We would like to thank the Canadian Institutes of Health Research (CIHR) who have provided funding for this research. Further, we would like to acknowledge Dr. Tim Taha and Dr. Scott Thomas from the University of Toronto for their assistance with the development of our protocol for the collection of resting state heart rate variability data.

O protocolo descrito inclui pré-lesão testing / linha de base e pós-lesão avaliação follow-up e é conduzido em três estações. Este ensaio pode ser completado individualmente ou em grupos de quatro indivíduos em cada estação de cada vez. Assuntos proceder em cada estação na ordem listada abaixo. A tabela 1 ilustra esquema de administração de testes do protocolo. Aprovação ética para a pesquisa foram obtidos a partir de Ética em Pesquisa Board Holland Bloorview na Holanda Bloorview Crianças Hospital de Reabilitação. Todos os participantes e seus responsáveis ​​legais fornecem assinado o consentimento informado antes de completar o protocolo e coleta de dados relacionados. Pré-lesão Testing / Base 1 Estação 1: Obtenção de pré-lesão informações demográficas, pós-concussão Sintoma Relatório e Resting Estado Variabilidade da Frequência Cardíaca (VFC) de dados <ol><li> Antes de submeter (s) que chegam para o teste, certifique-se todos os equipamentos é funçãoing corretamente e pronto para ser testado e que os quartos de avaliação são livre de distrações desnecessárias. </li><li> Depois de analisar o consentimento dos pais e sujeito, medir e registrar a altura eo peso do indivíduo. Configurar monitor de correias e relógios de freqüência cardíaca em cada assunto adequadamente. </li><li> Administrar o formulário de informações demográficas e recolher relatório sintoma pós-concussão usando a versão infantil do pós-concussão (Inventário de Sintomas PCSI-C), enquanto que cada sujeito está sentado por 5 min. </li><li> Faça com que cada assunto estava em decúbito dorsal no chão sobre uma esteira higienizado limpo. Ligue os monitores de freqüência cardíaca de repouso para gravar os dados de estado da variabilidade da freqüência cardíaca (VFC) (com função de intervalo RR ajustado para [Ligado]). Faça com que cada sujeito permanecer deitado em decúbito dorsal em silêncio, sem falar durante 10 minutos durante a gravação de RH. </li><li> Depois de 10 minutos, clique no botão volta no relógio para indicar o fim de deitado de costas descansando coleta de dados HRV estado. Peça ao indivíduo para voltar a uma posição sentada, clique nos bu colotton no relógio novamente para indicar início de estado de repouso sentado coleta de dados HRV. </li><li> Faça com que cada assunto permanecer na posição sentada por 5 minutos sem falar. Depois de 5 minutos, parar a função de gravação relógio para terminar a sessão e descansando coleta de dados HRV estado. Peça ao sujeito para tirar a cinta de frequência cardíaca e relógios. </li></ol> 2. Station 2: Obtenção de Dados de Desempenho Cognitivo <ol><li> Faça com que cada sit assunto em um cubículo indivíduo com um laptop pessoal configurado com um mouse. Certifique-se de testar ambiente é livre de distrações. </li><li> Administrar a avaliação imediata pós-concussão e testes cognitivos (impacto), uma ferramenta de avaliação rápida e informatizada neuropsicológica (cerca de 25 min para completar). </li></ol> 3. Station 3: Obtenção de equilíbrio estático, força de preensão e Agilidade / Motor Skills Dados <ol><li> Administrar a avaliação do equilíbrio estático usando o teste clínico modificado de Sensorial Integration of Balance (m-CTSIB) no sistema balança portátil. Enquanto estava na placa de força, sistema de equilíbrio, o indivíduo completa quatro condições ordenadas, que incluem em pé com os olhos abertos por 20 s; de pé, com os olhos fechados por 20 s; de pé, com os olhos abertos na almofada de espuma indexada por 20 s; e de pé com os olhos fechados na almofada de espuma indexada por 20 s. </li><li> Usando um dinamômetro, medir e força de preensão registro de mãos kg para ambas as mãos direita e esquerda. Registre a mão dominante para cada assunto enquanto ainda concluir 3 tentativas consecutivas para cada mão começando com a mão dominante. Dos três ensaios tomadas, a máxima aderência mão em cada lado, também será gravado. Para cada ensaio, o assunto é contada a apertar o aperto tão duro quanto possível para 3 seg mantendo uma posição de extremidade superior neutro (em pé, reta braço paralelo ao lado do corpo, com a palma voltada para o corpo e punho