Free Communications, Poster Presentations: Youth And High School Athletes

By Anonymous

Friday, June 29, 2007, 7:00AM-3:00PM, Main Lobby; authors present 8:30AM-9:30AM Base Rate Concussion-Related Symptoms Among Middle School Athletes

Mailer BJ, Valovich McLeod TC: Lindfield College, McMinnville, OR, and Athletic Training Program, A.T. Still University, Mesa, AZ

Context: Patient-centered variables, including symptoms, need to be evaluated to promote clinical outcomes and evidence based practice. Patient-centered symptom improvement is measured for sport- related concussion where a graded symptom scale (GSS) is commonly employed to obtain a healthy baseline and track recovery following injury. Objective: To characterize base rate concussion-related symptoms in young male and female athletes. Design: Descriptive survey. Setting: Middle school classrooms. Participants: A convenience sample of healthy middle school female (n=52,age=13.2+- 0.8years, height=158.6 +-8.8 cm, mass=48.1+-7.8 kg) and male (n=74, age=13.1+-0.8 years, height=159.9 +-9.8 cm, mass=48.8+-10.3 kg) athletes. Interventions: A patient self-report survey consisting of a demographic section and a GSS was utilized. The GSS was a modified version of the Head Injury Scale and included 16 concussion-related symptoms presented as a Likert scale. For the severity scale, a 7- point Likert scale was used with “O” representing the absence of the symptom, “1″ indicating mild and “6″ indicating severe symptom severity. The duration scale used an 8-point Likert scale with 0-7 indicating the number of days per week each symptom was experienced in the past week. The internal consistency of the severity scale was .86 and the duration scale was .84 as determined by pilot testing. The reliability for the severity scale total symptom score (TSS) (ICC=.93, SEM=3.5) and total symptoms endorsed (TSE) (ICC=.88, SEM=1.3) demonstrated excellent reliability. Descriptive statistics and frequencies were used to report base rate information on both the severity and duration scales. Independent t-tests were used to determine whether sex differences existed for TSS and TSE on the severity scale. Main Outcome Measures: An individual score for each individual symptom on the severity and duration scale and the TSS and TSE from the severity scale. Results: With respect to base rate symptoms, 92.1% of our sample reported at least one symptom with a severity rating greater than zero. Only 7.9% of our sample denied any symptoms (TSS=0). Headache was the most prevalent symptom with 61.9% reporting a headache on the duration scale within the week prior to the survey. This was followed by fatigue (50.0%), trouble sleeping (49.2%), trouble concentrating (37.3%), and sadness (36.5%). We found a significant difference in TSS between sexes (p=.033) with females (15.9+-14.7) reporting a higher TSS than males (11.0+-10.9). Females also had a significantly greater number of TSE

Self-Reported Parent Stature Is Acceptable In Estimates Of Maturity Status In Youth Soccer Players

Sweet SL, Dompier TP, Stoneberg KN, Ragan BG: Athletic Training Outcomes Research Laboratory, University of Northern Iowa, Cedar Falls, IA

