion appeared to be
the most sensitive testing done in the past. Thus, they combined
the two, and used the dual task model to include motor control, via
gait analysis, while performing the Stroop test. They were able to
do so while having age, mass, and height-matched controls
participate. Weaknesses were also evident in the study. The total N
of the study was 38, and in future studies, a greater power would
be beneficial to corroborate results. Also, the adolescent group
had 17 males and only 2 females, while the disparity between sexes
among young adults was not evident. We still do not know if there
are true differences in rate and recovery of concussion amongst the
two sexes, but this may have played a role in the results. Also
noteworthy was that the management of the concussed subjects was
done independently of the study, thus, some adolescents and/or
young adults may have received medication and therapies that could
have affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants, which
ultimately may have led to a selection bias. Although weaknesses
exist, the conclusions deduced by the authors are appropriately
reflected in their data. The methods and statistics used were
appropriate, and demonstrate a well thought out study. After
careful review, the findings prove to be valid. The take home point
of this article that I will take into my practice is to allow a
longer time period to elapse in the concussed adolescent population
before consideration of resuming activities. These conclusions were
formed on the basis that this study confirms the presence of motor
control issues in adolescents 2 months post-concussion. Future
studies corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding these
populations. Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
-
11
A Non-Profit Organization
Review JournalNFP
2014 Joshua Rothenberg. All Rights Reserved. 11
Sample 8Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell et al.
completed a level 2 prospective longitudinal cohort study on dual
task gait analysis, in which he hypothesized that adolescents may
need more time for recovery than their young adult counterparts
after sustaining a concussion. His research was predicated on
looking at gait stability while performing the Stroop test, a
secondary task that has been shown to engage executive function,
namely conflict resolution. The adolescent and young adult groups
were selected using a single concussion definition published by
McCrory. The testing was performed at 72 hours, 1 week, 2 weeks, 1
month, and 2 months post-concussion. Matched controls were selected
by age, height, sex, mass, and activity participation. They
completed the same testing at the same time periods. Both groups
underwent gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The gait
analysis was done while performing the Stroop test, which was
listening to the words high or low spoken in a high or low pitch,
and determining which pitch the word was spoken in. Center of mass
(COM) position data was then calculated using the weighted sum of
body segments. Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents demonstrated
larger peak COM medial-lateral velocity (p=0.001) and greater COM
medial-lateral displacement (p=0.001) at 72 hours. They also
demonstrated greater total medial-lateral COM displacement
(p=0.001) over the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM anterior
velocity (p=0.01) at 72 hours. Thus, the authors suggest that that
post concussive injuries may need to be managed more cautiously in
the adolescent age group. The manuscript demonstrated several
strengths. The authors recognized the lack of published data on
motor control in concussion studies. They also found that dual task
assessment of concussion appeared to be
the most sensitive testing done in the past. Thus, they combined
the two, and used the dual task model to include motor control, via
gait analysis, while performing the Stroop test. They were able to
do so while having age, mass, and height-matched controls
participate. Weaknesses were also evident in the study. The total N
of the study was 38, and in future studies, a greater power would
be beneficial to corroborate results. Also, the adolescent group
had 17 males and only 2 females, while the disparity between sexes
among young adults was not evident. We still do not know if there
are true differences in rate and recovery of concussion amongst the
two sexes, but this may have played a role in the results. Also
noteworthy was that the management of the concussed subjects was
done independently of the study, thus, some adolescents and/or
young adults may have received medication and therapies that could
have affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants, which
ultimately may have led to a selection bias. Although weaknesses
exist, the conclusions deduced by the authors are appropriately
reflected in their data. The methods and statistics used were
appropriate, and demonstrate a well thought out study. After
careful review, the findings prove to be valid. The take home point
of this article that I will take into my practice is to allow a
longer time period to elapse in the concussed adolescent population
before consideration of resuming activities. These conclusions were
formed on the basis that this study confirms the presence of motor
control issues in adolescents 2 months post-concussion. Future
studies corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding these
populations. Joshua Rothenberg, DO reviewing David Howell et al. Am
J Sports Med 2014; 43(1) published online ahead of print
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NFP
2014 Joshua Rothenberg. All Rights Reserved.
Sports Review Journal is a bimonthly publication produced and
edited by Fellowship Trained Sports Medicine Physicians which
include backgrounds in Physical Medicine and Rehabilitation,
Orthopedic Surgery, Pediatrics, Emergency Medicine, and Family
Medicine. The reviews and summaries included in the publication are
intended solely for the education of medical professionals as
assistance in reviewing the large volume of literature that exists
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the basis of clinical diagnosis, management, side effects, or
complications, and are not a substitute for analyzing the original
research. Reviews may include subjective components, and are not
entirely objective, thus, it remains noteworthy to refer to the
original research in the journal cited. All journal reviews and
summaries will include citation to the journal with the original
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