Search Results (1 - 25 of 159 Results)

Sort By  
Sort Dir
 
Results per page  

Walters, ElizabethThe Relationship Between Athletic Training Program Directors Self-Reported Leadership Style and Program Success
Doctor of Education (Ed.D.), Bowling Green State University, 2017, Leadership Studies
This dissertation explored the relationship between Athletic Training Program Directors’ (ATPDs) self-reported leadership style and Athletic Training Program (ATP) success. The metrics of determinants of ATP success were derived from data that the Commission on Accreditation of Athletic Training Education (CAATE) annual report seeks from all ATPs for continuing accreditation. Forty-six ATPDs from CAATE-accredited Athletic Training Programs (ATPs) completed the survey. Most ATPDs from this sample came from undergraduate ATPs, with a few responsible for graduate degree programs, and even fewer responsible for undergraduate and graduate programs. All ATPD participants completed the Multifactor Leadership Questionnaire (MLQ; Avolio & Bass, 2004), demographic information, educational history-related questions, years of experience as an ATPD, and other leadership roles/experience. This study established that ATPDs’ self-reported predominant leadership style is transformational in nature. This study demonstrated a statistically significant relationship when examining ATPDs’ self-reported leadership style and ATP success within one of the four ATP success metrics examined: Percent ATS post-graduation employment. This study was not able to demonstrate a statistically significant relationship between ATPDs’ self-reported leadership style and percent ATP retention, ATP percent first-time Board of Certification (BOC) pass rate, or percent ATP graduation rate. The lack of significance in three of the four variables likely is due to the small sample of participants. This study was underpowered. Furthermore, additional variables likely should be considered when determining the relationship between ATPD leadership style and ATP success.

Committee:

Chris Willis, EdD (Advisor); Sara Worley, PhD (Other); Debra Ball, EdD (Committee Member); Paul Johnson, PhD (Committee Member); Kristina LaVenia, PhD (Committee Member)

Subjects:

Education; Sports Medicine

Keywords:

Athletic Training Program Directors; Leadership; Program Success

Reynolds, TravisMuscle Activity of Primary and Core Muscles of the Seated Overhead Press with Unstable Loads
Master of Science, University of Toledo, 2017, Exercise Science
Core muscle strength and coordination are important components to resistance training and sports performance. Unstable training (UT), further divided into unstable surface training (UST) and unstable load training (ULT), is commonly chosen to improve core muscle strength. ULT has been accomplished by suspending resistance from a barbell with bands, allowing it to move vertically, but research has not been done on a horizontal type of ULT. The purpose of this study was to measure the impact of horizontal dynamic instability (HDI) on prime mover and core stabilizer muscle activity, during the seated overhead press, through use of electromyography (EMG). HDI was compared to a traditional type of ULT as well as stable load training (SLT). Thirteen resistance trained males (age = 24.1±2.4 years, height = 178±7.2cm, mass = 84.1±9.4 kg) participated in all three condition assignments. Subjects tested their 5-RM strength on the seated overhead press and performed five repetitions at 50% 5-RM strength for condition assignments. Electrodes were attached to 8 muscles (anterior deltoid, triceps brachii, upper trapezius, right & left external oblique, right & left rectus abdominis, erector spinae). Concentric and eccentric muscle actions were analyzed separately across all repetitions. Mean voltage of activation was acquired and processed (band pass filter 10-500 Hz, rectified, RMS 50ms window and normalized) and significance was set at p <0.05. A two-way RM ANOVA was used to compare condition x muscle action. Anterior deltoid and upper trapezius activity was higher during ULT concentric compared to SLT and HDI concentric. Erector spinae activity was higher during SLT and HDI concentric compared to ULT concentric. Left external oblique activity differed significantly between HDI and ULT eccentric, but no differences occurred at the right external oblique. These results suggest that HDI may require external oblique activity to a similar magnitude as traditional ULT. Continued research on HDI should address other exercises or loading intensities.

