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Official Journal of the American College of Sports Medicine CONCLusION: These data suggest a striking discrepancy between ATs’ perceived knowledge and competence in managing athletes with MHDs. Our findings will contribute to the currently limited sports medicine literature examining ATs’ competence and experiences with MHDs. Clinical implications, including the development of standards of care and clinical decision rules will be discussed. 1815 Board #2 May 30, 5:45 PM - 6:45 PM Examining Neurocognitive Function in Previously Concussed high school Female soccer Players Cameron R. Forbes, Joseph J. Glutting, Thomas W. Kaminski, FACSM. University of Delaware, Newark, DE. Care of sport-related concussions in soccer has gained recent attention in the medical community. Interestingly, purposeful heading_a unique, yet strategic and inherent part of soccer involves repeated sub-concussive blows to the head. Of importance, the developing female adolescent brain seems vulnerable to deficits in neurocognition and physical symptoms associated with sustaining a concussion. PurPOsE: To determine whether previous concussion history produces a decline in neurocognitive performance and concussion-related symptoms over the course of a competitive season when compared to healthy controls. METhOds: 210 female interscholastic soccer players were equally divided into control [CON] (never concussed) and experimental [EXP] (previously concussed) groups. We assessed neurocognitive performance using the ANAM (Automated Neuropsychological Assessment Metrics) computer program before and after their competitive season. Throughput scores, which measure cognitive speed and accuracy, were computed for seven subtests on the ANAM. In addition, total concussion symptom checklist (CSC) scores were gathered on each subject. Headers were recorded at all sanctioned matches throughout the season. Data were analyzed using a series of one-way ANCOVAs. Covariates comprised pretest scores on the dependent variables under consideration (ANAM and CSC scores), age, height, weight, and the total number of headers. Missing values were handled using multiple imputation. rEsuLTs: Despite having played in more games (16.1 vs. 12.9), the EXP had fewer total headers than the CON (24.9 vs. 28.1). Additionally, headers per game were surprisingly low in both groups (1.4 in EXP vs. 1.2 in CON). Unexpectedly, there were no significant differences between the EXP and CON across all dependent variables measured (p > .05). CONCLusION: History of previous concussion has been reported to increase subsequent concussion risk as much as fourfold. This study suggests that although previously concussed subjects involve themselves in purposeful heading (i.e. subconcussive insults) throughout a competitive season, there appears to be no additional risk for a decline of neuropsychological test performance or concussion symptoms. Additional research is needed as to what may result over the course of a playing career. 1816 Board #3 May 30, 5:45 PM - 6:45 PM Vestibular and Cognitive Impairment in athletes with Protracted Concussion Anthony P. Kontos 1 , R J. Elbin 2 , Jonathan French 3 , Michael Collins 3 . 1 University of Pittsburgh- School of Medicine, Pittsburgh, PA. 2 University of Pittsburgh-School of Medicine, Pittsburgh, PA. 3 UPMC Sports Medicine Concussion Program, Pittsburgh, PA. A “miserable minority” (~20%) of athletes require more than 21 days to recover from concussion. Researchers and clinicians have speculated that vestibular impairments may play a role in this protracted or “chronic” concussion population. PurPOsE: To compare cognitive performance and symptoms of athletes with and without vestibular impairments following protracted concussion. METhOds: A comparative cross-sectional design involving 48 athletes (28 males, 20 females) aged 9 to 23 yrs (M= 15.28, SD= 3.00) with a diagnosed protracted (>21 days since injury) concussion. Participants completed a computerized neurocognitive test and symptom report at their initial clinic visit. At this time, a health care provider trained in sport-related concussion and vestibular assessment completed a vestibular screening form for each athlete, which includes clinical interview and exams covering three domains: vestibular dizziness, vestibulo-spinal, vestibulo-ocular. Visual convergence and accommodation distances were also measured. Analyses included ANOVAs with Bonferroni adjustment (p6 cm) convergence distance scored lower on RT (F=3.96, p=.05) than those without. A dose-response for vestibular impairments was supported for total (F=4.59, p=.007), cognitive (F=3.25, p=.03), somatic (F=8.43, p=.001) and sleep (F=3.56, p=.02) symptoms. Non-significant dose-response trends for vestibular impairment on cognitive performance were also supported. CONCLusIONs: Athletes with vestibular impairment from protracted concussion experience slower RT and more symptoms than those without. Brief vestibular Vol. 45 No. 5 Supplement S351 assessments may help identify these athletes for targeted therapies. This research was supported by the Albert B. Ferguson, Jr. M.D. Orthopaedic Fund of the Pittsburgh Foundation Research Grant. 