Context: Maturity is a variable that should be considered when examining injury risk in children. Maturity can be estimated using relative stature, the percentage of a child’s current stature to their predicted adult stature. Regression equations used for predicting a child’s adult stature require the stature of the biologic parents. Ideally, parental statures would be measured, but doing so is not always practical. The use of reported parental statures with correction for overestimation has been recommended, but the impact of the overestimation on the predictions of adult stature by this method is unclear. Objective: To determine the effect of simulated overestimation of parental stature on predications of adult stature. Design: Cross-sectional. Setting: Data were collected during one soccer season as part of a broader study of injury risk in youth soccer. Patients or Other Participants: Convenience sample of 189 youth, 94 females and 95 males, aged 6-14 years and 6-16 years respectively. Interventions: The Khamis-Roche method was used to predict adult stature. Child stature and weight was measured using standardized procedures. Parental statures were self-reported and corrected for overestimation. Simulated overestimation of parent stature included adding 2.54 cm and 5.08 cm to original reported measures of the father, mother and both parents together. The Epstein corrections were used to correct the overestimation in reported and simulated parental stature. Main Outcome Measures: The root mean squared difference (RMSD) of the child’s actual predicted adult stature to each of the experimental conditions was calculated. The RMSD was compared to the median absolute deviation (MAD) (females = 1.8cm, males = 2.3cm) and 90% error bounds (females = 4.3cm, males = 5.3cm). Significance was set at p <.05 onetailed. Results: The overall RMSD for all experimental conditions ranged from 0.06cm to 1.13cm for females and 0.12cm to 0.17 for males. The RMSD with 5.08cm added to the stature of both parents was within the MAD and 90% error bounds for both females (1.13cm) and males (1.73cm). The RMSD was greatest in the 10 (1.3cm) and 11 (1.5cm) year old age groups for females, and the 12 (2.15cm) and 13 (1.98) year old age groups for males. Conclusions: These results demonstrate that corrected self-reported parental statures can be used in the Khamis- Roche regression equation for predicting adult stature when measurement of parent stature is impractical. Although self- reported stature rarely approaches 5.08cm of inaccuracy, the RMSD does exceed the 90% error bounds near the ages of the adolescent growth spurt in both females (10-12 years) and males (12-14). These results also demonstrate the increased variability of the adult stature prediction equation during the adolescent growth spurt indicating that parent stature should be measured if a higher level of accuracy is needed in these age ranges.

The Contribution Of Socioeconomic Status And Maturity On Injury Risk In Youth Soccer Players

Stoneberg KN, Dompier TP, Joslyn SA, Evans TA, Williams RB: Athletic Training Outcomes Research Laboratory, University of Northern Iowa, Cedar Falls, IA

Context: Early maturing children are typically taller, heavier, stronger, and perform better at functional skills than their later maturing peers. For this reason, maturity has been suspected as a risk factor for injury despite little evidence to support that assertion. In addition, socioeconomic status (SES) has been identified as a general risk factor for a variety of health conditions in children. Despite this, few studies have considered SES in youth sport injury epidemiology. Objective: The purpose of this study was to determine if maturity and SES are risk factors for injury in youth soccer players. Design: Observational cohort. Setting: Data were collected on a youth soccer league consisting of more than 3000 participants from 23 rural and urban communities during the 2005 fall soccer season. By league rules, teams were organized into age groups that included under-8, under-10, under- 12, and under-14 divisions. Patients or Other Participants: A total of 407 youth soccer players between the ages of 6 and 13 volunteered to participate in the descriptive portion of the study, and of those, 102 between the ages of 6 and 13 volunteered to participate in the injury risk portion. Interventions: Frequency data were collected by a certified athletic trainer (ATC) and coaches. Player hours of exposure were documented for each player. League rules mandate that each player play at least one half of each game. Relative stature was used to estimate terciles of maturity and terciles of SES were determined by questionnaire. Main Outcome Measures: Injury frequencies and hours of exposure were used to calculate injury rates (IR) and injury rate ratios (IRR) with 95% confidence intervals (CI). cases and non-cases were weighted by hours of exposure and logistic regression was used to determine if maturity and SES were risk factors controlling for gender and age. Results: Females accounted for 59.5% of the 131 injuries and 60.9% of the 7100 hours of exposure. The IR per 1000 hours of exposure was 18.2 (95% CI, 14.1-22.0) and 19.1 (95% CI, 14.0-24.2) for females and males, respectively. The IRR was 1.06 (95% CI, 0.8-1.5) and revealed no difference between male and female injury rates. Maturity status was a significant factor for females and progressively increased from average (OR=2.30, 95% CI, 1.03-5.13) to late (OR=3.38,95% CI, 1.33-8.58) maturity status. Middle SES females were also at risk (OR=2.31, 95% CI, 1.17-4.54). No significant factors were identified in males. Conclusions: Injury rates were consistent with previous reports. Females that mature later were at greater risk of injury. The interaction of maturity and SES with injury risk males appears to be different than females. These results may serve as pilot data for future investigations into the role of maturity and SES in youth injury epidemiology. Master’s research grant funded by the NATA Foundation.