Committee:

Suzanne Wambold, Ph.D. (Committee Chair); Charles Armstrong, Ph.D. (Committee Member); Grant Norte, Ph.D. (Committee Member)

Subjects:

Experiments; Physical Education; Physiology; Sports Medicine

Jackson, Allison N.Neurocognitive Ability in Individuals with Chronic Ankle Instability
Master of Science (MS), Ohio University, 2017, Athletic Training (Health Sciences and Professions)
Background: Chronic ankle instability (CAI) occurs following repetitive lateral ankle sprains. Studies suggest that brain regulation may be altered resulting in impaired motor control, translating to poor postural control and motor planning. Limited studies are available to identify etiology and suggest neurocognitive changes. Purpose: To determine if functional deficits are present in individuals with self-reported symptoms associated with CAI when compared to a control group. Methods: Participants completed the Identification of Functional Ankle Instability measure (IdFAI), the Foot and Ankle Ability Measure (FAAM) including the FAAM-Activities of Daily Living, and FAAM- Sport. In addition, a medical questionnaire identified individuals with CAI. Dynamic postural control was assessed using the Y-Balance Test. Participants then completed a protocol on the Bertec Vision Trainer (Bertec Inc, Columbus. OH), to identify neurocognitive deficits. Main outcome measures: Y-Balance, reaction time (wide and narrow), visual memory (wide and narrow), and random targets. Results: Comparing between groups, no functional or neurocognitive deficits were noted even though participants self-identified with CAI. Conclusion: Regardless of self-reported symptoms, participants in the CAI group were functioning with no neurocognitive or postural control deficits. The high activity level of this cohort or heterogeneity of CAI may contribute to the inability of the Y-Balance or neurocognitive function to discriminate between controls and participants with CAI.

Committee:

Dustin Grooms, PhD, AT, CSCS (Advisor); Janet Simon, PhD, AT (Committee Member); Andrew Krause, PhD, AT (Committee Member)

Subjects:

Anatomy and Physiology; Health Sciences; Medicine; Neurosciences; Sports Medicine

Keywords:

Chronic Ankle Instability; Foot and Ankle Ability Measure; Identification of Functional Ankle Ability

Bagley, Morgan CooperSingle-leg Aerobic Capacity, Muscular Strength, Balance, and Agility in Healthy and Surgically Repaired Anterior Cruciate Ligament Legs in College Age Students
PHD, Kent State University, 2015, College and Graduate School of Education, Health and Human Services / School of Health Sciences
Following anterior cruciate ligament (ACL) surgery there is known inconsistency of return to play criteria, which may explain why cleared athletes are at a greater risk for re-injury of the surgical limb or injury of the bilateral limb. The purpose of this study was to examine whether there are limb differences in single-leg aerobic capacity in subjects who have undergone ACL surgery. Our goal was to compare single-leg aerobic capacity to traditional return to play outcomes to determine if this novel outcome provides an additional criteria for clinicians to consider. Our secondary purpose was to compare the data from the ACL injured limb with a matched limb from a non-ACL surgery control. Eight non-ACL surgery controls and eight subjects with ACL surgery (average time since clearance 12.9 months) aged 18-29 completed two separate visits to determine strength, agility, balance, and single-leg aerobic capacity for each limb. Although there were some minor differences observed within the traditional return to play criteria, indices of aerobic capacity were no different between the ACL and control groups or the uninjured or injured limbs in the ACL group. Only minor differences were found in some of the more traditional tests that evaluated strength, agility, and balance. Additional research needs to be performed to determine the role of aerobic testing as a clinical measure following ACL or other lower limb injuries.

Committee:

Lisa Chinn, Ph.D. (Advisor); John McDaniel, Ph. D. (Advisor); Ellen Glickman, Ph.D. (Committee Member); Kerr Dianne, Ph.D. (Committee Member)

Subjects:

Health; Physical Therapy; Sports Medicine

Keywords:

ACL; cycling; clinical measures

Walia, PiyushThe Effect of Combined Bony Defects on the Anterior Stability of the Glenohumeral Joint and Implications for Surgical Repair
Doctor of Engineering, Cleveland State University, 2015, Washkewicz College of Engineering
The combined defects of the glenoid and humeral head defects are often associated with recurrent anterior instability. Past studies have only investigated the effects of isolated humeral head or glenoid defects. A cadaveric model was developed to investigate the effect of combined defects. Moreover, two different finite element models were developed to validate against the experimental data. It was hypothesized that combination of smaller sizes of the two defects would reduce the glenohumeral joint’s stability. Furthermore, it was hypothesized that the instability due to humeral head defect will be dependent on the arm position but this won’t be the case for the glenoid defect. Also, it was believed that both specimen-specific and population-based models will validate against the experimental data. Different sets of simulation were run with both isolated and combined defects to analyze the reaction forces and calculate distance to dislocation. The experiments were performed with displacement control under a 50N compressive load. The results from the study predicted a statistical model that explained the direct correlation between the anterior stability of glenohumeral joint and the size of the defect. It was found that with the increase in size of the defect, the distance to dislocation decreased. It was determined that a combination of 10% glenoid defect with a 19% humeral head defect resulted in lower stability (p<0.05) than that of an isolated 20% glenoid defect. Results from finite element analysis showed that both specimen-specific and population-based models were similar to cadaveric model.