neutro). </li><li> Em um corredor ou no ginásio, pelo menos, 2,5 m de largura e 15 m de comprimento administrar a agilidade do motor /avaliação de competências com base na avaliação ABI-Challenge (ABI-CA) - Módulo de concussão. Coloque fita adesiva no chão em uma marcação pontos para cada 1 m linear. Na seguinte ordem administrar esses 6 testes seguindo as diretrizes e critérios de pontuação previstos no módulo de concussão. <ol><li> Salto-jacks (cronometrado): <ol><li> Fique em pé com os braços ao lado do corpo e saltar para uma posição de &quot;X&quot; com os braços e pernas, e depois saltar imediatamente para a posição inicial. Contagem de quantos pode ser feito em 15 seg. </li></ol></li><li> Run Pylon / cone pista de obstáculos (Temporário): <ol><li> Correr dentro e fora dos postes até o final (10 m) e de volta tão rápido quanto você pode, mas a uma velocidade que você se sinta seguro. Não toque nos postes. Executar diretamente através da linha de chegada. (Pilões localizados em 3, 5, 7, 10 m) </li></ol></li><li> Backwards conjunto de caminhar (Temporário): <ol><li> Na pista alinhado, andar para trás em um padrão paralelo de 5 m. Padrão Tandem está tocando o calcanhar aos seus oppostoe ite em cada etapa. </li></ol></li><li> Shuttle run modificado (Temporário): <ol><li> Corra ao longo da faixa de 10 m, pegar um saco de feijão no final do curso, e correr de volta para colocar o saquinho de feijão em uma cesta no ponto de partida. Eles devem tocar a linha de partida com o pé cada vez que voltar para a cesta. Repita isso três vezes, até que todos os pufes são na cesta no ponto de partida. </li></ol></li><li> Prós e contras (Temporário): <ol><li> Fique em pé com os dois pés dentro de duas linhas paralelas (no caminho) que são 40 centímetros de distância. Mover um pé fora da linha correspondente, seguido pela perna oposta movimento fora do outro lado da linha. O primeiro pé é, então, devolvida para o interior, seguindo-se o segundo pé. Ciclos devem ser consecutivos e deve ser realizada de forma rítmica (tempo igual entre cada etapa), e será repetido 10x sem se mover para a frente ou para trás. </li></ol></li><li> Salto em extensão parado: Salto para a frente do pé, com os dois pés como far que puder e mantenha o patamar de 3 seg. Medir e registar a distância a partir da frente do pé o mais para trás. Três ensaios são dadas para alcançar a maior distância </li></ol></li></ol> 4 Pós-lesão / Testing Acompanhamento <ol><li> A obtenção de dados pós-concussão enquanto sujeito está experimentando sintomas pós-concussão <ol><li> No mesmo dia, a vítima sofre uma lesão, a equipe de pesquisa é contactado por assunto usando telefone ou e-mail. Equipe de pesquisa registra detalhes clínicos e funcionais em relação à lesão. </li><li> Imediatamente após concussão (24-48 horas pós lesão), recolher: Descanso dados da VFC estado (repita os passos 1.3, 1,5-1,10); dados de sintomas pós-concussão (repita o passo 1.4); e dados do balanço (repita o passo 3.1). Se os sintomas são exacerbados durante os testes, parar a coleta de dados e permitir assunto para descansar. </li><li> Continuar a recolher dados da VFC em repouso estado (repita os passos 1.3, 1,5-1,10), dados de sintomas pós-concussão (repita o passo 1.4), edados do balanço (repita o passo 3.1) semanalmente até que os sintomas pós-concussão ter resolvido. Se os sintomas são exacerbados durante os testes, parar a coleta de dados e permitir assunto para descansar. </li><li> Equipe de pesquisa segue-se com assunto semanal por telefone para determinar quando os sintomas pós-concussão resolver (usando PCSI-C). </li></ol></li></ol> 5 Obtenção de dados pós-concussão enquanto sujeito não é mais a sentir os sintomas pós-concussão <ol><li> Em uma semana depois que os sintomas pós-concussão ter resolvido, coletar: Descanso dados da VFC estado (repita os passos 1.3, 1,5-1,10); dados de sintomas pós-concussão (repita o passo 1.4); dados de desempenho cognitivo (repita os passos de 2,1-2,2); dados do balanço (repita o passo 3.1); Dados da pega (repita o passo 3.2); e, os dados de habilidades agilidade / motor (repita o passo 3.3). Se os sintomas são exacerbados durante os testes, parar a coleta de dados e permitir assunto para descansar. </li><li> Em um mês depois que os sintomas pós-concussão ter resolvido, repita o passo 5.1. Aos 3 meses após o POST-concussion o desaparecimento dos sintomas, repita o passo 5.1. Aos 6 meses após a pós-abalos o desaparecimento dos sintomas, repita o passo 5.1. </li></ol>

