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Tamara C. Valovich McLeod, Megan N. Houston, and Cailee E. Welch

Concussions resulting from sports and recreational activities are a significant concern in the pediatric population. The number of children and adolescents sustaining sport-related concussions is increasing and, as a result, legislation has been passed in all 50 states to ensure appropriate recognition and referral of pediatric athletes following concussion. The developing brain may make the diagnosis, assessment, and management of concussion more challenging for health care providers and requires the use of specific age-appropriate assessment tools. Concussion management must also include considerations for cognitive and physical rest, a collaborative concussion management team that includes medical and school personnel, and more conservative stepwise progressions for returning to school and to physical activity.

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Diane M. Wiese-Bjornstal, Andrew C. White, Hayley C. Russell, and Aynsley M. Smith

The psychology of sport concussions consists of psychological, psychiatric, and psychosocial factors that contribute to sport concussion risks, consequences, and outcomes. The purpose of this paper is to present a sport concussion-adapted version of the integrated model of psychological response to sport injury and rehabilitation (Wiese-Bjornstal, Smith, Shaffer, & Morrey, 1998) as a framework for understanding the roles of psychological, psychiatric, and psychosocial factors in sport concussions. Elements of this model include preinjury psychological risk factors, postinjury psychological response and rehabilitation processes, and postinjury psychological care components. Mapped onto each element of this model are findings from the research literature through a narrative review process. An important caveat is that the subjective nature of concussion diagnoses presents limitations in these findings. Future research should examine psychological contributors to concussion risk, influences of physical factors on psychological symptoms and responses, and efficacy of psychological treatments utilizing theory-driven approaches.

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Sandra J. Shultz

Despite extensive research, we still do not fully understand the biological mechanisms that underlie a female's increased susceptibility for suffering a noncontact ACL injury. While sex differences in neuromuscular control are often implicated, prevention efforts addressing these differences have not resulted in a profound or sustainable reduction in injury rates. This paper will explore two likely scenarios that explain this greater susceptibility in females: (1) females have a structurally weaker ligament that is more prone or susceptible to failure at a given load (scenario #1), or (2) females develop less knee protection and experiences higher relative loads on the ACL (scenario #2). While we have learned much over the last two decades about ACL injury risk in females, much remains unknown. Continued research is of paramount importance if we are to effectively identify those females who are at greatest risk for injury and effectively reduce their susceptibility through appropriate interventions.

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Kathleen F. Janz and Shelby L. Francis

Although there is strong and consistent evidence that childhood and adolescent physical activity is osteogenic, the evidence concerning its sustained effects to adult bone health is not conclusive. Therefore the value of interventions, in addition to beneficial bone adaptation, could be exposure to activities children enjoy and therefore continue. As such, interventions should provide skills, pleasure, and supportive environments to ensure continued bone-strengthening physical activity with age. Until the dose-response as well as timing of physical activity to bone health is more fully understood, it is sensible to assume that physical activity is needed throughout the lifespan to improve and maintain skeletal health. Current federal guidelines for health-related physical activity, which explicitly recommend bone-strengthening physical activities for youth, should also apply to adults.

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Jeffrey J. Martin

In the last 10-20 years sport psychologists have started to emphasize the value of mental strengths such as self-confidence for disability sport athletes (Martin, 2012). The pinnacle of disability sport competition, the Paralympics, is becoming increasingly competitive, suggesting a strong need for athletes to possess effective mental skills. Like the Olympics there is intense pressure to win at the Paralympics. In the current review article I discuss the body of knowledge in sport psychology that focuses on potential direct and indirect determinants of performance in elite disability sport. The review is organized around a personnel developmental model used by Martin (1999, 2005, 2012). This model is a humanistic model and revolves around foundation qualities, psychological methods and skills, and facilitative and debilitative factors. The premise of the model is also similar to McCann's sentiment that “at the Olympics [Paralympics], everything is a performance issue” (2008, p. 267).

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Guillaume Lamotte, Elizabeth Skender, Miriam R. Rafferty, Fabian J. David, Steve Sadowsky, and Daniel M. Corcos

Objective:

This paper reviews the therapeutically beneficial effects of progressive resistance exercise training (PRET) on motor and nonmotor symptoms in Parkinson's disease (PD).

Methods:

First, we perform a systematic review of the literature on the effects of PRET on motor signs of PD, functional outcomes, quality of life, and patient perceived improvement, strength, and cognition in PD. Second, we perform a meta-analysis on the motor section of the UPDRS. Finally, we discuss the results of our review and we identify current knowledge gaps regarding PRET in PD.

Conclusion:

This systematic review synthesizes evidence that PRET can improve strength and motor signs of Parkinsonism in PD and may also be beneficial for physical function in individuals with PD. Further research is needed to explore the effects of PRET on nonmotor symptoms such as depression, cognitive impairment, autonomic nervous system dysfunction, and quality of life in individuals with PD.

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John B. Bartholomew

Numerous interventions have been designed to modify children's physical activity and eating behaviors. While early research centered on the individual as the target of intervention, more recent work targets change in the environment. These studies have consistently supported the importance of environmental contributors to both physical activity and eating behavior, but little research has considered those who are responsible for implementing environmental change. For example, if we expect school environments to support activity and healthy eating, we must consider the motivation of school administrators to affect change. This review will present examples of an ecological approach to behavior change along with recent data to support this approach.

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James H. Rimmer

People with newly acquired and existing disability have one of the highest rates of physical inactivity compared with any other subgroup in the United States. For more than 50 million Americans with disabilities, lack of regular exercise increases their risk for developing the health problems associated with a sedentary lifestyle. Professionals in rehabilitation and exercise science must join forces in promoting higher levels of physical activity among people with newly acquired or existing disability after they are discharged from rehabilitation. Establishing a strong and cohesive relationship between rehabilitation providers and exercise professionals at the ‘infection point’ when rehabilitation ends and sustainable exercise must begin will capture individual awareness and knowledge of how and why extending the recovery process into community-based exercise facilities has substantial potential for improving their health and quality of life.

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Barry Braun

The concept that participation in exercise/physical activity reduces the risk for a host of chronic diseases is undisputed. Along with adaptations to habitual activity, each bout of exercise induces beneficial changes that last for a finite period of time, requiring subsequent exercise bouts to sustain the benefits. In this respect, exercise/physical activity is similar to other “medications” and the idea of “Exercise as Medicine” is becoming embedded in the popular lexicon. Like other medications, exercise has an optimal dose and frequency of application specific to each health outcome, as well as interactions with food and other medications. Using the prevention of type-2 diabetes as an exemplar, the application of exercise/physical activity as a medication for metabolic “rehabilitation” is considered in these terms. Some recommendations that are specific to diabetes prevention emerge, showing the process by which exercise can be prescribed to achieve health goals tailored to individual disease prevention outcomes.