VCOM Research Appreciation Day 2012 Stephanie Aldret, DO Sports - PowerPoint PPT Presentation

VCOM Research Appreciation Day 2012 Stephanie Aldret, DO Sports Medicine Fellow VCOM/Virginia Tech

The speaker for this CME program has affirmed to have no relevant financial relationship with any of the products, manufacturers or provider of services that may be discussed in this presentation.

¨ Mild traumatic brain injury ¨ Symptoms ¡ Headache ¡ Confusion ¡ Dizziness ¡ Nausea ¡ Emotional irritability ¡ Balance deficits

¨ Very common in contact sports 1 ¡ Football ú Highest number of concussions ú Highest number of participants at all levels

¨ National Collegiate Association for Athletics (NCAA) requires baseline assessment for athletes who participate in sports at risk for concussion 2,3,4,5 ¡ Symptom checklist ¡ Standardized cognitive assessment ¡ Balance assessment

¨ Balance assessment ¡ Balance Error Scoring System (BESS) ¡ Force plate technology ¡ Nintendo Wii ¡ Sensory Organization Testing

¨ Methods ¡ Baseline balance testing ¡ Two 30-second trials ú Eyes open ú Eyes closed ¡ Measurements ú Center of Pressure (COP) ú Total travel time (COP TT ) ú Anterior-posterior travel (COP TTY ) ú Lateral travel (COP TTX )

¨ Division I college football players at VT evaluated using IsoBALANCE 2.0 Force Plate prior to start of contact drills ¨ Conclusions 1) Postural control was influenced by the variables of height, weight, and position of play 2) Heel to toe travel was significant for weight and position; therefore anterior-posterior travel could be used in the evaluation of balance 3) ONL players have better postural control that OL players

¨ Evaluate history of concussion compared to balance ¨ Larger sample size than 2009 study ¡ Football, swimming/diving, soccer, wrestling ¨ Conclusions 1) Height/weight statistically significant between football positions of play 2) COP TTY appropriate criterion for assessment of balance 3) Soccer had best postural control 4) Statistical significance COP TTY in eyes closed experiments in history of concussion vs no history of concussion

¨ Comparison of balance among Division I college football players from VT over 2009-2011 seasons using IsoBALANCE 2.0 force plate technology ¡ History of concussion ¡ New concussion ¡ No history of concussion

No history of History of concussion History of concussion No history of concussion and no new and no new concussion and new concussion concussion and new concussion (NHxNNC) (HxNNC) (HxNC) concussion (NHxNC) (n = 154) (n = 31) (n = 6) (n = 4) p-value § Eyes Closed Experiment Mean ± SD Mean ± SD Mean ± SD Mean ± SD Total Travel (COP TT ) 11.63 ± 4.77 11.15 ± 5.32 12.81 ± 5.37 12.49 ± 5.43 <0.0001 *** Lateral side to side travel (COP TTx ) 4.80 ± 2.64 5.02 ± 2.97 5.09 ± 2.56 4.88 ± 2.54 0.0071 ** Anterior-posterior travel (COP TTy ) 6.83 ± 2.64 6.14 ± 2.74 7.72 ± 3.39 7.61 ± 3.71 <0.0001 *** Percent time staying in the center of 93.17 ± 9.89 94.30 ± 8.95 91.62 ± 7.27 91.12 ± 12.17 0.3401 pressure within 0.6 inches (%COP 60 ) Eyes Opened Experiment Mean ± SD Mean ± SD Mean ± SD Mean ± SD p-value § 8.50 ± 5.03 7.37 ± 2.84 9.85 ± 3.99 7.71 ± 4.35 0.0210 ** Total Travel (COP TT ) 3.88 ± 2.77 3.54 ± 1.65 4.72 ± 2.52 3.68 ± 2.47 0.3493 Lateral side to side travel (COP TTx ) 4.62 ± 2.67 3.83 ± 1.47 5.13 ± 2.07 4.03 ± 2.29 0.0003 ** Anterior-posterior travel (COP TTy ) Percent time staying in the center of 93.52 ± 11.92 96.85 ± 4.32 95.80 ± 5.78 96.38 ± 6.11 0.0754 * pressure within 0.6 inches (%COP 60 ) § p-value is the result from Analysis of Covariance adjusted for the football players' weights and heights * p-value ≤ 0.10; ** p-value ≤ 0.05; *** p-value <0.0001 ** p-value ≤ 0.01

96.0 14 95.6 95.5 11.92 12 95.0 10.17 10.13 10 94.5 9.26 Percentage 93.9 94.0 8 7.14 COP (TT) Inches 93.3 93.5 %COP (0.6) 93.2 COP (TTX) 5.77 5.7 6 COP (TTY) 93.0 5 4.78 4.47 4.36 4.27 92.5 4 92.0 2 0 NHxNNC HxNNC HxNC NHxNC

14 12 p = <0.0001 p = 0.0210 12 10 10 8 p = <0.0001 8 Inches p = 0.0003 Inches 6 p = 0.0071 p = 0.3493 6 4 4 2 2 0 0 COP (TT) COP (TTX) COP (TTY) COP (TT) COP (TTX) COP (TTY) NHxNNC 8.5 3.88 4.62 NHxNNC 11.63 4.8 6.83 HxNNC 7.37 3.54 3.83 HxNNC 11.15 5.02 6.14 HxNC 9.85 4.72 5.13 HxNC 12.81 5.09 7.72 NHxNC 7.71 3.68 4.03 NHxNC 12.49 4.88 7.61

95 98 p = 0.0754 97 94 p = 0.3401 96 Percentage 93 Percentage 95 NHxNNC NHxNNC 92 94 HxNNC HxNNC 91 HxNC HxNC 93 NHxNC NHxNC 90 92 89 91 %COP (0.6) %COP (0.6) NHxNNC 93.17 NHxNNC 93.52 HxNNC 94.3 HxNNC 96.85 HxNC 91.62 HxNC 95.8 NHxNC 91.12 NHxNC 96.38

¨ Concussions acutely effect balance ¡ COP TT , COP TTX , COP TTY ¨ COP TTY most affected by concussion ¨ History of concussion with new incidence of concussion largest COP TTY ¨ History of concussion had no effect on balance

P. Gunnar Brolinson, DO ¨ Suporn Sukpraprut, PhD ¨ John Schifflett, ATC ¨ Mike Goforth, ATC ¨ Crystal Dyer, MD ¨ Jonathan D. Tait, DO ¨ Quinton J. Nottingham, PhD ¨ Terrence Vardy, DO ¨ Jarrod Harrall, DO ¨ Dave Dietter, ATC ¨ Kieth Doolan, ATC ¨ Stefan Duma, PhD ¨ Steve Rowson, MS ¨ Elaine Powers, MSLS ¨ Veera Motashaw, OMSIII ¨ Ryan Wennell, OMSIII ¨ Simbex ¨ IsoTechnology ¨ Virginia Tech Football Athletes ¨ Edward Via Virginia College of Osteopathic Medicine ¨

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