<ol>
	<li>McCrory, P., Meeuwisse, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Consensus+statement+on+Concussion+in+Sport+3rd+International+Conference+on+Concussion+in+Sport+held+in+Zurich,+November+2008.">Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008.</a> Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine. 19 (3), 185-200 (2009).</li><li>Kirkwood, M. W., Yeates, K. O., Wilson, P. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+sport-related+concussion:+a+review+of+the+clinical+management+of+an+oft-neglected+population.">Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population.</a> Pediatrics. 117 (4), 1359-1371 (2006).</li><li>Khan, F., Baguley, I. J., Cameron, I. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=4:+Rehabilitation+after+traumatic+brain+injury.">4: Rehabilitation after traumatic brain injury.</a> The Medical journal of Australia. 178 (6), 290-295 (2003).</li><li>Langlois, J. A., Rutland-Brown, W., Wald, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+epidemiology+and+impact+of+traumatic+brain+injury:+a+brief+overview.">The epidemiology and impact of traumatic brain injury: a brief overview.</a> The Journal of head trauma rehabilitation. 21 (5), 375-378 (2006).</li><li>Browne, G. J., Lam, L. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concussive+head+injury+in+children+and+adolescents+related+to+sports+and+other+leisure+physical+activities.">Concussive head injury in children and adolescents related to sports and other leisure physical activities.</a> British Journal of Sports Medicine. 40 (2), 163-168 (2006).</li><li>Emery, C. A., Meeuwisse, W. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Injury+rates,+risk+factors,+and+mechanisms+of+injury+in+minor+hockey.">Injury rates, risk factors, and mechanisms of injury in minor hockey.</a> The American journal of sports medicine. 34 (12), 1960-1969 (2006).</li><li>Keightley, M., Reed, N., Green, S., Taha, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Age+and+competition+level+on+injuries+in+female+ice+hockey.">Age and competition level on injuries in female ice hockey.</a> International journal of sports medicine. 34 (8), 756-759 (2013).</li><li>McCrory, P., Meeuwisse, W. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Consensus+statement+on+concussion+in+sport:+the+4th+International+Conference+on+Concussion+in+Sport+held+in+Zurich,+November+2012.">Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.</a> British journal of sports medicine. 47 (5), 250-258 (2013).</li><li>Krol, A. L., Mrazik, M., Naidu, D., Brooks, B. L., Iverson, G. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+symptoms+in+a+concussion+management+programme:+method+influences+outcome.">Assessment of symptoms in a concussion management programme: method influences outcome.</a> Brain injury: [BI. 25 (13-14), 1300-1305 (2011).</li><li>Williamson, I. J. S., Goodman, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Converging+evidence+for+the+under-reporting+of+concussions+in+youth+ice+hockey.">Converging evidence for the under-reporting of concussions in youth ice hockey.</a> British Journal of Sports Medicine. 40 (2), 128-132 (2006).</li><li>Cassidy, J. D., Carroll, L. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence,+risk+factors+and+prevention+of+mild+traumatic+brain+injury:+results+of+the+WHO+Collaborating+Centre+Task+Force+on+Mild+Traumatic+Brain+Injury.">Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.</a> Journal of Rehabilitation Medicine: Official Journal of the UEMS European Board of Physical and Rehabilitation Medicine. (43 Suppl), 28-60 (2004).</li><li>Collins, M. W., Lovell, M. R., Iverson, G. L., Cantu, R. C., Maroon, J. C., Field, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cumulative+effects+of+concussion+in+high+school+athletes.">Cumulative effects of concussion in high school athletes.</a> Neurosurgery. 51 (5), 1175-1179 (2002).</li><li>Lovell, M. R., Collins, M. W., Iverson, G. L., Johnston, K. M., Bradley, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grade+1+or+&#8220;ding&#8221;+concussions+in+high+school+athletes.">Grade 1 or &#8220;ding&#8221; concussions in high school athletes.</a> The American Journal of Sports Medicine. 32 (1), 47-54 (2004).</li><li>Guskiewicz, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postural+stability+assessment+following+concussion:+one+piece+of+the+puzzle.">Postural stability assessment following concussion: one piece of the puzzle.</a> Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine. 11 (3), 182-189 (2001).</li><li>Guskiewicz, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+postural+stability+following+sport-related+concussion.">Assessment of postural stability following sport-related concussion.</a> Current Sports Medicine Reports. 2 (1), 24-30 (2003).</li><li>Reed, N., Taha, T., Tremblay, L., Monette, G., Keightley, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concussion+and+strength+performance+in+youth+hockey+players.">Concussion and strength performance in youth hockey players.</a> Brain Injury. 26 (4-5), 766 (2012).</li><li>Chevignard, M., Toure, H., Brugel, D. G., Poirier, J., Laurent-Vannier, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comprehensive+model+of+care+for+rehabilitation+of+children+with+acquired+brain+injuries.">A comprehensive model of care for rehabilitation of children with acquired brain injuries.</a> Child: care, health and development. 36 (1), 31-43 (2010).</li><li>Goldstein, B., Toweill, D., Lai, S., Sonnenthal, K., Kimberly, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Uncoupling+of+the+autonomic+and+cardiovascular+systems+in+acute+brain+injury.">Uncoupling of the autonomic and cardiovascular systems in acute brain injury.</a> The American journal of physiology. 275 (4 Pt 2), R1287-R1292 (1998).</li><li>Korpelainen, J. T., Huikuri, H. V., Sotaniemi, K. A., Myllyl&#228;, V. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Abnormal+heart+rate+variability+reflecting+autonomic+dysfunction+in+brainstem+infarction.">Abnormal heart rate variability reflecting autonomic dysfunction in brainstem infarction.</a> Acta neurologica Scandinavica. 94 (5), 337-342 (1996).</li><li>Leddy, J. J., Kozlowski, K., Fung, M., Pendergast, D. R., Willer, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regulatory+and+autoregulatory+physiological+dysfunction+as+a+primary+characteristic+of+post+concussion+syndrome:+implications+for+treatment.">Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post concussion syndrome: implications for treatment.</a> NeuroRehabilitation. 22 (3), 199-205 (2007).</li><li>Covassin, T., Weiss, L., Powell, J., Womack, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+a+maximal+exercise+test+on+neurocognitive+function.">Effects of a maximal exercise test on neurocognitive function.</a> British journal of sports medicine. 41 (6), 370-374 (2007).</li><li>McCrory, P., Collie, A., Anderson, V., Davis, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+we+manage+sport+related+concussion+in+children+the+same+as+in+adults?.">Can we manage sport related concussion in children the same as in adults?.</a> British Journal of Sports Medicine. 38 (5), 516-519 (2004).</li></ol>

