Browsing by Author "Schneider, Kathryn J."
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Item Open Access Advancing Concussion Assessment in Pediatrics (A-CAP): a prospective, concurrent cohort, longitudinal study of mild traumatic brain injury in children: protocol study(BMJ, 2017-07-01) Yeates, Keith O.; Beauchamp, Miriam; Craig, William; Doan, Quynh; Zemek, Roger; Bjornson, Bruce H.; Gravel, Jocelyn; Mikrogianakis, Angelo; Goodyear, Bradley; Abdeen, Nishard; Beaulieu, Christian; Dehaes, Mathieu; Deschenes, Sylvain; Harris, Ashley D.; Lebel, Catherine; Lamont, Ryan; Williamson, Tyler; Barlow, Karen M.; Bernier, Francois; Brooks, Brian L.; Emery, Carolyn; Freedman, Stephen B.; Kowalski, Kristina; Mrklas, Kelly; Tomfohr-Madsen, Lianne; Schneider, Kathryn J.Introduction Paediatric mild traumatic brain injury (mTBI) is a public health burden. Clinicians urgently need evidence-based guidance to manage mTBI, but gold standards for diagnosing and predicting the outcomes of mTBI are lacking. The objective of the Advancing Concussion Assessment in Pediatrics (A-CAP) study is to assess a broad pool of neurobiological and psychosocial markers to examine associations with postinjury outcomes in a large sample of children with either mTBI or orthopaedic injury (OI), with the goal of improving the diagnosis and prognostication of outcomes of paediatric mTBI. Methods and analysis A-CAP is a prospective, longitudinal cohort study of children aged 8.00-16.99 years with either mTBI or OI, recruited during acute emergency department (ED) visits at five sites from the Pediatric Emergency Research Canada network. Injury information is collected in the ED; follow-up assessments at 10 days and 3 and 6 months postinjury measure a variety of neurobiological and psychosocial markers, covariates/confounders and outcomes. Weekly postconcussive symptom ratings are obtained electronically. Recruitment began in September 2016 and will occur for approximately 24 months. Analyses will test the major hypotheses that neurobiological and psychosocial markers can: (1) differentiate mTBI from OI and (2) predict outcomes of mTBI. Models initially will focus within domains (eg, genes, imaging biomarkers, psychosocial markers), followed by multivariable modelling across domains. The planned sample size (700 mTBI, 300 OI) provides adequate statistical power and allows for internal cross-validation of some analyses. Ethics and dissemination The ethics boards at all participating institutions have approved the study and all participants and their parents will provide informed consent or assent. Dissemination will follow an integrated knowledge translation plan, with study findings presented at scientific conferences and in multiple manuscripts in peer-reviewed journals.Item Open Access Assessing Spatial Orientation Skills in Athletes After Sustaining a Concussion: A Pilot Study(2019-07-03) McFarlane, Liam Heath; Iaria, Giuseppe; Yeates, Keith Owen; Schneider, Kathryn J.; Brooks, Brian L.As a pilot study I investigated whether suffering a sport-related concussion (SRC) affected adolescent hockey participants’ abilities to form and use cognitive maps. To assess cognitive map formation and use a modified version of the Spatial Configuration Task (m-SCT), a computerized tool that has been shown to quantitatively measure an individual’s ability to form and use cognitive maps (Burles, 2014), was administered to a group of 18 adolescent hockey participants suffering from a SRC and a group of 19 adolescent controls with similar age, sex, handedness and no reported history of concussion. Using age as a covariate, an ANCOVA revealed a significant difference between athletes’ with a concussion (M = 42.61, SD = 7.22) m-SCT performances when compared to healthy controls’ (M = 48.32, SD = 8.27; F(1,34) = 5.82, p = .021, d ̂ = -0.72). As a group, adolescent participants with concussion performed significantly worse than the control group. There was no significant difference between groups average response time and no significant correlation between m-SCT performance and athlete reported symptoms on the Sport Concussion Assessment Tool, version 5 (SCAT5). However, a post hoc one-tailed Pearson’s partial correlations analysis revealed that participants with a concussion, as an independent group, show a positive relationship between average response time and performance on the m-SCT (r(15) = .51, p = .038). A discussion is provided and focuses on implications of the observed groups difference in performances on the m-SCT, the study’s limitations and recommendations for future studies wishing to investigate cognitive map formation in adolescents’ athletes with concussion. Additionally, this study also provides preliminary results showing that the Spatial Configuration Task may be modified in difficulty when assessing cognitive map formation in adolescents and children.Item Open Access Changes in exertion-related symptoms in adults and youth who have sustained a sport-related concussion.