Kevin M. Guskiewicz
“Concussion” is all over the news, and—yes—it has implications for combating chronic diseases such as obesity and diabetes. Many parents are pushing their children away from collision sports such as football, hockey, and lacrosse because they fear the risk of chronic neurodegenerative problems later in life. However, there is good logic in emphasizing the importance of physical activities such as collision type sports, during the developmental years. Physical educators, researchers, policy makers, and coaches must work together to encourage safe play and rules changes that can keep youth and adolescents active in sports that build character, discipline, and teach teamwork. Understanding the complexity of the highly adaptable adolescent brain both prior to and following sport-related concussion is critically important in accomplishing this goal.
Kevin Guskiewicz and Elizabeth Teel
In order to promote the most successful outcomes following concussion, a multifaceted team of individuals is required for appropriate injury diagnosis and management. This review explores the primary roles of sports medicine personnel in the concussion diagnosis and management process. We will discuss the psychometric properties, including sensitivity, specificity, and clinical utility, of on-field/sideline, laboratory, and neurophysiological assessment tools. Additionally, we will discuss the roles of other kinesiology experts in concussion management and recovery, and their importance to concussion research. By developing a thorough and consistent roadmap for concussion management, clinicians and researchers will be capable of providing athletes with the most successful outcomes.
Kevin M. Guskiewicz
Kevin M. Guskiewicz and David H. Perrin
Returning athletes to competition following injury often creates a dilemma for athletic trainers and team physicians. Most clinicians gather as much data as possible before deciding whether to return an athlete to competition following injury. The status of the postural control system and balance is important for certain pathologies and therefore should be considered in these clinical decisions. As more high-tech balance systems become available, it is important for clinicians to understand not only what is available but what these devices measure. This paper will review the relationship between the postural control system and the kinetic chain, traditional and contemporary techniques for assessing balance, and ways in which clinicians can bridge the gap between balance research and clinical practice.
Bryan L. Riemann and Kevin M. Guskiewicz
Mild head injury (MHI) represents one of the most challenging neurological pathologies occurring during athletic participation. Athletic trainers and sports medicine personnel are often faced with decisions about the severity of head injury and the timing of an athlete's return to play following MHI. Returning an athlete to competition following MHI too early can be a catastrophic mistake. This case study involves a 20-year-old collegiate football player who sustained three mild head injuries during one season. The case study demonstrates how objective measures of balance and cognition can be used when making decisions about returning an athlete to play following MHI. These measures can be used to supplement the subjective guidelines proposed by many physicians.
Kevin M. Guskiewicz
Column-editor : Brent L. Arnold
Bryan L. Riemann, Kevin M. Guskiewicz and Edgar W. Shields
Although sophisticated forceplate systems are available for postural stability analyses, their use is limited in many sports medicine settings because of budgetary constraints. The purpose of this investigation was to compare a clinical method of evaluating postural stability with a force-platform sway measure. Participants completed a battery of three stance variations (double, single, and tandem) on two different surfaces (firm and foam) while standing on a force platform. This arrangement allowed for simultaneous comparisons between forceplate sway measures and clinical assessments using the Balance Error Scoring System (BESS). Significant correlations were revealed for the single-leg and tandem stances on the firm surface and for double, single, and tandem stances on the foam surface. These results suggest that the BESS is a reliable method of assessing postural stability in the absence of computerized balance systems.
Mary E. Ubinger, William E. Prentice and Kevin M. Guskiewicz
When the upper extremity is injured, open kinetic chain (OKC) exercises are primarily used to increase strength and restore functional ability—the goals of rehabilitation. It is also imperative, however, that the receptors responsible for static and dynamic stabilization of the joint be trained. This can be done with closed kinetic chain (CKC) exercises. The purposes of this study were to investigate the effect of a 4-week CKC training program on the neuromuscular control of the upper extremity and to determine whether there was a significant difference between skill-dominant limb and nondominant limb stability indices. Thirty-two physically active participants (14 men, 18 women) were tested on the FASTEX 4 weeks apart. The training group's scores significantly improved, whereas the control group's scores remained the same. It was concluded that the CKC training significantly improved the training group's ability to remain stable. The results suggest that CKC training can increase the accuracy of joint position sense because of increased stimulation of the mechanoreceptors.
Kevin M. Guskiewicz, Gregory G. Degnan and Thomas L. Schildwachter
Ligamentous injuries of the wrist and hand are the most common upper extremity injuries seen in young athletes. Unfortunately, these injuries are also the most frequently misdiagnosed. The “sprained wrist” often becomes the diagnosis of convenience, especially once a fracture has been ruled out. In many cases the athlete is treated symptomatically with cryotherapy, immobilization, and rest, and returns to activity as pain allows. Concern, however, has increased recently over potential complications related to associated ligamentous injuries in young athletes. The most common recognized, carpal instability is between the scaphoid and the lunate, the so-called scapholunate dissociation (3).