An Examination Of The Medical Care For High School Athletics In South Carolina

Wham GS, Saunders RP, Mensch JM: University of South Carolina, Columbia, SC Context; Medical care provided for interscholastic athletes has lagged that of college/elite athletes. Research suggests inconsistencies between high schools in regard to medical care provided to athletes. Objective: To examine medical care for interscholastic athletics and identify factors associated with variations in provision of care. Design; A mailed, self- administered survey was used to assess variables in the cross- sectional study. Setting: Policies/ practices related to medical care provided in South Carolina (SC) high schools. Participants: Athletics directors at all high schools in SC (263) were surveyed. 63%( 166) responded. Interventions: The 132-item Appropriate Medical Care Assessment Tool (AMCAT) was developed and pilot-tested; it included 119-items assessing medical care based on the Appropriate Medical Care for secondary School-aged Athletics (AMCSSAA) Consensus Statement/Monograph. Also included were seven items assessing independent variables (presence, employer, and number of ATC’s; sports medicine supply budget; school size; distance to nearest hospital; public/private status; football championships) and three items assessing control variables (rate of free/ reduced lunch qualifiers; setting; region) as potential influences on provision of medical care. Internal consistency was strong (r=.89). SPSS was used to test associations between independent and dependent variables using one-way AVO VA’s, tests for multiple comparisons, and regression analysis. Main Outcome Measures: The Appropriate Care Index (ACI) score from AMCAT provided a quantitative measure of medical care by a high school and served as dependent variable. ACI score was determined based on a school’s response to items relating to AMCSSAA guidelines. Most items utilized a 4-point scale and were scored 3, 2, 1, or 0. Scores from the items for each point of the AMCSSAA Consensus Statement were averaged to form an ACI score ranging from O(lowest) to 1 (highest). Results: Multiple comparison tests revealed higher ACI scores were associated with having an ATC versus no ATC [ACI=.61(.15) and .49(.13),p<001]; having school- employed ATC versus contracted ATC [ACI=.68(.13) and .56(.14),p<.001]; having multiple ATC’s versus one [.69(.14) and .60(.15),p<.034]; having sports medicine supply budgets >$3500 versus $1001-$3500 versus <$1000 [.67(.12),.59(.13), and .47(.15), p<.001]. Regression analysis examining influence of multiple independent variables revealed associations between ACI and two independent variables: athletic training services (P<.001) and sports medicine supply budget (P<.001) when controlling for rate of free/reduced lunch qualifiers, setting, and region. These two variables accounted for 30% of variance in ACI score (R^sup 2^=302). Conclusions: AMCAT provides an evaluation of medical care provided by an interscholastic athletics program. In SC schools, athletic training services and sports medicine supply budget were associated with higher levels of medical care for high school athletes. These results provide guidance for improvement of medical care in interscholastic athletics.

High School Football Player’s Nutritional Knowledge And Application

Molnar KA, Sandrey MA, Kerschner R, Fitch C: West Virginia University, Morgantown, WV, and Wheeling Jesuit University, Wheeling, WV

