The issue of concussion in sport is a matter of global public interest that is currently under dispute by educational, legal, and medical professionals and scientists. In this article we discuss the problem from philosophical, bioethical, and sports ethical perspectives. We articulate conceptual differences in approaches to definition and therefore diagnosis of concussion. We critically review similarities and differences in the leading consensus statements that guide the treatment of concussion diagnosis and treatment in sports. We then present a series of ethical problems including issues that relate to paternalistic intervention in the lives of athletes in order to prevent harm to athletes, conflicting and competing interests, and confidentiality.
Michael J. McNamee, Bradley Partridge, and Lynley Anderson
Charles R. Thompson
The incidence of concussions and potential for long-term health effects has captured the attention of the media, general public, medical professionals, parents, and obviously the athletes themselves. Concussions have been blamed for a variety of mental and physical health issues. The athletic trainer is at the forefront of the concussion management team, as they are typically on the scene when the concussion occurs and are often the first medical personnel to evaluate and, hopefully, remove the athlete from activity. There has been controversy of late regarding the influence of coaches in the care of concussed athletes. Therefore, a move to the “medical model” of sports medicine management can go a long way in resolving conflict of interest issues regarding the care of concussed athletes. A comprehensive concussion team and protocol are also essential to providing the highest level of care. This article takes a closer look at concussion management in the collegiate arena, with a particular focus on Princeton University.
In the article by Whitall, J., “Physical Activity Alone May Enhance Health But it May Not Reduce Disability in Chronic Stroke Survivors,” in Kinesiology Review, 4(1), pp. 3–10, http://dx.doi.org/10.1123/kr.2014-0072, the affiliation listed for the author was incomplete. In addition to the Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, Jill Whitall is affiliated with the Faculty of Health Sciences, University of Southampton, Southampton, England. The online version of the article has been corrected.
Maureen R. Weiss
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.
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.
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.
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.
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).
Guillaume Lamotte, Elizabeth Skender, Miriam R. Rafferty, Fabian J. David, Steve Sadowsky, and Daniel M. Corcos
This paper reviews the therapeutically beneficial effects of progressive resistance exercise training (PRET) on motor and nonmotor symptoms in Parkinson's disease (PD).
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.
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.