Committee:

Stephen Fening, Ph.D. (Committee Chair); Antonie van den Bogert, Ph.D. (Advisor); Anthony Miniaci, M.D., F.R.C.S.C. (Committee Member); Morgan Jones, M.D., M.P.H (Committee Member); Ahmet Erdemir, Ph.D. (Committee Member); Brian Davis, Ph.D. (Committee Member)

Subjects:

Biomechanics; Biomedical Engineering; Biomedical Research; Design; Engineering; Experiments; Mathematics; Pathology; Sports Medicine

Keywords:

Shoulder, Glenohumeral Joint, Anterior Instability, Combined Bone Defects, Hill-Sachs Defect, Bony Bankart Lesion, Humeral Head Bone Loss, Bipolar Defects, Concavity Depth, Stability Ratio

Holley, Siera JadeEvaluation of Sports Nutrition Knowledge between NCAA Student-Athletes across Divisions
MS, Kent State University, 2015, College and Graduate School of Education, Health and Human Services / School of Health Sciences
The purpose of this study was to evaluate sports nutrition knowledge and experiences with registered dietitians amongst collegiate student-athletes across NCAA Divisions I, II, and III. A total of 171 student-athletes from 13 academic institutions with NCAA sanctioned varsity athletic programs participated. Five Division I, 5 Division II, and 3 Division III institutions are represented. A questionnaire consisting of the following components was administered: nutrition knowledge, feelings towards sports nutrition statements, sources of nutrition information, participant characteristics and demographics, and sports nutrition experience. Overall, the sample achieved a mean Nutrition Knowledge Score (NKS) of 61.22% ± 12.57. There was no significant difference in knowledge scores across NCAA Divisions (F = .385, p = .681), however, female participants scored significantly higher than males (F = 6.313, p = .008). Approximately 82.4% (n = 141) of participants indicated that having a dietitian/nutritionist on their team’s staff does or would help them in achieving a healthy diet, and 81.8% (n = 140) responded that having a dietitian/nutritionist on staff does or would help them in improving their athletic performance. Collectively, participants responded they would be most likely to consult a dietitian/nutritionist over other resources when obtaining current information regarding nutrition. Results indicate there is still a need for further sports nutrition education. Additionally, participants’ perceive that having a dietitian on their athletic staff would be advantageous for obtaining nutrition information and in achieving a healthier diet and improved performance.

Committee:

Amy Miracle, PhD, RD, CSSD, LD (Advisor); Natalie Caine-Bish, PhD, RD, LD (Committee Member); Karen Lowry Gordon, PhD, RD, LD (Committee Member)

Subjects:

Health Sciences; Nutrition; Sports Medicine

Keywords:

Sports Nutrition; Sports Nutrition Knowledge; NCAA Student-Athletes

Lepley, Adam ScottExamining Neural Alterations as the Origins of Disability in Patients Following Anterior Cruciate Ligament Reconstruction
Doctor of Philosophy, University of Toledo, 2014, College of Health Sciences
Objective: To examine quadriceps spinal-reflexive, corticospinal, and intracortical excitability before, at 2-weeks post and at 6-months post-anterior cruciate ligament reconstruction (ACLr) compared to healthy controls. A secondary aim of this study was to investigate the association between quadriceps neural excitability and neuromuscular, biomechanical and self-reported function at times of pre-surgery and 6-months post-surgery. Patient and Other Participants: Seventeen ACL injured patients scheduled to undergo surgical reconstruction (9 Female, 8 Male; age:21.0 ± 4.8years; height:173.1±7.3cm; weight:77.7±11.2kg; 35.8±14.8days-post-injury) volunteered and were compared to seventeen healthy controls (9 Female, 8 Male; age:22.1 ± 3.8years; height:173.3±10.7cm; weight:75.3±21.3kg). Methods: This investigation utilized a case-control study design. For aim 1, quadriceps spinal-reflexive, corticospinal, and intracortical excitability were tested at pre-surgery, 2-weeks post-surgery (2-wks; average: 15.8 ± 2.5days post-surgery) and 6-months post-surgery or when returned to participation (6-mo; average: 28.1 ± 2.8wks post-surgery). For aim 2, quadriceps strength, voluntary activation, knee joint biomechanics during stair walking and self-reported function were collected at the pre-surgery and 6-mo post time points. For aim 1, all measures were collected bilaterally in the ACLr group and in a dominance matched limb of the control group. For aim 2, outcome measures were collected in the injured limb of ACLr patients and a matched limb from the healthy control group for aim 2. Main Outcome Measures: Quadriceps spinal-reflexive excitability was assessed using Hoffmann reflexes normalized to maximal muscle responses. Corticospinal excitability was evaluated with active motor thresholds (AMT) and motor evoked potentials at 120% of AMT. Intracortical excitability was assessed using short interval intracotical inhibition and intracortical facilitation. Quadriceps strength and voluntary activation were quantified using maximal voluntary isometric contractions and the central activation ratio, respectively. Peak knee joint angles and internal extension moments were calculated during the first 50% of stance phase during stair ascent and descent gait trials. The International Knee Documentation Committee questionnaire was used to evaluate self-reported function. Statistical Analyses: Aim 1: 3x3 (limb x time) repeated measures ANOVAs were performed with Tukey post-hoc tests where appropriate. Aim 2: Spearmen Rho correlation matrices were performed at the pre-surgery and 6-mo post-surgery time points on the injured limb of the ACLr group and matched limb of the control group independently. Results: Aim 1: ACLr patients demonstrated lower spinal-reflexive excitability than controls at pre-surgery and 2-wks. At 6-mo post-surgery, spinal-reflexive excitability was not different between groups. Over-time, spinal-reflexive excitability in the ACLr group decreased from pre-surgery to 2-wks, and increased higher than pre-surgery at 6-mo, while controls did not change. Corticospinal excitability was not different between groups at pre-surgery or 2-wks post-surgery, however ACLr patients had lower corticospinal excitability at 6-mo compared to controls. Corticospinal excitability in the ACLr group increased from pre-surgery to 2-wks, and at 6-mo was decreased compared to pre-surgery, while controls did not change. Intracortical excitability was not different between groups, nor did the values change over time in either group. Aim 2: At pre-surgery, corticospinal excitability was related to knee joint moments during stair ascent in ACLr patients, with higher corticospinal excitability relating to higher joint moments during gait. At 6-mo post-surgery, intracortical facilitation was inversely related to spinal-reflexive excitability. In addition, quadriceps strength had strong correlations with self-reported function and knee joint angle during stair ascent, indicating that ACLr patients with weaker quadriceps muscles reported higher levels of dysfunction and demonstrated straighter knee joint angles during stair ascent. Conclusions: Spinal-reflexive deficits are present before surgery and at 2-wks post-reconstruction, but not at a time when these individuals are cleared for full activity. In contrast, corticospinal deficits existed at 6-mo post-surgery, however not prior to or at 2-wks post-surgery. Deficits in neural excitability are present following ACL injury, potentially due to loss of ligament mechanoreceptors or joint effusion. Separate neuromuscular alterations occur at different stages of injury, with decreases in spinal-reflexive excitability early (pre-surgery, 2-weeks post) and deficits in corticospinal excitability observed at a time when individuals are returned to participation. Early rehabilitation strategies targeting spinal-reflexive excitability may help to improve post-operative outcomes, while later-stage rehabilitation may benefit from modalities aimed at improving corticospinal excitability. In addition, these neural alterations may have negative effects on neuromuscular, biomechanical and self-reported function. Clinically, targeting these neural changes may benefit patients who are recovering from ACL injury and surgical reconstruction, and future research should examine the efficacy of the treatments proposed to target neural alterations.

Committee:

Phillip Gribble, PhD, ATC (Committee Chair); Brian Pietrosimone, PhD, ATC (Advisor); Abbey Thomas, PhD, ATC (Committee Member); Michael Tevald, PT, PhD (Committee Member); David Sohn, MD, JD (Committee Member)

Subjects:

Biomechanics; Kinesiology; Sports Medicine

Keywords:

Spinal-reflexive excitability; corticospinal excitability; intracortical ecitability; neuromuscular control; quadriceps muscle; stair gait; anterior cruciate ligament