Context: High School football players lack proper nutritional knowledge and application of that knowledge, even though nutrition education is included in health classes starting with the primary grades. Objective: The purpose of this study is to determine the nutritional knowledge of high school football players and the application of this knowledge through food choices. Design: A prospective descriptive survey design. Setting: A rural class AA high school. Patients or Other Participants: Using a sample of convenience, a total of 57 (15.44+-1.12 yrs) varsity, junior varsity, and freshman football players (24 freshman, 13 sophomores, 11 juniors and 9 seniors) completed the nutritional knowledge questionnaire and diet recall. Interventions: Two questionnaires including a 9-item demographic questionnaire were distributed to the football athletes during a team meeting. A 27-item nutritional knowledge questionnaire was developed from previous studies. A 15 question diet recall (reliability using Cronbach’s alpha r=0.717) contained modified questions from the nutritional section of the Centers for Disease Control and Prevention 2005 Youth Risk Behavior Survey. The diet recall was based on the 1996 Food Guide Pyramid (FGP). Face and content validity was established for the questionnaires and diet recall using psychometric experts, a registered and licensed dietitian, a health educator and certified athletic trainers. Analyses consisted of a one way ANOVA (year in school), a two way MANOVA (year in school and 5 sections) and frequencies. Main Outcome Measures: Score on the 27-item nutritional knowledge questionnaire; Scores for the five sections: carbohydrate and fats (CF), fruits and vegetables (FV), vitamins and minerals (VM), diet (D), and hydration (H); and frequencies of responses from the 15-item diet recall based on a 7-day food intake. Results: A total of 56.1% participants (n=32) answered 17 or more questions correctly on the nutritional knowledge questionnaire. There was a significant difference between the number correct on the nutritional knowledge questionnaire and year in school (P=.005) between freshman and sophomores (15.08+-2.88, 19.0+-2.67, P=.006). There was a significant difference between the number correct between the five sections for CF (P=.012) between freshman and sophomores (3.2+-1.0, 4.6+-1.4, P=.011), VM (P=.019) between freshman and sophomores (1.8+- .8, 2.9+-.9, P=.015), and D (P=.004) between sophomores andjuniors (6.0+-1.1,4.5+-1.9, P=.044), and juniors and seniors (6.4+- .6, 5.6+- 1.5, (P=.004). All other results were not significant. A majority of the responses, excluding water and the meat group, were below the recommended servings in the 1996 food guide pyramid for milk (82.5%, n=47), fruit (72%, n=41), bread/cereal (87.8%, n=50) and vegetables (95.1%, n=55). Conclusion: In this study high school football players lack the knowledge about the FGP servings for each food group and what constitutes proper serving sizes. They are also not applying knowledge that they have when making food choices.

Exertion Has No Effect On Neuropsychological Test Performance In High School Athletes

Martilik T, Livingston SC, Hertel J, Broshek D, Perriello V, Ingersoll CD: University of Virginia, Charlottesville, VA

Context. The ability to distinguish impairments of cognition following concussion is critical to clinical decision making regarding safe return to play. Neuropsychological tests are sensitive to slight changes in information processing, memory, concentration and reaction time following concussive injury. Accurate neuropsychological assessment necessitates minimizing or eliminating confounding variables. Exertion resulting from physical activity is one factor that may affect neuropsychological test performance. Objective. To determine if neuropsychological test performance is affected by physical exertion in non-concussed high school athletes. Design. Pretest-posttest randomized groups design. Setting. Computer laboratory and athletic practice field. Patients or Other Participants. Twenty healthy student-athlete volunteers (age=15.6+-1.1 yrs, height=151.6+-9.5 cm, mass=73.8+-21.9kg) participated. Interventions. All subjects completed 2 baseline (pretest) Concussion Resolution Index (CRI) assessments separated by 1 week. Repeated testing was done to account for learning effects. Subjects were randomly assigned to an exertion group (n=10) and a control group (n=10). The exertion group participated in a 60- minute team practice session while the control group rested for the same time period. All subjects were asked to give a rating of perceived exertion (RPE) following the 60-minute period and immediately prior to the posttest administration of the CRI. Main Outcome Measures. CRI Composite test scores: simple reaction time (SRT), complex reaction time (CRT), and processing speed (PS). CRI scores were adjusted for practice effects using a reliable change index (RCI). Results. There were no significant differences in SRT (exertion = 0 -0.06+-0.59, rest = -0.7311.02; F^sub 1,11^=0.31, P=0.6, 1beta=0.08), CRT (exertion = 0.07+-0.66, rest = 0.27+-0.88; F^sub 1,14^=0.04, P=0.9, 1-beta=0.05) or PS (exertion = 1.06+0.66, rest = 0.66+0.71; F^sub 1,6^ =0.003, P=0.95, 1-beta=0.05) between the 2 groups. CRI scores were not significantly different between testing sessions (F^sub 1,16^=0.02, P=0.9, 1-beta=0.05). Conclusions. Among high school athletes, a 60-minute exertion bout does not significantly affect neuropsychological test performance on the CRI. Further investigation of other factors which may influence CRI test performance (including intensity of exercise, fitness level, and subject motivation) is necessary.