(2018-12-20) Rutschmann, Trevor Dean; Schneider, Kathryn J.; Toomey, Clodagh M.; Emery, Carolyn A.; Yeates, Keith OwenDesign: Prospective Case-Series Background: Exertional testing is an important component of a multifaceted assessment following concussion, however, the literature evaluating symptom responses to exertion is limited. Objectives: To identify the primary symptoms responsible for the cessation of exertional testing and evaluate changes in post-concussion symptom scores (PCSS) from pre-exertion scores using the Sport-Concussion Assessment tool (SCAT5) at the following timepoints: immediate post- exertion, 1-4 hours post-exertion, 6-12 hours post-exertion and 20-26 hours post-exertion in both youth and adults who have sustained a sport-related concussion. Methods: Forty-five individuals consisting of both youth and adults (range 13-57 years) that were diagnosed with a sport-related concussion and self-reported difficulties with exertion were recruited from a university sports medicine clinic and performed the BCTT. Results: The most commonly reported symptoms reported for the cessation of exertional testing were headache (48.9%), dizziness (44.4%) and pressure in the head (26.7%). The majority (60%) of participants experienced an increase in symptoms from pre-exertion to immediate post exertion, however, collectively 75.8% of the respondents either improved or returned to pre- exertion symptom scores at the 6-12 hour time period. Conclusion: This study found that there were similar responses to exertion between males and females. The results of this study suggest that individuals who experience an exacerbation of concussion symptoms are likely to regress to pre-exertion scores within the same day. Future research with larger sample sizes would allow researchers to evaluate several covariates and their modifying behavior on symptom responses to exertion.Item Open Access The Effect of High-Intensity Exertion on Sport Concussion Assessment Tool 5 Subcomponents(2020-09-12) Burma, Joel Stephen; Schneider, Kathryn J.; Dunn, Jeff F.; Debert, Chantel Teresa; Phillips, AaronIntroduction: The Sport Concussion Assessment Tool 5 (SCAT5) is a commonly used assessment tool following a suspected sport-related concussion. However, little is known how SCAT5 subcomponent scores change following high-intensity exertion. Methods: Participants were recruited from the varsity womens rugby and mens and womens wrestling teams at the University of Calgary. The SCAT5 was administered prior to and following the 30-15 Intermittent Fitness test, where the primary outcome measures included: total symptom scores and severity, standardized assessment of concussion, neurological screening, and balance error during the modified balance error scoring system, as measured with the SCAT5. Wilcoxon signed-rank tests were utilized to evaluate differences in ordinal data between pre- and post-exertion. Bonferroni corrections were performed to account for multiple comparisons (0.05/9, p<0.006). Results: Thirty-seven varsity athletes (median age: 19 years, range: 17-23, 28 female) consented to participate in this investigation. The SCAT5 was administered by trained health care professionals a median of 20 minutes (range: 1–47 minutes) following exertion. No differences were found before and after the exertion test for Post-Concussion Symptom Score total number of symptoms (z=1.05, p=0.29), standardized assessment of concussion (z=-1.98, p=0.048), neurological screen (z=0.58, p=0.56), and modified Balance Error System Score (z=0.37, p=0.71). Conclusions: SCAT5 subcomponent scores were not significantly altered following high-intensity exertion in collision and combative varsity athletes. In agreement with previous literature, a 20 minute recovery period appears to be an acceptable timeframe for SCAT5 subcomponent scores to return to resting/baseline levels.Item Open Access Feasibility, reliability and concurrent validity of a field test of exertion in high school students(2019-07-02) Miutz, Lauren Nicole; Schneider, Kathryn J.; Emery, Carolyn A.; Jordan, Matthew J.; Black, Amanda M.Study Design: Test-retest reliability and concurrent validation study. Background: Exertional testing is an important component of a multifaceted