Context: Increased injury rates following concussive injury have been attributed to decreased neuromuscular coordination frequently documented following a concussion. However, altered integration between the vestibular system and oculomotor pathways following impacts at subconcussive thresholds implicate all sports-related impacts not just those at a concussive threshold in future musculoskeletal injury. While, several studies have explored the utility of vestibular and oculomotor clinical testing to detect altered neuromuscular control and then correlated those alterations to future injury risk, no research has explored the use of cervical clinical tests in the same capacity. Outcome Measures: Cervical joint position error test, Neck Disability Index and head acceleration. Interventions: Soccer headers, fatigue protocol, soccer headers + fatigue. Objective: To explore the clinical utility of a novel clinical approach to measuring changes in cervical neuromuscular control following subconcussive impacts in a controlled lab environment. Participants: 40 current female colligate club soccer athletes were recruited. Inclusion criteria included between the age of 18 and 25 and a minimum of 4-year soccer heading experience. Setting: Laboratory. Design: A repeated-measures design with 4 groups was utilized to test the hypothesis. Results: A 65%, 54%, and 49% increased error was observed following the soccer heading, fatigue only, and soccer heading + fatigue interventions, respectively. Meanwhile, the controls saw a 6% decrease in neck position error. Concussion: While, cervical joint position error testing was sensitive to decreased neuromuscular coordination following soccer heading, it was not specific enough to rule out an exercise effect in the absence of subconcussive impacts. Further research is warranted to explore the clinical utility and specificity of cervical joint position error testing to measured alterations in supraspinal processing following subconcussive impacts, and how these alterations may lead to decreased coordination and movement of the body during sports-related task.
Kelly Cheever, Jeffrey T. Howard and Keisuke Kawata
Kelly M. Cheever, Jane McDevitt and Jacqueline Phillips
Focused Clinical Question: In concussed patients, are signs and symptoms of cervical dysfunction a cause for delayed symptom resolution and return to play? Clinical Bottom Line: Based on the results of this Critically Appraised Topic, there is some evidence to suggest that the presence of cervical symptoms and cervical dysfunction following sport-related concussion elevates a patient’s risk of delayed recovery and return to play.
Jacqueline Phillips, Kelly Cheever, Jamie McKeon and Ryan Tierney
Near point of convergence (NPC) is an emerging concussion assessment tool and researchers have reported NPC scores using different administration methods which may influence assessment interpretation. The purpose of this study is to investigate the effect of different administrative methods on NPC scores in healthy, active young adults. NPC was measured using two different accommodative rulers and a fingertip, with three different placements. No significant difference in NPC score was observed between rulers. Significant differences were observed between ruler placements. Furthermore, fingertip use was significantly different compared to all ruler placements.