Baker, Frank W.Mental Toughness: Effect on Factors Associated with Injury and Illness in Adolescent Athletes
Master of Science (MS), Ohio University, 2014, Athletic Training (Health Sciences and Professions)
Background: High school sports participation has increased in the past decade, notably in multiple sport participation and sport specialization by adolescent athletes. Stressful circumstances during training and competition can predispose athletes to overtraining syndrome and athlete burnout. Others have used a mental toughness training program to determine how athletes handle stressors during training and competition, and whether the training positively affects factors associated with illness and injury. Objective: This study is an extension of previous research on mental toughness.1 This study measured the effect of a mental toughness intervention on mental toughness, somatic manifestation, athlete burnout, stress recognition, stress response, coping aptitude, and athletic performance. Participants: Six Caucasian male varsity track athletes from a rural public high school participated in this study. Methods: The participants completed instruments assessing mental toughness, athlete burnout, somatic manifestations, stress recognition, and stress response prior to, during, and at the conclusion of a 4-wk mental toughness intervention. The Mental, Emotional, and Bodily Toughness Inventory (MeBTough) was used for assessing mental toughness. Spearman rho correlation coefficients (r) assessed the relationships between mental toughness, athlete burnout, somatic manifestations, stress response, stress recognition, and coping aptitude. A related sample Wilcoxon signed rank test was used to determine if the MeBTough, Athlete Burnout Questionnaire (ABQ), Cohen-Hoberman Inventory of Physical Symptoms (CHIPS), Stress Response Scale for Adolescents (SRSA), Brief Cope Inventory (BriefCOPE) and Perceived Stress Scale (PSS) scores after the intervention were significantly different than baseline scores. Results: At baseline, mental toughness displayed a negative relationship with athlete burnout (r = -0.07), somatic manifestations (r = -0.46), and stress recognition (r = -0.17). There was a decrease in somatic manifestations (P = 0.04) and athlete burnout (P = 0.04) following the intervention. Active coping (P = 0.04), use of emotional support (P = 0.04), and planning (P = 0.04) subscale scores of the BriefCOPE increased from pre- to postintervention. No significant change in mental toughness (P = 0.17), stress recognition (P = 0.34), or stress response (P = 0.71) from pre- to postintervention was observed. Increases in mental toughness resulted in enhanced performance, most noticeably by a decrease in the team’s 4 x 800 m event time by 1 min. Conclusion: Though mental toughness was inversely related to athlete burnout and somatic manifestations in these 6 rural high school track athletes, a 4-wk mental toughness intervention did not improve their mental toughness. Future studies, including a longer intervention in a larger sample of a variety of athletes, are needed to assess the true impact of the online intervention on mental toughness scores and the factors associated with overtraining injury and illness.

Committee:

Cheryl Howe, PhD (Advisor); Sheri Huckelberry, PhD (Committee Member); Chad Starkey, PhD, AT (Committee Member)

Subjects:

Behaviorial Sciences; Health Sciences; Sports Medicine

Keywords:

mental toughness; athlete burnout; overtraining syndrome; adolescent athlete

Zaldivar-Lopez, SaraBlood Gases and Cooximetry in Retired Racing Greyhounds: Unique Hemoglobin Physiology and Oxygen Carrying Properties
Master of Science, The Ohio State University, 2010, Veterinary Clinical Sciences
Greyhounds have differences in many hematological parameters compared to other breeds [i.e. higher PCV and red blood cell counts], attributed to selective breeding, and to a compensatory mechanism for their high oxygen affinity hemoglobin (Hb). The purpose of this study was to evaluate this oxygen affinity of Hb in retired racing Greyhounds (RRGs) using a blood gas analyzer with cooximeter (Nova CCX), and to establish reference intervals in this breed. Venous blood samples from 57 RRGs (G) and 30 non-Greyhounds (NG) were analyzed, and groups were compared using T-test. The G group had significantly higher pH, partial pressure of oxygen (PO2), oxygen saturation (SO2), oxyhemoglobin (O2Hb), total Hb (tHb), oxygen content (O2Ct), and oxygen capacity (O2Cap) and significantly lower deoxyhemoglobin (HHb) and P50 when compared to NG, supporting the higher oxygen-carrying capacity in this breed. Consistent with previous reports, P50 was lower (high oxygen affinity). Current studies on Hb-based oxygen carriers have revealed that in tissues which need more oxygen, a high-affinity oxygen carrier is beneficial (i.e. strenuous exercise), potentially explaining the benefits of having a high-affinity Hb. Given the narrow range found in the P50 value, and Greyhounds’ high mean Hct, we postulated that the high viscosity had affected the results by impairing a constant blood flow through the analyzer. Venous samples from 13 RRGs were obtained, and divided in two heparinized tubes, diluting one to 20% with PBS. Both undiluted and diluted samples were analyzed simultaneously, and P50 was also calculated manually (formula in the user’s manual). No significant differences were found among undiluted and diluted samples, but when calculated manually, mean P50 was significantly lower than the one generated by the instrument in both undiluted and diluted samples. In conclusion, the high viscosity did not affect the results obtained in the previous study. In order to evaluate the P50 variation during storage, venous blood from 19 RRGs was analyzed and then stored at 4°C for 3 weeks. At this time, the analysis was repeated and the two time points were compared. The mean P50 value decreased, but unexpectedly, almost half of the values remained the same after 3 weeks. The Hemox-Analyzer is an instrument that accurately records and plots the oxyhemoglobin dissociation curve (ODC) during deoxygenation, providing information about the delivery of oxygen to the tissues. We evaluated venous samples from two adult dogs (one RRG and one mixed breed); both dogs had blood gas and cooximetry analysis performed too. Although both dogs had the same P50 using the Nova CCX, the Greyhound had lower P50 than the mixed breed dog using the Hemox-Analyzer. Overall, we conclude that Greyhounds have high affinity Hb, as reflected by a low P50, compared to NG. However, this is not accurately assessed by the Nova CCX analyzer, probably because it is not designed for animals (uses human ODC algorithms). Based on limitations imposed by the machine’s calculation of P50, higher SO2 in Greyhounds (>80%) could also make the analyzer assign a default value, explaining such a narrow range in P50 values.