assessment following concussion, however the literature evaluating a non-laboratory field test of exertion is limited. Objectives: 1) To evaluate the feasibility of a field test of aerobic capacity (modified shuttle run test - mSRT), 2) to examine the test-retest reliability of the mSRT, and 3) to evaluate the concurrent validity of a mSRT compared to the Buffalo Concussion Treadmill Test (BCTT) in uninjured high school students. Methods: Sixty uninjured adolescent males enrolled in high school sports performance courses (age 15-16 years) completed the mSRT twice (one week apart) and the BCTT once. Heart rate (HR) utilizing a Polar HR monitor, self-reported rating of perceived exertion (RPE), and overall symptoms were assessed. Results: The mSRT was feasible in high school students, with 95% of participants (n=57) completing all three testing sessions and no adverse events reported. The mSRT had a moderate level (ICC=0.68) of test-retest reliability. The mean difference between peak heart rates on the mSRT1 and BCTT was -2.62 (95% CI -7.14, 1.91). Median HRpeak (187 bpm), RPEpeak (18), and stage achieved (23) was highest following the BCTT. Fatigue or low energy was the most commonly reported symptom following all three testing sessions. Conclusions: This study found that there were similar responses to BCTT and mSRT in uninjured adolescent male participants. Further research to better understand the reliability and concurrent validity in a more heterogeneous sample, including female participants and participants following concussion, is warranted.Item Open Access Heat, cold, and pressure pain thresholds following a sport-related concussion(2020-07-07) Johnstone, Corson; Schneider, Kathryn J.; Debert, Chantel Teresa; Noel, MelanieConcussions are among the most common sport and recreational injuries. Head and neck pain are commonly reported symptoms following concussion, but pain may also occur at regions secondary to the region of primary injury suggesting central sensitization. Central sensitization may be assessed using quantitative sensory testing (QST) to quantify heat (HPT), cold (CPT), and pressure pain thresholds (PPT). Pain thresholds have shown to predict worse prognosis of whiplash associated disorder. However, changes in pain thresholds as a consequence of SRC have not been well evaluated despite acute and persistent pain commonly occurring following SRC. Here we discuss the feasibility of QST among a consecutive sample of patients aged 13-60 that were seen at the Acute Sport Concussion Clinic (ASCC) and local sport medicine clinics in Calgary, Alberta, Canada, and diagnosed with SRC. Pain thresholds in patients with SRC were compared against orthopaedic injured (OI) and uninjured (UI) controls. There were no adverse reactions to QST in patients with SRC. There were no significant differences in heat, cold, and pressure pain thresholds across groups. Of interest, when looking at the data descriptively, patients with SRC had lower median HPTs and higher median CPTs than OI and UI controls as well as higher PPTs than OI controls. Further research including prospective cohort design is warranted to better understand how heat, cold, and pressure pain thresholds may be altered in patients with SRC.Item Open Access Incidence, Risk Factors, and Mechanisms of Concussion and Musculoskeletal Injury in Youth Soccer Players(2019-01-18) Codd, Chevonne; Schneider, Kathryn J.; Emery, Carolyn A.; Yeates, Keith Owen; Palacios-Derflingher, Luz Maria; Reed, NickolasObjective: Assessment of incidence, risk factors, and mechanisms of concussion and musculoskeletal (MSK) injuries in youth soccer players over one outdoor season of play. Methods: Prospective cohort study conducted. Participants completed a pre-season baseline questionnaire (demographic and injury history questions). A team safety advocate collected exposure and injury data. Results: A sample of 361 players (10-18 years) participated. Most injuries were reported in games (37 MSK, 24 concussions). MSK and concussions occurred at a rate (/1000player hours) of 5.47 (95%CI:2.99-9.18) and 3.12 (95%CI:0.13-6.16), respectively in males and 5.26 (95%CI: 3.33-7.89) and 3.66 (95%CI: 2.09-5.94), respectively in females. In a univariate model, female sex [IRRmsk=1.18(95% CI:1.02-1.36), IRRconc=1.18(95%CI:1.02-1.36)], previous concussion [IRRconc=1.07(95%CI:1.01-1.15)], higher level of play [IRR: 1.02(Tier II) to 0.63(Tier IV), reference Tier I] and older age group [IRR:1.48(U13) to 1.72(U14), reference U12] were risk factors for MSK injury and/or concussion. Conclusions: Injuries and concussions are common in youth soccer