The authors have nothing to disclose.

Este protocolo apresenta uma abordagem multi-modal para medir a recuperação em atletas jovens após uma concussão. Uma característica fundamental deste protocolo é a comparação de dados pós-concussão em uma ampla gama de domínios de desempenho (cognição, equilíbrio, força, agilidade, variabilidade da freqüência cardíaca em repouso estado, etc) para pré-lesão / linha de base. Estes dados servem como um meio para indicar a recuperação entre os atletas juvenis individuais, após uma concussão...

Concussão pode ser definida como &quot;um processo fisiopatológico complexo que afeta o cérebro induzidas por forças biomecânicas traumáticas&quot; 1, e pode resultar em sintomas somáticos curto e longo prazo, cognitivos e / ou emocionais / comportamentais 2. Funcionalmente, concussão e sintomas relacionados pode ter um impacto significativo sobre a sua participação nas atividades diárias e atividades 3. Estima-se que nos Estados Unidos, entre 1,6 e 3,8 milhões de concussão ocorrem a cada ano como resultado da participação desportiva 4. Específico para crianças e jovens envolvidas em esportes, concussão é uma das lesões mais comumente relatados 5-7. Apesar do abalo pode ter impacto nas atividades diárias ea prevalência de concussão entre crianças e jovens, ainda há uma falta de dados científicos que relatam a forma como o cérebro responde a juventude concussão através de uma variedade de domínios de desempenho. Linha de base tressante, ou a utilização de escores de testes de pré-lesão como referência para comparação com os escores de testes pós-lesão para informar a recuperação, é uma prática de crescente popularidade no seio da comunidade desporto juvenil e tem sido sugerido internacionalmente 8 para ser &quot;útil para adicionar útil information &quot;(p.3) durante a gestão de concussão. A fim de melhor representar a natureza variada dos sintomas pós-concussão (somáticas, cognitivas e emocionais / comportamentais), é importante que a avaliação da recuperação pós-concussão incluem uma variedade de medidas de resultados. Além disso, a gestão de concussão atual depende muito do relato subjetivo de sintomas pós-concussão. A validade do presente relatório subjetiva pode ser influenciada por uma variedade de fatores 9 e pode levar tanto a sub-notificação de sintomas 10,11 e um índice de menos precisa e confiável de recuperação. Como resultado, existe uma necessidade significativa para explorar abordagens para a medição de recuperação pós-concussão através performandomínios ce que são objetiva e sensível. Demonstrou-se que a cognição, equilíbrio, força e agilidade pode ser prejudicada em jovens após concussão e lesão cerebral 12-17. As medidas incluídas no âmbito deste protocolo de teste foram escolhidos para fornecer informações sobre a recuperação em todos estes domínios seguinte concussão e para incorporar o uso de ferramentas de testes clínicos validados que são comumente usados ​​em diferentes contextos clínicos com foco em gestão de concussão. Além disso, a partir de uma perspectiva mais exploratória, descansando HRV estado pode ser visto como uma medida precisa do balanço simpático 18,19. Em uma população saudável, balanço simpático é definido como o sistema parassimpático ser dominante em repouso, enquanto o sistema simpático está sob controle inibitório tônico. Supõe-se que pós-concussão, devido ao estresse fisiológico, um desequilíbrio entre os dois sistemas irão existir e descansando estado pode mudar a hiperatividade dosistema simpático e hipoatividade do sistema parassimpático 20. O objetivo do protocolo deste estudo é realizar uma avaliação multi-modal de desempenho pré e pós-concussão entre atletas jovens (idades 10-18 anos), a fim de obter uma compreensão mais holística, objetiva e precisa da recuperação após concussão. Este estudo tem como objetivo fornecer uma visão sobre o desenvolvimento e entrega de gerenciamento de concussão e de reabilitação protocolos específicos para crianças e jovens.

