OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51–8.95), presenting SCAT2 score < 80 (aOR 5.58, 95% CI 2.61–11.93), and female sex (aOR 3.48, 95% CI 1.43–8.49) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days. For patients without SCAT2 scores, female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery (aOR 4.41, 95% CI 1.93–10.07 and aOR 3.87, 95% CI 1.13–13.24, respectively). Concussions resulting from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores (OR 2.59, 95% CI 1.28–5.26 and OR 2.17, 95% CI 0.99–7.73, respectively). Amnesia, balance abnormalities, and a history of migraines were not associated with symptoms lasting longer than 28 days. CONCLUSIONS This case-control study suggests candidate risk factors for predicting prolonged recovery following sports-related concussion. Large prospective cohort studies of youth athletes examined and treated with standardized protocols will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery.

Object Recent legislation and media coverage have heightened awareness of concussion in youth sports. Previous work by the authors' group defined significant variation of care in management of children with concussion. To address this variation, a multidisciplinary concussion program was established based on a uniform management protocol, with emphasis on community outreach via traditional media sources and the Internet. This retrospective study evaluates the impact of standardization of concussion care and resource utilization before and after standardization in a large regional pediatric hospital center. Methods This retrospective study included all patients younger than 18 years of age evaluated for sports-related concussion between January 1, 2007, and December 31, 2011. Emergency department, sports medicine, and neurosurgery records were reviewed. Data collected included demographics, injury details, clinical course, Sports Concussion Assessment Tool-2 (SCAT2) scores, imaging, discharge instructions, and referral for specialty care. The cohort was analyzed comparing patients evaluated before and after standardization of care. Results Five hundred eighty-nine patients were identified, including 270 before standardization (2007–2011) and 319 after standardization (2011–2012). Statistically significant differences (p < 0.0001) were observed between the 2 groups for multiple variables: there were more girls, more first-time concussions, fewer initial presentations to the emergency department, more consistent administration of the SCAT2, and more consistent supervision of return to play and return to think after adoption of the protocol. Conclusions A combination of increased public awareness and legislation has led to a 5-fold increase in the number of youth athletes presenting for concussion evaluation at the authors' center. Establishment of a multidisciplinary clinic with a standardized protocol resulted in significantly decreased institutional resource utilization and more consistent concussion care for this growing patient population.

Concussions affect over 3.8 million Americans annually, and youths comprise the majority of those affected. "Return to play" (RTP) and "return to think" (RTT) decisions following concussions are based on the assessment of several factors including symptom resolution and neuropsychological functioning. The Sport Concussion Assessment Tool-Second Edition (SCAT-2) was developed as a sideline assessment tool to aid in these decisions. Clinicians may infer neuropsychological status from results of the tool, but no studies have directly examined validity of this relationship. Fifty-seven concussed participants between the ages of 10 and 19 were assessed using the SCAT-2 as well as with a memory task (California Verbal Learning Test [CVLT]) and a computerized measure of attention (Conners' Continuous Performance Test II [CPT-II]). Performance on the Standardized Assessment of Concussion [SAC] scale, a component of the SCAT-2, was associated with verbal learning and various measures of inattention. Implications of these findings for concussion assessment and future research are discussed.

INTRODUCTION Winging scapula is a rare condition that can be painful and debilitating to the upper extremity involved1. This condition can affect the functional ability of the upper extremity, resulting in loss of range of motion, decreased power, and pain.1 The purpose of this study was to introduce and determine the clinical applicability of a custom thermoplastic scapulothoracic orthosis to aid in management of winging scapula. The thermoplastic scapulothoracic orthosis offers total contact and provides anterior-posterior compressive forces to stabilize the winging scapula. This design provides a semi-rigid structure that is lightweight and allows user adjustability. The study highlights the potential applicability of the custom thermoplastic scapulothoracic orthosis in the categories of pain, active range of motion at the shoulder, and overall self-reported activities of daily living. Abstract PDF  Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32043/24457 How to cite: Brown S,  Trexler G. CASE STUDY: THERMOPLASTIC SCAPULOTHORACIC ORTHOSIS FOR TREATMENT OF WINGING SCAPULA. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32043 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee.  http://www.aopanet.org/

Background Background: Electromyogram (EMG) burst duration can provide additional diagnostic information when investigating hyperkinetic movement disorders, particularly when a functional movement disorder is suspected. It is generally accepted that EMG bursts <50 milliseconds are pathological. Objective Objective: To reassess minimum physiological EMG burst duration. Methods Methods: Surface EMG was recorded from face, trunk, and limb muscles in controls (n = 60; ages 19-85). Participants were instructed to generate the briefest possible ballistic movements involving each muscle (40 repetitions) or, in muscles spanning joints, to generate rapid rhythmic alternating movements (20-30 seconds), or both. Results Results: We found no effect of age on EMG burst duration. However, EMG burst duration varied significantly between body regions. Rhythmic EMG bursts were shorter than ballistic bursts but only significantly so for lower limbs (P < 0.001). EMG bursts of duration <50 milliseconds were frequently observed, particularly in appendicular muscles. Conclusion Conclusion: We present normal reference data for minimum EMG burst duration, which may assist clinical interpretation when investigating hyperkinetic movement disorders.