CME Educational Objectives 1. Review the expanded differential diagnosis of mental status changes in the patient with mild to severe traumatic brain injury. 2. Discuss the workup and monitoring for suspected cerebral vasospasm in patients with a history of traumatic subarachnoid hemorrhage. 3. Review potential therapeutic options for mental status changes attributed to cerebral vasospasm. An unemployed young man with a history of poly-substance abuse suffered a closed head injury as the result of a motor vehicle crash. At the scene, the patient had a prolonged period of unconsciousness and was intubated. Computed tomography (CT) of the brain upon arrival to the trauma center reveals a mild bilateral subarachnoid hemorrhage (SAH) in a nonspecific pattern. The imaging is thought to be consistent with trauma and is without a space occupying lesion.

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ObjectiveThe female breast is a passive tissue with little intrinsic support. Therefore, women rely on external breast support (sports bras) to control breast motion during athletic tasks. Research has demonstrated that lower levels of breast support are associated with altered trunk and pelvis movement patterns during running, a common athletic task. However, no previous study has identified the effect of sports bra support on movement patterns during other athletic tasks including landing. Therefore, the purpose of this study was to examine the effects of breast support on trunk and knee joint biomechanics in female collegiate athletes during a double-leg landing task.MethodsFourteen female collegiate athletes completed five double-leg landing trials in each of three different sports bra conditions: no support, low support, and high support. A 10-camera motion capture system (250 Hz, Qualisys, Goteburg, Sweden) and two force platforms (1,250 Hz, AMTI, Watertown, MA, USA) were used to collect three-dimensional kinematics and ground reaction forces simultaneously. Visual 3D was used to calculate trunk segment and knee joint angles and moments. Custom software (MATLAB 2021a) was used to determine discrete values of dependent variables including vertical breast displacement, knee joint and trunk segment angles at initial contact and 100 ms post-initial contact, and peak knee joint moments. A repeated measures analysis of covariance with post-hoc paired samples t-tests were used to evaluate the effect of breast support on landing biomechanics.ResultsIncreasing levels of breast support were associated with reductions in peak knee flexion (Right: p = 0.008; Left: p = 0.029) and peak knee valgus angles (Right: p = 0.011; Left: p = 0.003) as well as reductions in peak knee valgus moments (Right: p = 0.033; Left: p = 0.013). There were no changes in peak knee extension moments (Right: p = 0.216; Left: p = 0.261). Increasing levels of breast support were associated with greater trunk flexion angles at initial contact (p = 0.024) and greater peak trunk flexion angles (p = 0.002).ConclusionsLower levels of breast support are associated with knee joint and trunk biomechanical profiles suggested to increase ACL injury risk.

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The bone-specific physical activity questionnaire (BPAQ) algorithms were developed from ground reaction forces-derived loading values, which account for lifetime physical activity affecting bone health. Previous studies report that the total BPAQ score was a stronger predictor of bone strength and geometry as well as areal bone mineral density; however, its relations to a radial quantitative ultrasound-assessed speed of sound (SOS in m/s) has not been well studied in healthy young adults. PURPOSE: The purpose of this cross-sectional study was to determine if bone-loading physical activity was positively related to a radial SOS in healthy young adults. METHODS: Ninety-five healthy participants, 45 women (21.6 ± 2.3 years, 162.9 ± 6.5 cm, 61.1 ± 11.7 kg) and 50 men (21.1 ± 1.9 years, 176.3 ± 8.0 cm, 78.8 ± 14.1 kg), were recruited for this study. The BPAQ scores (current, cBPAQ-previous 12 months; past, pBPAQ-from one year of age to the current age; total, tBPAQ-average of pBPAQ and cBPAQ) were used to obtain a comprehensive account of lifetime physical activity related to bone health. We measured the SOS at one-third distal radius of the nondominant hand using a radial QUS system. Body composition was estimated by bioelectrical impedance analysis. RESULTS: Student's t-tests revealed that the radial SOS was significantly higher in young women (4146 m/s) than in young men (4032 m/s) (p<0.001). The pBPAQ and tBPAQ scores were significantly higher in young women than in young men (p<0.001). Pearson's correlations indicated that there were positive associations between pBPAQ (r=0.256, p=0.013), tBPAQ (r=0.273, p=0.008), and the radial SOS for the whole cohort, but sex-specific associations were not found (>0.05). There were no significant associations between cBPAQ and the radial SOS (>0.05). CONCLUSIONS: These data suggest that the tBPAQ score-derived physical activity was a stronger predictor of the radial SOS in healthy young adults. Future studies are needed to further clarify this implication comparing results obtained from objective physical activity assessment tools.