<table border="0" cellpadding="0" cellspacing="0" width="584">
	<tbody>
		<tr>
			<td>Name of Reagent/ Equipment</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments/Description</td>
		</tr>
		<tr>
			<td>Scale</td>
			<td>Weight Watchers: Conair&#160;</td>
			<td>WW30WB</td>
			<td></td>
		</tr>
		<tr>
			<td>Measuring Tape</td>
			<td>Hi-Viz Lufkin</td>
			<td>HVC716CME</td>
			<td></td>
		</tr>
		<tr>
			<td>Heart Rate Monitor (Chest Strap and Watch)</td>
			<td>Polar</td>
			<td>RS800CX GPS</td>
			<td></td>
		</tr>
		<tr>
			<td>Exercise/Yoga Mat</td>
			<td>Pur Athletics</td>
			<td>WTE10126</td>
			<td></td>
		</tr>
		<tr>
			<td>Sportline Stopwatch (Model 228)</td>
			<td>EB Sport Group</td>
			<td>#2787</td>
			<td></td>
		</tr>
		<tr>
			<td>Laptop - MacBook Pro</td>
			<td>Apple</td>
			<td>A1278</td>
			<td></td>
		</tr>
		<tr>
			<td>Computerized Cognitive Assessment- Immediate Post-Concussion Assessment and Cognitive Task</td>
			<td>ImPACT Application&#39;s Inc.&#160;</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Hand Grip Dynamometer</td>
			<td>Sammons Preston- Smedley-Type</td>
			<td>5032P</td>
			<td></td>
		</tr>
		<tr>
			<td>BioSway</td>
			<td>Biodex Medical Supplies Inc.&#160;</td>
			<td>950-510</td>
			<td></td>
		</tr>
		<tr>
			<td>Painter&#39;s Mate Green Tape</td>
			<td>ShurTech Brands LLC</td>
			<td>#49462</td>
			<td></td>
		</tr>
		<tr>
			<td>Pylons/Cones (12&#34;)</td>
			<td>Canadian Tire</td>
			<td>84-295-4</td>
			<td></td>
		</tr>
		<tr>
			<td>Basket</td>
			<td>Canadian Tire</td>
			<td>42-9919-2</td>
			<td></td>
		</tr>
		<tr>
			<td>Bean Bags</td>
			<td>Eastpoint/Go Gater</td>
			<td>1-1-16392</td>
			<td></td>
		</tr>
	</tbody>
</table>

a multi-modal approach to assessing recovery in youth athletes following concussion

Concussão é uma das lesões mais comumente relatados entre crianças e jovens envolvidos na participação desportiva. Na sequência de um abalo, os jovens podem experimentar uma variedade de sintomas neurocomportamentais curto e longo prazo (somático, cognitivo e emocional / comportamental) que pode ter um impacto significativo sobre a sua participação nas atividades diárias e atividades de interesse (por exemplo, escola, esportes, trabalho, família / vida social, etc). Apesar disso, ainda há uma escassez na pesquisa clínica conduzida voltado especificamente para explorar abalo na população desporto juvenil e, mais especificamente, as abordagens multi-modal para medir a recuperação. Este artigo fornece uma visão geral de uma novela e uma abordagem multi-modal para medição de recuperação entre os atletas juvenis seguinte concussão. A abordagem apresentada envolve o uso de ambos os pré-lesão / testes de linha de base e pós-lesão / follow-up de testes para avaliar o desempenho em uma ampla variedade de domínios (pós-concussintomas Sion, cognição, equilíbrio, força, agilidade / habilidades motoras e variabilidade da freqüência cardíaca em repouso estado). O objetivo desta pesquisa é obter uma compreensão mais objetiva e precisa de recuperação após concussão em atletas jovens (idades 10-18 anos). Os resultados desta pesquisa podem ajudar a informar o desenvolvimento ea utilização de métodos melhorados para concussão gestão e reabilitação específico para a comunidade esportiva de jovens.

O protocolo apresentado é uma investigação em curso. Tabela 1 apresenta esquema de administração de testes do protocolo. Os resultados representativos são apresentados para demonstrar a viabilidade da recolha de dados de linha de base / pré-lesão e pós-concussão através de uma variedade de domínios de desempenho conhecidos por ser afetados por concussão na juventude. Um único caso de um jovem com uma concussão que tenha completado todas as fases do protocolo é apresentada para demonstrar...

Watch this Scientific Journal Video about A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion at JoVE.com

A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion

This article provides an overview of a multi-modal approach to assessing recovery following concussion in youth athletes. The described protocol uses pre- and post-concussion assessment of performance across a wide variety of domains and can inform the development of improved concussion rehabilitation protocols specific to the youth sport community.

Uma Abordagem Multi-Modal de Recuperação Avaliando em atletas jovens após concussão

Concussion is one of the most commonly reported injuries amongst children and youth involved in sport participation. Following a concussion, youth can ...

a-multi-modal-approach-to-assessing-recovery-youth-athletes-following

Research

JoVE Journal

Medicine

13.3K visualizações.  Holland Bloorview Kids Rehabilitation Hospital. This article provides an overview of a multi-modal approach to assessing recovery following concussion in youth athletes. The described protocol uses pre- and post-concussion assessment of performance across a wide variety of domains and can inform the development of improved concussion rehabilitation protocols specific to the youth sport community.