players.Item Open Access STICK ITT - Study to Increase Current Knowledge of Injuries in Trampoline and Tumbling(2021-01-28) Downie, Sheila; Kenny, Sarah J.; Emery, Carolyn A.; Schneider, Kathryn J.; Doyle-Baker, Patricia K.; van Wyk, NadineObjectives: To examine incidence rates, severity, characteristics, mechanism and potential risk factors for injury in competitive Trampoline and Tumbling (T&T) athletes ages 8 to 25 years. Methods: Competitive T&T athletes were recruited from across Canada to complete an online questionnaire (e.g., demographics, one-year injury history, injury type and location). Injury was defined as an injury that kept the athlete from T&T training and/or competing for more than one day and/or required medical attention. Univariate Poisson regression analyses were used to estimate incidence rates (IR) and incidence rate ratios (IRR), controlling for cluster by club and offset by exposure hour. Differences in rates were estimated across level of competition (sub-elite/elite), sex (male/female), age (years), T&T experience (years) and exposure (training/competition hours). Descriptive statistics (medians, ranges, proportions, 95% confidence intervals) for athlete demographics and injury characteristics are reported. Results: A total of 132 athletes [89 female; median age=14 (range 10-24 years), 43 males; median age 15 (range 9-24)] from 25 clubs completed the survey with 65% reporting at least one T&T related injury in the previous year. A total of 135 injuries were reported (IR 2.01/1000 exposure hours 95%CI 1.69-2.39). The median time-loss was 30 days (range 0-482) and 125/135 (92.5%) of the injured athletes sought medical attention. The injury rate for elite athletes was 115 injuries/100 athletes/year (95% CI 89.4-143.1) and 92 injuries/100 athletes (95%CI 70.8-116.6) for sub-elite. The most common injury locations were the ankle [28% (24/135)] and head/face [18% (24/135)]. Ligament sprains [22% (30/135)] and concussion [17% (23/135)] were the most common injury type. Females reported significantly higher rate of injury than males [IRR 1.49 (95%CI 1.12-1.92)]. Conclusion: This study examined injury incidence in terms of exposure and found females were at greater rate of injury over their male counterparts. Athletes experience ankle, head (concussion) and overuse type injuries as they engage in competitive T&T. Additional prospective research is needed to inform the development of effective injury prevention strategies among these high-risk young athletes.Item Open Access Using Active Video Games to Improve Physical Literacy Levels in Older Adults: A Mixed-Methods Approach(2020-10-02) Campelo, Alexandre Monte; Katz, Larry; Sheehan, Dwayne Patrick; Schneider, Kathryn J.; Parker, James R.; Hall, Nathan D.; Sieppert, Jackie D.The concept of physical literacy has become widely adopted in the past few decades into education, sport, and recreation to support active and healthy lifestyles. Concomitantly, the advancement of technologies, especially those in wearable activity trackers and active video games, has allowed mind-body integrated physical activity, preventing sedentary lifestyles. The implications of technologies to physical literacy seem promising, however, they have been mostly explored in children and youth populations. This thesis explores, in six chapters, the use of active video games in a structured exercise program for older adults in order to improve their physical literacy. The first chapter introduces the thesis topics, the research questions that this thesis seeks to answer. Chapter two presents the relevant literature on the benefits and challenges of using active video games for physical activity promotion, functional skills maintenance, injury, and chronic diseases prevention in the elderly. Based on the literature background, chapter three presents an ecological model to implement active video games as part of exercise programs to improve older adults’ physical literacy. In order to understand the effects of active video game training on older adults’ physical literacy, chapter four presents a randomized controlled trial conducted with community-dwelling older adults. From a total of 40 participants who completed the trial, 15 were selected to provide their perceptions of using technologies to engage in physical activity, which was addressed in chapter five. The mixed-method analysis demonstrated the feasibility of using technologies to improve older adults’ physical literacy, and chapter six summarizes the overall results, limitations, and recommendations for researchers, healthcare providers, policymakers, and technology designers.