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Concussion management has evolved to de-emphasize rest in favor of early introduction of post-injury physical activity. However, the optimal quantity, frequency and intensity of physical activity are unclear. Our objective was to examine the association between objective physical activity metrics and clinical recovery after concussion. We prospectively enrolled a cohort of 32 youth athletes with concussion, evaluated within 14 days of injury and after return-to-play (RTP) clearance. For two weeks after enrollment, we quantified steps/day and exercise frequency, duration, and intensity via wrist-worn actigraphy. We grouped participants by RTP clearance timing (<28 days vs. ≥28 days). Seventeen (53%) participants required ≥28 days post-concussion for RTP clearance. Groups were similar in age (14.9 ± 1.9 vs. 15.4 ± 1.5 years; p = 0.38), proportion of females (47% vs. 40%; p = 0.69), and concussion history (59% vs. 47%; p = 0.49). During the study period, the RTP ≥ 28 days group took fewer steps/day (8158 ± 651 vs. 11,147 ± 4013; p = 0.02), exercised fewer days/week (2.9 ± 2.4 vs. 5.0 ± 1.9 days/week; p = 0.01), and exercised fewer total minutes/week (117 ± 122 vs. 261 ± 219 min/week; p = 0.03). Furthermore, we observed ≥10,251 average steps/day, ≥4 exercise sessions/week, and exercising ≥134 total minutes/week were optimal cutpoints to distinguish between groups. These findings support the benefit of physical activity during concussion recovery.

Context: Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of post-injury motor performance, has demonstrated clinical utility, but is limited by time availability and test uniformity. Objective: To assess intrasession reliability between tandem gait test trials and determine the number trials necessary for optimal utility and feasibility in clinical decision-making following concussion. Design: Cross-Sectional Study Setting: Pediatric Sport Medicine Clinic Participants: Adolescent athletes who recently sustained a concussion (n=44; age=15.4±1.8 years; 39% female) and were seen for care within 14 days (7.3±3.2 days) of their injury, as well as uninjured control participants (n=73; age=15.8±1.3 years; 41% female). All participants completed three single-task and three dual-task tandem gait trials. Outcome Measures: We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and Intraclass Correlation Coefficients to determine intrasession reliability. We also compared performance between groups, and calculated area under the curve (AUC) values to identify the ability of each trial to distinguish between groups. Results: Both the concussion and control group demonstrated high intrasession reliability between tandem gait trials under single (R ≥ 0.82; ICC≥ 0.93) and dual-task conditions (R ≥ 0.79; ICC≥ 0.92). The greatest group classification values were obtained from the second single-task trial (AUC = 0.89) and first dual-task trial (AUC = 0.83). Test completion time provided excellent between-group discrimination in single-task and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC ≤ 0.67). Conclusion: Tandem gait assessments may only require two trials under single-task and one trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (time requirement) of the test, while maintaining excellent discriminatory ability.

Context: Sever's is a common condition in youth athletes, including those who participate in barefoot sports. Health care professionals often recommend that young athletes with Sever's should wear heel cups in their shoes while active, but barefoot athletes are unable use heel cups. Objective: We wanted to compare the efficacy of two braces used by barefoot athletes with Sever's disease. Design: Randomized controlled clinical trial. Setting: Pediatric sports medicine clinic. Participants: Barefoot athletes 7–14 years old with Sever's disease completed self-reported assessments after diagnosis (baseline), and again 1-month, 2-months, and 3-months later. Interventions: Participants were randomized to Cheetah heel cup™ or X-brace™ groups for use during barefoot sports over the 3-month study period. Main Outcome Measures: Primary outcome: Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical score (3-months post-enrollment). Secondary outcomes: OxAFQ-C school/play and emotional scores, and Visual Analog Scale (VAS) pain scores. Results: We enrolled 43 participants and 32 completed the study (n=16/group; age=13.3±1.6 years; 91% female). The Cheetah heel cup™ and X-brace ™ groups spent a non-significantly different percentage of time wearing the brace during barefoot sport (81% vs 64% of time in-sports, p=0.08). At 3-months, there were no significant differences for OxAFQ-C physical, (0.79 vs 0.71, p=0.80: Hedge's g=0.06), school/play (0.94 vs 1.00, p=0.58, Hege's g=0.26) or emotional (1.00 vs 1.00, p=0.85, Hedge's g=0.21) scores. VAS pain scores during ADLs and sports were significantly lower (better) at 2- and 3-month time points as compared to baseline (p&lt;0.001). Conclusions: Both groups demonstrated improvements in ankle/foot function across time, however, no between-group differences were observed at 3 months. Given these results, barefoot athletes with Sever's disease may consider using either brace with barefoot activity to help improve pain and functional status.