Vídeo: A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion

An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth involved in organized sports such as competitive hockey are nearly six times more likely to suffer a severe concussion compared to children involved in other leisure physical activities2. While the most common cognitive sequelae of mTBI appear similar for children and adults, the recovery profile and breadth of consequences in children remains largely unknown2, as does the influence of pre-injury characteristics (e.g. gender) and injury details (e.g. magnitude and direction of impact) on long-term outcomes. Competitive sports, such as hockey, allow the rare opportunity to utilize a pre-post design to obtain pre-injury data before concussion occurs on youth characteristics and functioning and to relate this to outcome following injury. Our primary goals are to refine pediatric concussion diagnosis and management based on research evidence that is specific to children and youth. To do this we use new, multi-modal and integrative approaches that will:
 1.Evaluate the immediate effects of head trauma in youth 
2.Monitor the resolution of post-concussion symptoms (PCS) and cognitive performance during recovery 
3.Utilize new methods to verify brain injury and recovery
To achieve our goals, we have implemented the Head Impact Telemetry (HIT) System. (Simbex; Lebanon, NH, USA). This system equips commercially available Easton S9 hockey helmets (Easton-Bell Sports; Van Nuys, CA, USA) with single-axis accelerometers designed to measure real-time head accelerations during contact sport participation 3 - 5. By using telemetric technology, the magnitude of acceleration and location of all head impacts during sport participation can be objectively detected and recorded. We also use functional magnetic resonance imaging (fMRI) to localize and assess changes in neural activity specifically in the medial temporal and frontal lobes during the performance of cognitive tasks, since those are the cerebral regions most sensitive to concussive head injury 6. Finally, we are acquiring structural imaging data sensitive to damage in brain white matter.

This article provides an overview of a multi-modal approach to mild traumatic brain injury diagnosis and recovery in youth. This approach combines neuropsychological testing with functional magnetic resonance imaging and the Head Impact Telemetry System to monitor the relationship between head impacts and brain activity during cognitive testing.

Uma Investigação dos Efeitos da Sports-relacionados concussão na Juventude Utilizando Ressonância Magnética Funcional e do Chefe Sistema de Telemetria de Impacto

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth ...

Medicina

Assessing Teratogenic Changes in a Zebrafish Model of Fetal Alcohol Exposure

Fetal alcohol syndrome (FAS) is a severe manifestation of embryonic exposure to ethanol. It presents with characteristic defects to the face and organs, including mental retardation due to disordered and damaged brain development. Fetal alcohol spectrum disorder (FASD) is a term used to cover a continuum of birth defects that occur due to maternal alcohol consumption, and occurs in approximately 4% of children born in the United States. With 50% of child-bearing age women reporting consumption of alcohol, and half of all pregnancies being unplanned, unintentional exposure is a continuing issue2. In order to best understand the damage produced by ethanol, plus produce a model with which to test potential interventions, we developed a model of developmental ethanol exposure using the zebrafish embryo. Zebrafish are ideal for this kind of teratogen study3-8. Each pair lays hundreds of eggs, which can then be collected without harming the adult fish. The zebrafish embryo is transparent and can be readily imaged with any number of stains. Analysis of these embryos after exposure to ethanol at different doses and times of duration and application shows that the gross developmental defects produced by ethanol are consistent with the human birth defect. Described here are the basic techniques used to study and manipulate the zebrafish FAS model.

In order to understand the molecular mechanisms of the ethanol-induced developmental damage, we have developed a zebrafish model of ethanol exposure and are exploring the physical, cellular, and genetic alterations that occur after ethanol exposure1. We then seek to find potential interventions and rapidly test them in this animal model.

Avaliar as alterações teratogênicos em um modelo de Zebrafish de exposição fetal ao álcool

Fetal alcohol syndrome (FAS) is a severe manifestation of embryonic exposure to ethanol. It presents with characteristic defects to the face and organs, ...

Multi-modal Imaging of Angiogenesis in a Nude Rat Model of Breast Cancer Bone Metastasis Using Magnetic Resonance Imaging, Volumetric Computed Tomography and Ultrasound

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell proliferation in the bone marrow cavity as well as for interaction of tumor and bone cells resulting in local bone destruction. Our aim was to develop a model of experimental bone metastasis that allows in vivo assessment of angiogenesis in skeletal lesions using non-invasive imaging techniques.
For this purpose, we injected 105 MDA-MB-231 human breast cancer cells into the superficial epigastric artery, which precludes the growth of metastases in body areas other than the respective hind leg1. Following 25-30 days after tumor cell inoculation, site-specific bone metastases develop, restricted to the distal femur, proximal tibia and proximal fibula1. Morphological and functional aspects of angiogenesis can be investigated longitudinally in bone metastases using magnetic resonance imaging (MRI), volumetric computed tomography (VCT) and ultrasound (US).
MRI displays morphologic information on the soft tissue part of bone metastases that is initially confined to the bone marrow cavity and subsequently exceeds cortical bone while progressing. Using dynamic contrast-enhanced MRI (DCE-MRI) functional data including regional blood volume, perfusion and vessel permeability can be obtained and quantified2-4. Bone destruction is captured in high resolution using morphological VCT imaging. Complementary to MRI findings, osteolytic lesions can be located adjacent to sites of intramedullary tumor growth. After contrast agent application, VCT angiography reveals the macrovessel architecture in bone metastases in high resolution, and DCE-VCT enables insight in the microcirculation of these lesions5,6. US is applicable to assess morphological and functional features from skeletal lesions due to local osteolysis of cortical bone. Using B-mode and Doppler techniques, structure and perfusion of the soft tissue metastases can be evaluated, respectively. DCE-US allows for real-time imaging of vascularization in bone metastases after injection of microbubbles7.
In conclusion, in a model of site-specific breast cancer bone metastases multi-modal imaging techniques including MRI, VCT and US offer complementary information on morphology and functional parameters of angiogenesis in these skeletal lesions.