Committee:

C. Guillermo Couto, DVM (Committee Chair); Edward Cooper, VMD, MS (Committee Member); Maxey Wellman, DVM, PhD (Committee Member)

Subjects:

Sports Medicine; Veterinary Services

Keywords:

hemoglobin; oxygen affinity; Greyhound

Vernau, Daniel P.Gender, Athletic Identity, and Playing Through Pain and Injury in Recreational Basketball Players
Master of Science in Sport Studies, Miami University, 2009, Physical Education, Health, and Sport Studies
The psychology of injury literature has not addressed whether recreational male and female athletes have positive attitudes toward playing through injury or play through injury. The purpose of this investigation was to determine recreational basketball players’ injury attitudes  and self-perceived behaviors, as a function of gender and athletic identity. Participants were 68 male and 62 female collegiate intramural basketball players, who completed the Athletic Identity Measurement Scale, Risk, Pain, & Injury Questionnaire-Rec, and a Self-Perceived Behavioral Questionnaire. Results of a factor analysis on the RPIQ-Rec indicated two factors of injury attitudes for recreational athletes. Results of a gender x athletic identity MANOVA indicated differences between high and low athletic identity in injury attitudes, and perceived playing through injury behaviors. However, no gender differences were found. Regression analyses showed athletic identity significantly predicted injury attitudes and behaviors. Results are discussed in regard to socio-psychological injury literature, and the gender similarities hypothesis.

Committee:

Dr. Robert Weinberg (Committee Chair); Dr. Thelma Horn (Committee Member); Dr. Rose Marie Ward (Committee Member)

Subjects:

Behaviorial Sciences; Gender; Recreation; Social Psychology; Sports Medicine

Keywords:

psychology of injury; athletic identity; sex differences; playing with pain; playing with injury; pain; injury; gender; injury attitudes; recreational; intramural; athletes

Cameron, Shawn P.Focal Wrist Cooling Does Not Alter Indices of Spinal Excitability in the Flexor Carpi Radialis Muscle
Master of Science (MS), Ohio University, 2011, Athletic Training Education (Health and Human Services)
Focal joint cooling has been shown to increase the Hoffmann reflex (H-reflex), an index of spinal excitability, in the lower extremity. Unfortunately, the H-reflex is influenced by many segmental physiological factors making it difficult to delineate the mechanistic underpinnings of this previously observed phenomenon. Accordingly, this thesis sought to determine if cryotherapy alters motoneuron excitability by using an innovative technique that permits a more direct assessment of A-motoneuron excitability. To approach this aim, we investigated the effects of focal wrist joint cooling on the flexor carpi radialis muscle’s H-reflex response as well as cervicomedullary evoked potentials (CMEPs) in 10 healthy male participants. A 2 x 2 repeated measures ANOVA was used to compare the H-reflex and CMEP measurements following a cryotherapy or sham intervention. No time by treatment interactions were observed for any outcome variables. In summary, focal joint cooling does not alter H-reflex or CMEP amplitude measurements immediately posttreatment.

