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Effect of a High-Intensity Intermittent-Exercise Protocol on Neurocognitive Function in Healthy Adults: Implications for Return-to-Play Management After Sport-Related Concussion

Enda F. Whyte, Nicola Gibbons, Grainne Kerr, and Kieran A. Moran

Context: Determination of return to play (RTP) after sport-related concussion (SRC) is critical given the potential consequences of premature RTP. Current RTP guidelines may not identify persistent exercise-induced neurocognitive deficits in asymptomatic athletes after SRC. Therefore, postexercise neurocognitive testing has been recommended to further inform RTP determination. To implement this recommendation, the effect of exercise on neurocognitive function in healthy athletes should be understood. Objective: To examine the acute effects of a high-intensity intermittent-exercise protocol (HIIP) on neurocognitive function assessed by the Symbol Digits Modality Test (SDMT) and Stroop Interference Test. Design: Cohort study. Setting: University laboratory. Participants 40 healthy male athletes (age 21.25 ± 1.29 y, education 16.95 ± 1.37 y). Intervention: Each participant completed the SDMT and Stroop Interference Test at baseline and after random allocation to a condition (HIIP vs control). A mixed between-within-subjects ANOVA assessed time- (pre- vs postcondition) -by-condition interaction effects. Main Outcome Measures: SDMT and Stroop Interference Test scores. Results: There was a significant time-by-condition interaction effect (P < .001, η 2 = .364) for the Stroop Interference Test scores, indicating that the HIIP group scored significantly lower (56.05 ± 9.34) postcondition than the control group (66.39 ± 19.6). There was no significant time-by-condition effect (P = .997, η 2 < .001) for the SDMT, indicating that there was no difference between SDMT scores for the HIIP and control groups (59.95 ± 10.7 vs 58.56 ± 14.02). Conclusions: In healthy athletes, the HIIP results in a reduction in neurocognitive function as assessed by the Stroop Interference Test, with no effect on function as assessed by the SDMT. Testing should also be considered after high-intensity exercise in determining RTP decisions for athletes after SRC in conjunction with the existing recommended RTP protocol. These results may provide an initial reference point for future research investigating the effects of an HIIP on the neurocognitive function of athletes recovering from SRC.

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Is Poor Hamstring Flexibility a Risk Factor for Hamstring Injury in Gaelic Games?

Siobhán O’Connor, Noel McCaffrey, Enda F. Whyte, Michael Fop, Brendan Murphy, and Kieran A. Moran

Context: Hamstring injuries are a leading cause of injury in Gaelic games. Hamstring flexibility as a risk factor for hamstring injury has not yet been examined prospectively in Gaelic games. Objective: To examine whether hamstring flexibility, using the modified active knee extension (AKE) test, and previous injury are risk factors for hamstring injury in Gaelic players and to generate population-specific AKE cutoff points. Design: Prospective cohort study. Setting: School and colleges. Patients (or Other Participants): Adolescent and collegiate Gaelic footballers and hurlers (n = 570). Intervention(s): The modified AKE test was completed at preseason, and hamstring injuries were assessed over the course of one season. Any previous hamstring injuries were noted in those who presented with a hamstring injury. Main Outcome Measures: Bilateral AKE scores and between-leg asymmetries were recorded. Receiver operating characteristic curves were implemented to generate cutoff points specific to Gaelic players. Univariate and backward stepwise logistic regression analyses were completed to predict hamstring injuries, hamstring injuries on the dominant leg, and hamstring injuries on the nondominant leg. Results: Mean flexibility of 64.2° (12.3°) and 64.1° (12.4°) was noted on the dominant and nondominant leg, respectively. Receiver operating characteristic curves generated a cutoff point of < 65° in the AKE on the nondominant leg only. When controlled for age, AKE on the nondominant leg was the only predictor variable left in the multivariate model (odds ratio = 1.03) and significantly predicted hamstring injury (χ2 = 9.20, P = .01). However, the sensitivity was 0% and predicted the same amount of cases as the null model. It was not possible to generate a significant model for hamstring injuries on the dominant leg (P > .05), and no variables generated a P value < .20 in the univariate analysis on the nondominant leg. Conclusions: Poor flexibility noted in the AKE test during preseason screening and previous injury were unable to predict those at risk of sustaining a hamstring strain in Gaelic games with adequate sensitivity.

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Are Irish Athletic Therapy Students Confident in Concussion Assessment and Management? A Cross-Sectional Study of Final Year Students’ Self-Efficacy

Anna P. Postawa, Enda F. Whyte, and Siobhán O’Connor

Concussion is one of the most challenging injuries for sports medicine clinicians. It is crucial that students develop high self-efficacy for concussion-relevant skills during professional education, as it impacts the quality of their patient care. This study aimed to explore Irish final year athletic therapy students’ self-efficacy in concussion assessment and management and the factors that impact its development. Participants’ level of self-efficacy varied, from low to high, depending on the skill assessed. Lack of practice and lecturer’s positive feedback impacted student self-efficacy the most. Educators should provide students with an opportunity to practice their skills in an environment that facilitates feedback.