In the pathogenesis of bone metastasis, angiogenesis is a crucial process and therefore represents a target for imaging and therapy. Here, we present a rat model of site-specific breast cancer bone metastasis and describe strategies to non-invasively image angiogenesis in vivo using magnetic resonance imaging, volumetric computed tomography and ultrasound.

Multi-modal de imagem de angiogênese em um modelo de rato nu de Câncer de mama utilizando a ressonância magnética, tomografia computadorizada volumétrica e ultra-som

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell ...

A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually. Concussion as defined by the 2013 Concussion Consensus Statement &#8220;may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an &#8216;impulsive&#8217; force transmitted to the head.&#8221; Concussions leave the individual with both short- and long-term effects. The short-term effects of sport related concussions may include changes in playing ability, confusion, memory disturbance, the loss of consciousness, slowing of reaction time, loss of coordination, headaches, dizziness, vomiting, changes in sleep patterns and mood changes. These symptoms typically resolve in a matter of days. However, while some individuals recover from a single concussion rather quickly, many experience lingering effects that can last for weeks or months. The factors related to concussion susceptibility and the subsequent recovery times are not well known or understood at this time. Several factors have been suggested and they include the individual&#8217;s concussion history, the severity of the initial injury, history of migraines, history of learning disabilities, history of psychiatric comorbidities, and possibly, genetic factors. Many studies have individually investigated certain factors both the short-term and long-term effects of concussions, recovery time course, susceptibility and recovery. What has not been clearly established is an effective multifaceted approach to concussion evaluation that would yield valuable information related to the etiology, functional changes, and recovery. The purpose of this manuscript is to show one such multifaceted approached which examines concussions using computerized neurocognitive testing, event related potentials, somatosensory perceptual responses, balance assessment, gait assessment and genetic testing.

There is great variability in an individual&#8217;s risk for concussion and their corresponding recovery. A multifaceted approach to concussion evaluation is warranted; including baseline testing of athletes before participation in sport and timely evaluation post injury. The goal of this protocol is to provide an appropriate multifaceted approach to examine concussions.

Uma abordagem neurocientífica para o Exame de abalos em alunos-atletas

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 ...

Non-invasive Assessments of Subjective and Objective Recovery Characteristics Following an Exhaustive Jump Protocol

Fast recovery after strenuous exercise is important in sports and is often studied via cryotherapy applications. Cryotherapy has a significant vasoconstrictive effect, which seems to be the leading factor in its effectiveness. The resulting enhanced recovery can be measured by using both objective and subjective parameters. Two commonly measured subjective characteristics of recovery are delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE). Two important objective recovery characteristics are countermovement jump (CMJ) performance and peak power output (PPO). Here, we provide a detailed protocol to induce muscular exhaustion of the frontal thighs with a self-paced, 3 x 30 countermovement jump protocol (30-s rest between each set). This randomized controlled trial protocol explains how to perform local cryotherapy cuff application (+ 8 &#176;C for 20 min) and thermoneutral cuff application (+ 32 &#176;C for 20 min) on both thighs as two possible post-exercise recovery modalities. Finally, we provide a non-invasive protocol to measure the effects of these two recovery modalities on subjective (i.e., DOMS of both frontal thighs and RPE) and objective recovery (i.e., CMJ and PPO) characteristics 24, 48, and 72 h post-application. The advantage of this method is that it provides a tool for researchers or coaches to induce muscular exhaustion, without using any expensive devices; to implement local cooling strategies; and to measure both subjective and objective recovery, without using invasive methods. Limitations of this protocol are that the 30 s rest period between sets is very short, and the cardiovascular demand is very high. Future studies may find the assessment of maximum voluntary contractions to be a more sensitive assessment of muscular exhaustion compared to CMJs.

This protocol describes the procedure for non-invasive recovery assessments during a 72 h recovery period. This protocol induces muscular exhaustion of the frontal thighs using countermovement jumps and uses either local cold-cuff or thermoneutral-cuff application as a recovery modality.

Avaliações não-invasivas de características subjetivas e objetivas de recuperação após um protocolo de salto exaustivo

Fast recovery after strenuous exercise is important in sports and is often studied via cryotherapy applications. Cryotherapy has a significant ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Um ensaio clínico avaliando a segurança, eficácia e entrega de sacos de três câmaras à base de azeite para nutrição parenteral