1817 Board #4 May 30, 5:45 PM - 6:45 PM Test-retest and Inter-rater reliability Of The Functional Lower Extremity Evaluation Melissa Hodgins1 , Karyn Haitz1 , Rebecca Shultz2 , Gordon Matheson2 . 1Stanford University, STANFORD, CA. 2Stanford University, Stanford, CA. PurPOsE: The Functional Lower Extremity Evaluation (FLEE) is a standardized testing protocol that may be a valuable tool in return to play decision making for measuring lower extremity function and assessing re-injury risk factors. This study aimed to establish the test-retest and inter-rater reliability of the FLEE. METhOds: FLEE is a battery of tests (Table 1) that were administered and rated for 40 uninjured student athletes from various disciplines. Each athlete was tested twice, one week apart, to assess test-retest reliability. The same research intern administered and scored all tests during both sessions, whereas a physical therapist and an athletic trainer scored only one session per athlete to determine inter-rater reliability. The intern was blinded to first session scores during the second session, and all raters were blinded to each other. For six of the tests (excluding “Lateral Leap and Catch” and “LEFT” tests), limb symmetry means were calculated and 95% confidence intervals of the three scores using a one-sample t-test. The LEFT (Lower Extremity Functional Test) was not included in this study as it requires a learning session. rEsuLTs: Inter-rater reliability was shown to be in the excellent range (0.80 to 1.00) for all tests (Table 1). Test-retest reliability was also excellent for all tests except for the “Timed Lateral Step Down,” for which it was moderate (0.60 to 0.80). CONCLusION: FLEE is a reliable assessment tool. Future studies should investigate the validity of FLEE to reduce re-injury rates. Table 1 Results for test-retest (Pearson’s correlation), inter-rater ( Intra-class correlation coefficient (ICC)), limb symmetry means and 95% confidence interval using the FLEE test for healthy athletes. Pearson ICC Limb Symmetry Limb Symmetry (test(inter- Mean [%] 95% CI retest)rater) Timed Lateral Step 0.772 0.829 114.4 [102.3, 126.4] Down Lateral Leap and 0.731 0.846 -- -- Catch Single Leg Hop for 0.912 0.996 97.3 [97.8, 102.0] Distance Timed Hop 0.917 0.891 98.6 [97.0, 100.3] Triple Hop 0.948 0.996 98.6 [96.8, 100.4] Crossover Hop 0.942 0.997 100.2 [98.0, 102.3] Square Hop 0.833 0.982 102.2 [93.7, 110.7] 1818 Board #5 May 30, 5:45 PM - 6:45 PM Tingling and Weakness - Gymnastics Nailah Coleman, FACSM. Children’s National Medical Center, Alexandria, VA. (No relationships reported) hIsTOry: 16 y/o gymnast presented with sharp right patellar tendon pain and midlower back pain after two separate vault injuries within the prior two weeks. Her pain was exacerbated by movement and use of her knee and back. She denied sedentary pain, sleep disturbance, or bowel-bladder insufficiency. She noted atraumatic “pins and needles” on her right dorsal hand over the past five days but denied neck, elbow, or jaw pain or injury. Her past medical and surgical histories were unremarkable. Her only medicine was Aleve. She had no known allergies. Exam: she was WDWN in NAD. She had symmetric appearance of her extremities and a minimal curvature of her spine. She had a normal gait and was able to heel, toe, and duck walk. She was nontender to palpation. She had full motion of her trunk and extremities but pain with lumbar extension. Strength, sensation, and neurovascular status were intact and symmetric, except for 4+/5 strength in the right upper extremity. She had right hand cramping with elevated arm stress test and right shoulder pain with empty can, O’Brien’s test, and Speed’s test. PhysICaL EXaMINaTION: •Spinal cord lesion •Nerve root compression •Peripheral nerve disease •Patellar tendinitis •Spondylolysis •Back strain TEsTs aNd rEsuLTs X-rays •Cervical spine with oblique views: increased transverse processes Abstracts were prepared by the authors and printed as submitted. Thursday, May 30, 2013