Committee:

Andrew Krause, PhD, AT (Committee Chair); Brian Clark, PhD (Committee Member); Thad Wilson, PhD (Committee Member)

Subjects:

Sports Medicine

Keywords:

Cryotherapy; H-reflex; CMEP

Hoch, Matthew C.Effect of Functional Fatigue on the Soleus Hoffmann Reflex in Subjects with Functional Ankle Instability
Master of Science (MS), Ohio University, 2008, Athletic Training Education (Health and Human Services)
Arthrogenic muscle inhibition of the soleus has been identified in subjects reporting functional ankle instability (FAI). This investigation sought to determine if functional muscular fatigue creates acute changes in soleus motoneuron activation that may account for alterations in dynamic ankle stabilization. All subjects completed a functional fatigue protocol and a 10-minute rest session. H-reflex recruitment curves were used to identify a stimulus that elicited submaximal H-reflexes (H20%Mmax) at 20% of the maximum muscle response. H20%Mmax was recorded prior to and every 5min following the fatigue protocol. A 2 x 2 x 6 repeated measures ANOVA was used to compare peak-to-peak H20%Mmax across time, intervention, and condition. A main effect was observed for time by intervention. The fatigue protocol caused a decrease in peak-to-peak H20%Mmax compared to the resting session. This indicates that fatigue could create a disruption in dynamic ankle stabilization; however, it does not explain sensations of instability exhibited by patients with FAI.

Committee:

Andrew Krause, PhD (Committee Chair); Chad Starkey, PhD (Committee Member); Roger Gilders, PhD (Committee Member)

Subjects:

Health Care; Rehabilitation; Sports Medicine

Keywords:

functional ankle instability; fatigue; soleus; sprain; hoffmann reflex

Porter, Julie A.Observation and Analysis of Competitiveness and the Self-Perception of Female Athletes
Master of Arts in Education, Defiance College, 2009, Education
This study was conducted with 17 women basketball players of a private, Midwest, NCAA Division III (National Collegiate Athletic Association) college. The purpose of this project was to determine if self-perception of competitiveness among collegiate female basketball players changed after the implementation of competitive drills during practice. The researcher used two instruments for data analysis for this project which were the Sports Orientation Questionnaire and the Sports Orientation Written Prompts. These two instruments were utilized as assessment tools and were administered before and after the intervention period. The intervention period consisted of three weeks of competitive drills conducted daily during basketball practices. The findings from this project indicated a slight increase in the self-perception towards being competitive among the female collegiate basketball players that participated in this research project.

Committee:

Jo Ann Burkhardt (Advisor)

Subjects:

Psychology; Sports Medicine

Keywords:

basketball; female athletes; NCAA Division III; competitiveness; Sports Orientation Questionnaire; Sports Orientation Written Prompts

Schroeder, Matthew JasonFactors Related to the Timing of Anterior Cruciate Ligament Reconstruction Failure Among an Active Population
Doctor of Philosophy, The Ohio State University, 2012, Public Health

Anterior cruciate ligament rupture is a serious event linked to detrimental sequelae such as short-term functional deficits and long-term morbidity involving osteoarthritis and degenerative, progressive disability. In most cases, highly active patients that desire to return to pre-injury activity levels require ACL reconstruction surgery with 75-97 percent experiencing positive results with respect to knee function and stability, reduced pain, and a return to normal levels of activity. Despite this, there remain patients who experience negative outcomes such as knee pain and stiffness, restricted motion, instability, graft failure, and osteoarthritis. An increasing number of studies have focused on revision outcomes, with the vast majority reporting subjective data collected from validated questionnaires and objective data in the form of functional testing and radiographic results. It is estimated that between 2 and 6 percent of primary ACL reconstructions will fail, requiring revision surgery. Due to the relative rarity of graft failure the collection of a sufficient number of graft failures leading to revision in a prospective manner can be lengthy and costly. The Multicenter ACL Revision Study was designed to prospectively assess revision outcomes and has amassed nearly 1000 patients since 2006. The extraction of demographic and primary ACL reconstruction surgical data from this study allows for the calculation of time from primary reconstruction to revision and time from primary ACL reconstruction to graft failure. To date no published study has been designed to investigate time-to-revision or time-to-failure as a dependent outcome of interest.