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology

Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To date, return-to-activity decision-making has been anchored in the monitoring of self-reported concussion symptoms and neurocognitive testing. However, multi-modal assessments that corroborate objective physiological measures with traditional subjective symptom reporting are needed and can be valuable. Heart rate variability (HRV) is a non-invasive physiological indicator of the autonomic nervous system, capturing the reciprocal interplay between the sympathetic and parasympathetic nervous systems. There is a dearth of literature exploring the effect of concussion on HRV in youth athletes, and developmental differences preclude the application of adult findings to a pediatric population. Further, the current state of HRV methodology has primarily included short-term (5-15 min) recordings, by using resting state or short-term physical exertion testing to elucidate changes following concussion. The novelty in utilizing a 24 h&#160;recording methodology is that it has the potential to capture natural variation in autonomic function, directly related to the activities a youth athlete performs on a regular basis. Within a prospective, longitudinal research setting, this novel approach to quantifying autonomic function can provide important information regarding the recovery trajectory, alongside traditional self-report symptom measures. Our objectives regarding a 24 h recording methodology were to (1) evaluate the physiological effects of a concussion in youth athletes, and (2) describe the trajectory of physiological change, while considering the resolution of self-reported post-concussion symptoms. To achieve these objectives, non-invasive sensor technology was implemented. The raw beat-to-beat time intervals captured can be transformed to derive time domain and frequency domain measures, which reflect an individual&#39;s ability to adapt and be flexible to their ever-changing environment. By using non-invasive heart rate technology, autonomic function can be quantified outside of a traditional controlled research setting.

We demonstrate a 24 h heart rate recording methodology to evaluate the influence of concussion across the recovery trajectory in youth athletes, within an ecologically valid context.

Função autonómica após concussão em jovens atletas: uma exploração da variabilidade da frequência cardíaca, usando a metodologia de gravação de 24 horas

Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To ...

A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids direct contact with the measured area, it is suitable for monitoring blood flow changes during wound healing in human patients. Vestibuloplasty is periodontal surgery to the oral vestibule, aiming to restore vestibular depth with simultaneous enlargement of the keratinized gingiva. In this special clinical case, a split thickness flap was elevated at the first upper premolar and a xenogenic collagen matrix was adapted to the resulting recipient bed. LSCI was used to monitor the re- and neovascularization of the graft and the surrounding mucosa for one year. A protocol is introduced for the correct adjustment of microcirculation measurement in the oral mucosa, highlighting difficulties and possible failures.
The clinical case study presented demonstrated that &#8212; following the appropriate protocol &#8212; LSCI is a suitable and reliable method for following up microcirculation in a healing wound in the human oral mucosa and gives useful information on graft integration.

This study introduces a protocol for measuring microcirculation in human oral mucosa by laser speckle contrast imaging. The monitoring of wound healing after vestibuloplasty combined with a xenogenic collagen graft is presented on a clinical case.

Uma nova abordagem para o monitoramento de neovascularização de enxerto na gengiva humana

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids ...

Multi-Modal Home Sleep Monitoring in Older Adults

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and research participants. Home sleep testing has gained momentum in the field of sleep medicine due to its convenience and lower cost, as well as being more naturalistic. The accuracy and quality of home sleep testing, however, may be variable because studies are not monitored by sleep technologists. There has been some success in improving the accuracy of home sleep studies by having trained sleep technicians assist participants inside their homes with putting on the devices, but this can be intrusive and time-consuming for those involved. In this protocol, participants undergo at-home sleep monitoring with multiple devices: 1) a single-channel EEG device; 2) a home sleep test for sleep-disordered breathing and periodic limb movements; 3) actigraphy; and 4) sleep logs. A major challenge of this study is obtaining high-quality sleep monitoring data on the first attempt in order to minimize participant burden. This protocol describes the implementation of educational manuals with step-by-step instructions and photos. The goal is to improve the quality of home sleep testing.

Here, we present a protocol to improve the quality of data from home sleep testing by providing a method to enhance instructions through a structured participant visit. This protocol includes the implementation of a step-by-step educational manual with photos to ensure proper placement of equipment.

Multi-Modal casa sono monitoramento em adultos mais velhos

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and ...

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion

The evidence-informed standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The aim of this project is to 1) describe the development and implementation of the Concussion Carepath, 2) demonstrate the process of integrating technology in the form of a mobile application to enable the carepath and guide clinical decision-making, and 3) present data on the utility of the C3 app in facilitating decision-making throughout the injury recovery process. A multi-disciplinary team of experts in concussion care was formed to develop an evidence-informed algorithm, outlining best practices for the clinical management of concussion along three phases of recovery &#8211; acute, subacute, and post-concussive. A custom mobile application, the Cleveland Clinic Concussion (C3) app was developed and validated to provide a platform for the systematic collection of objective, biomechanical outcomes and to provide guidance in clinical decision-making in the field and clinical environments. The Cleveland Clinic Concussion app included an electronic incident report, assessment modules to measure important aspects of cognitive and motor function, and a return to play module to systematically document the six phases of post-injury rehabilitation. The assessment modules served as qualifiers within the carepath algorithm, driving referral for specialty services as indicated. Overall, the carepath coupled with the C3 app functioned in unison to facilitate communication among the interdisciplinary team, prevent stagnant care, and drive patients to the right provider at the right time for efficient and effective clinical management.

A multidisciplinary carepath to standardize disparate concussion care was developed and implemented at the Cleveland Clinic. The Cleveland Clinic Concussion (C3) mobile application was used to enable the carepath through biomechanical outcomes characterizing cognitive and motor function. Patient outcomes improved while cost of care was reduced following implementation.

Desenvolvimento e implementação de uma tecnologia multidisciplinar avançado cuidados Pathway para jovens e adultos com concussão

The evidence-informed standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The aim of this project ...