IntroductionA lack of obvious long-term effects of concussion on standard clinical measures of behavioral performance capabilities does not preclude the existence of subtle neural processing impairments that appear to be linked to elevated risk for subsequent concussion occurrence, and which may be associated with greater susceptibility to progressive neurodegenerative processes. The purpose of this observational cohort study was to assess virtual reality motor response variability and survey responses as possible indicators of suboptimal brain function among military cadets and college athletes with self-reported history of concussion (HxC).MethodsThe cohort comprised 75 college students (20.7 ± 2.1 years): 39 Reserve Officer Training Corp (ROTC) military cadets (10 female), 16 football players, and 20 wrestlers; HxC self-reported by 20 (29.2 ± 27.1 months prior, range: 3–96). A virtual reality (VR) test involving 40 lunging/reaching responses to horizontally moving dots (filled/congruent: same direction; open/incongruent: opposite direction) was administered, along with the Sport Fitness and Wellness Index (SFWI) survey. VR Dispersion (standard deviation of 12 T-scores for neck, upper extremity, and lower extremity responses to congruent vs. incongruent stimuli originating from central vs. peripheral locations) and SFWI response patterns were the primary outcomes of interest.ResultsLogistic regression modeling of VR Dispersion (range: 1.5–21.8), SFWI (range: 44–100), and an interaction between them provided 81% HxC classification accuracy (Model χ2[2] = 26.03, p < .001; Hosmer & Lemeshow χ2[8] = 1.86, p = .967; Nagelkerke R2 = .427; Area Under Curve = .841, 95% CI: .734, .948). Binary modeling that included VR Dispersion ≥3.2 and SFWI ≤86 demonstrated 75% sensitivity and 86% specificity with both factors positive (Odds Ratio = 17.6, 95% CI: 5.0, 62.1).Discussion/ConclusionDetection of subtle indicators of altered brain processes that might otherwise remain unrecognized is clearly important for both short-term and long-term clinical management of concussion. Inconsistency among neck, upper extremity, and lower extremity responses to different types of moving visual stimuli, along with survey responses suggesting suboptimal well-being, merit further investigation as possible clinical indicators of persisting effects of concussion that might prove to be modifiable.

This case report retrospectively reviewed competition sprinting performances by a cohort of eight female high school soccer players before and after the incidence of coronavirus 2019 (COVID-19). Performances were split into COVID-19-positive and COVID-19-negative groups, and metrics were collected using a global positioning system for each player during each game. An apparent decrease of 21.13% was found in the COVID-19-positive group’s performances in distance sprinted per game in contrast to an increase of 8.43% for the COVID-19-negative group’s performances. Results suggest patient-athletes experience decreases in intense sprinting performances following COVID-19 infection.

BackgroundIntegrated movement and cognitive load paradigms are used to expose impairments associated with concussion and musculoskeletal injury. There is currently little information on the discriminatory nature of dual-task complexity and the relative influence of physical exertion on cognitive outcomes.PurposeAssess cognitive performance while under motor conditions of increasing complexity before and after a standardized exercise protocol.Methods34 participants were recruited (17 male and 17 female; 24 ± 1.4 yrs). A modified Eriksen flanker test was used to assess cognitive performance under four conditions (seated, single-leg stance, walking, and lateral stepping) before and after a 20-min moderate-to vigorous intensity treadmill protocol. The flanker test consisted of 20 sets of 5-arrow configurations, appearing in random order. To complete the response to cognitive stimulus, participants held a smartphone horizontally and were instructed to respond as quickly and as accurately as possible by tilting the device in the direction corresponding to the orientation of the middle arrow. The metrics used for analysis included average reaction time (ms), inverse efficiency index (average reaction time penalized for incorrect responses), and conflict effect (the average time cost of responding to an incongruent repetition vs. a congruent repetition). Mixed effects (condition by time) RMANOVAs were conducted to examine the effects of motor task complexity and physical exertion on cognitive performance.ResultsThere was a condition by time interaction for inverse efficiency index (p < 0.001), in which participants displayed higher cognitive efficiency for the pre-activity lateral stepping condition compared to the other three conditions (Cohen's d = 1.3–1.6). For reaction time and conflict effect, there were main effects for condition (p = 0.004 and 0.006, respectively), in which performance during lateral stepping was improved in relation to the seated condition (reaction time Cohen's d = 0.68; conflict effect Cohen's d = 0.64).ConclusionParticipants tended to display better dual-task cognitive performance under more stimulating or complex motor tasks before physical exertion, likely associated with the inverted-U arousal-performance relationship. When using dual-task assessments, clinicians should be mindful of the accompanying motor task and baseline exertion levels and their potential to disrupt or optimize cognitive performance.

Context The Commission on Accreditation of Athletic Training Education Professional and Residency and Fellowship Standards indicate athletic training students, residents, and fellows must be trained in diversity, equity, inclusion, and social justice (DEI&SJ). Diversity, equity, inclusion, and social justice is a broad, complicated subject. Stereotyping and bias training are 2 topics within DEI&SJ that are important for providing culturally competent health care. Objective To detail a strategy for implementing concepts of DEI&SJ into athletic training education programs. Background As part of the health care team, athletic trainers are at the forefront of access to the medical system. Athletic trainers need to be prepared to service a growing diverse population. Description This learning activity enables athletic training educators to creatively engage students in discussion using graphic novels. This article describes the preparation and delivery methods for using graphic novels to teach stereotyping and bias concepts. Clinical Advantage(s) Integrating graphic novels into a classroom activity allows students the opportunity for open communication with classmates. Interpreting graphic novels may increase patient-centered care by increasing empathy in athletic training students. Conclusion(s) The inclusion of graphic novels into athletic training education using interpretation and open discussion techniques can expose students to complicated topics related to DEI&SJ.

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