Thursday, May 30, 2013 S352 Vol. 45 No. 5 Supplement •Scoliosis views: minimal curvature •Lumbar spine with oblique views: normal •Shoulder: normal •Knee: normal MRI •Spine: a lesion at C4-C5 measuring 5 mm (width) x 15 mm (cranial-caudal) with mild enhancement, which could signal a demyelinating process, tumor, or trauma. •Brain: findings suggestive of volume loss without evidence of gliosis or demyelination process. Final Working Diagnosis: transverse myelitis TrEaTMENT aNd OuTCOMEs •Urgently seen by Neurology and admitted from clinic with a progressively symptomatic exam, including hyperreflexia and clonus. •CSF and serum studies for infectious and rheumatologic diseases were normal, except for an elevated ANA. A definitive etiology has not been found. •She was given a three-day course of methylprednisolone and responded well. •She was discharged home with plans for Neuro-Ophthalmology, PM&R, and repeat imaging. •New studies are pending. 1819 Board #6 May 30, 5:45 PM - 6:45 PM Functional Movement screen is a Poor Predictor of Injury in division I athletes Meghan Warren 1 , Craig A. Smith 1 , Ryan Pinson 1 , Nicole J. Chimera 2 . 1 Northern Arizona University, Flagstaff, AZ. 2 Daeman College, Amherst, NY. The Functional Movement Screen (FMS) evaluates performance in deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability pushup, and rotational stability using a 4 point ordinal scale (3-0). A summed FMS score of 14 or less has been associated with increased risk of serious injury (i.e., 3 wks inactivity) in professional football players and lower extremity injury in female Division II volleyball, basketball, and soccer athletes. These studies are limited to specific sports and injury definition. PurPOsE: To determine the association between FMS total score and component scores and non-contact and overuse injuries in Division I (DI) athletes. METhOds: 170 athletes (20.2 ± 1.5 yrs, 1.77±0.10 m, 79.2± 20.7 kg, n = 89 male), injury-free at the time of testing, completed the FMS prior to their respective seasons. Athletes competed in their season and any injury that caused the athlete to report to the athletic training room was collected. Contact injuries were excluded. ROC curves were created to determine the best FMS cut-points (7, 10, 12, 14, 16, 18) for predicting injury. An independent t-test assessed differences in mean FMS between those injured or not. Logistic regression determined the odds of injury with FMS total score and components. History of previous injury and sex were included in the models as confounders. rEsuLTs: 74 athletes were injured during their sport season. FMS total score was not different between those who sustained an injury (14.3±2.5) and those who did not (14.1±2.4; p = 0.57). No ROC curve maximized sensitivity and specificity, so previous published cut-point of 14 or less (n=92) vs. greater than 14 (n=78) was used for analysis with injury (sensitivity = 54%, specificity 46%). After adjustment for confounders, no statistically significant association between FMS total score (dichotomoized at 14) and injury (odds ratio [OR] = 1.02, 95% confidence interval [CI] 0.54 - 2.0) existed. Lunge was the only component that was statistically associated with injury; those scoring 3 were less likely to have an injury compared with those who scored 2 (OR = 0.21, 95% CI 0.08 - 0.58). CONCLusIONs: Using a clinically relevant definition of injury, FMS total score was a poor predictor of non-contact and overuse injury in this group of DI athletes. The lunge was able to predict injury. 1820 Board #7 May 30, 5:45 PM - 6:45 PM Exercise related syncope In active duty soldiers Chad Asplund. Eisenhower Army Medical Center, Fort Gordon, GA. PurPOsE: To better characterize the prevalence of exercise related syncope (ERS) in an active duty military population as well as examine possible factors associated with ERS. Methods and Study Design: Cohort study design. The Armed Forces Health Longitudinal Technical Application (AHLTA) electronic health record was queried for all cases of syncope (780.2) seen at Eisenhower Army Medical Center in primary care clinics from 2005-2010 and charts were reviewed. Those with syncope related to exercise had charts followed prospectively until completion of specialty evaluation and diagnosis. Main outcome measure was a medical diagnosis requiring restriction from duty or from participation in sports. Demographic data analyzed with descriptive statistics and main outcome measure with multiple logistic regression. rEsuLTs: 123 total cases of syncope and 58 cases of ERS were reviewed. 40 cases had witnessed collapse, 16 cases were found to have a medical etiology (6 neurological, 3 pulmonary, 3 cardiac, 2 migraine, 2 heat related), 24 had unexplained etiology. Average age was 25.67 +/- 5.92 (range 18-39) years. After controlling for age, past medical history, history of collapse, and smoking, those Soldiers with a history of MEDICINE & SCIENCE IN SPORTS & EXERCISE ® migraine headaches were 11.3 times more likely to have a medical etiology associated with their exercise related syncope compared to those without migraine (p
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