Body Temperature, Stress Hormone, And Perceptual Responses Of Adolescents During High School Preseason Football Practices

Yeargin SW, Casa DJ, McDermott BP, Ganio MS, Lopez RM, Lee EC, Hatfield DL, Vingren JL, Warchol MD, Chow SB, Blowers JA, Armstrong LE, Anderson JM, Maresh CM: Department of Kinesiology, University of Connecticut, Storrs, CT

Context: Different physiologic and perceptual responses in heat acclimatized adolescents during preseason football practices (PFP) remain under-reported. Objective: To determine natural thermoregulatory responses and differences between younger and older adolescents during PFP. Design: Observational field study looking at minimum and maximum thermoregulatory responses to PFP within and across practices with a comparison of younger and older pubertal adolescents. Setting: High school PFP outside in August. Average maximum DB was 26+- 4 [degrees]C and WBGT was 23+-4 [degrees]C, which were determined by measurements taken every 30 minutes during practice. Participants: 25 heat-acclimatized male football players (mean +- SD: 15+-1 y, 4+.1 Tanner Stage, 180+-8 cm, 81.4+-15.8 kg, 12+-5 % body fat). Interventions: Initial 10 days observation of PFP. Days 1-5 consisted of one practice; days 6-8, two practices; days 9-10, one practice. An ingestible telemetric sensor measured body temperature (T^sub GI^) throughout practice. The ratio of saliva testosterone and cortisol concentrations (T/ C) on days 1,4,7, & 9 in the AM (upon the subject waking) and PM (upon the close of practice) calculated stress state. Perceptual measures of thermal sensation and an environmental symptoms questionnaire (ESQ) were collected before, during, and/or after practice. Results were compared as an overall total and by age group: Young (Y: 14-15 y, n=13) and Old (O: 16-17 y, n=12) as tanner stage results were limited in range. Repeated Measure ANOVAs, descriptive statistics, dependent t-tests, and simple correlations determined differences. Main Outcomes Measures: T^sub GI^,T/C, and perceptual responses. Results: Resting and maximum T^sub GI^ were 37.6+-0.1[degrees]C (99.5 +-0.2[degrees]F) and 38.6+-0.3[degrees]C (101.5+- 0.7[degrees]F), respectively; this did not differ (p=0.34) between Y and O. Average maximum T^sub GI^ for days 1,2,3 was 39+- 0.1[degrees]C (102.2+-0.2[degrees]F), days 5,6,7 was 38.4+- 0.2[degrees]C (100.8+-0.3[degrees]F), and day 10 was 38.5[degrees]C (101.3[degrees]F). We observed significant differences (p=0.009) in T^sub GI^ on select days. Importantly, a correlation (r=0.37, p<0.001) was observed between T^sub GI^ and maximum WBGT across all days. AM T/C ratio for Y and O was 44.58+-10.57 and 75.42+-29.22 respectively (p=0.58). PM T/C ratio for Y and O was 44.2+-17.12 and 52.5+-13.28 respectively (p=0.178). ESQ scores increased (p<0.001) pre to post within practices on days 1,2,3 while post scores across days 5-10 decreased (p<0.001). Maximum WBGT and post ESQ scores correlated (r=0.15, P=0.001). Thermal sensation showed significant correlations with maximum WBGT (r=0.57, p0.001) and maximum T^sub GI^ (r=0.38, p<0.001). Conclusion: Heat acclimatization prior to preseason may have benefited physiologic responses. Likely, due to the heat acclimatization, T^sub GI^ had the greatest relationship with environmental conditions across all days and to a lesser degree, age. Doctoral Research Grant funded by the NATA Foundation.

Copyright National Athletic Trainers Association Apr-Jun 2007

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