The goals of this study were: 1. Describe patient and surgical characteristics of the largest collection of anterior cruciate ligament graft failures in the US, 2. Identify factors associated with occurrence of revision surgery within 30 months of primary reconstruction, and 3. Specifically investigate the association of sex and time-to-graft failure and the modifying effects of graft type and activity level.

The main finding of this research is that among patients with confirmed ACL graft failure, factors associated with greater odds of revision within 30 months of primary ACL reconstruction are: age at primary of 18 years or less, a return to a high activity level, allograft use in primary surgery, hamstring with semitendinosis plus gracilis use in primary surgery, and prior lateral meniscus surgery. Patients with a femoral tunnel position deemed too anterior or too vertical had reduced odds of revision within 30 months of primary ACL surgery when compared to a position deemed ideal. A sex difference was not observed for revision occurring within 30 months of primary surgery. However, an additional finding suggests that when time-to-graft failure, rather than revision, is taken into account a significant difference between males and females exists, with female grafts failing earlier. Activity level and prior graft type modify this difference. Future, prospective studies should investigate the temporal component of graft failure and results from this study suggest age at primary ACL surgery, activity level to which the patient wishes to return, and prior graft type, graft source, and femoral tunnel position should be considered as potential factors.

Committee:

John Wilkins, III, Dr.P.H. (Advisor); Randall Harris, PhD (Committee Member); Judith Schwartzbaum, PhD (Committee Member)

Subjects:

Epidemiology; Health Care; Health Sciences; Sports Medicine

Keywords:

anterior cruciate ligament (ACL); revision; reconstruction; epidemiology; time-to-event

Braun, Kaitlyn N.Single-Leg Power Generation in Adolescent & Young Adult Athletes Returning to Sport Following Anterior Cruciate Ligament Reconstruction
Master of Science in Exercise and Health Studies, Miami University, 2010, Physical Education, Health, and Sport Studies
The increase in adolescent and young adult sport participation has contributed to a rapid rise in sports-related knee injuries, particularly anterior cruciate ligament (ACL) injuries. Even following surgical reconstruction and comprehensive rehabilitation, asymmetries in performance of the injured knee may increase the risk of future injury. Muscle power is an important representation of an athlete‘s abilities to perform various demands imposed in sports; however, relatively little research has examined measures of single leg power in athletes following ACL reconstruction. The purpose of this study is to examine single leg power generation in adolescent and young adult athletes following ACL reconstruction. A portable force platform was used to compare power generation of the injured and uninjured legs during single leg hopping. The findings from this study offer clinical implications for future rehabilitation interventions and prevention of future injury.

Committee:

Valerie A. Ubbes, PhD, CHES (Advisor); Susan C. Lipnickey, PhD (Advisor); Randal P. Claytor, PhD (Committee Member)

Subjects:

Health; Rehabilitation; Sports Medicine

Keywords:

single leg power; power generation; ACL; ACL reconstruction; adolescent; young adult; athletes

Haworth, Joshua LewisNonlinear Analysis of Proprioceptive Training Induced Changes in Postural Control on a Dynamic Surface
Master of Science in Exercise and Health Studies, Miami University, 2008, Physical Education, Health, and Sport Studies
This research seeks to describe the postural sway performance of participants during quiet stance on a dynamic surface, longitudinally throughout a balance training program. A nonlinear method of data processing was presented, along with traditional linear statistics, as an effective movement descriptor. COP was measured on a compliant surface atop a force plate, during each laboratory visit. Results show no change in COP range, change in variability only in the anteroposterior direction, and reductions in both velocity and LyE in the mediolateral and anteroposterior directions. Reduced LyE values indicate a more periodic (self-similar) structure within the COP path. It appears that the participants were able to develop a more calculated approach to the maintenance of balance by moving both more slowly and with a more regular movement pattern. Support for the use of both a dynamic surface and a nonlinear analysis for the evaluation of postural sway has been provided.

Committee:

Mark Walsh (Advisor); Thelma Horn (Committee Member); Dean Smith (Committee Member)

Subjects:

Behaviorial Sciences; Biomedical Research; Rehabilitation; Sports Medicine

Keywords:

postural sway; nonlinear analysis; dynamic surface; balance; training; proprioception; balance; center of pressure; Lyapunov exponent; postural control; emergent behavior

Stayton, BenEffect of Pre-Exercise Drinks on Anaerobic Endurance Performance
Honors Theses, Ohio Dominican University, 2008, Honors Theses
This study was undertaken to discover the effects of pre-exercise drinks on anaerobic endurance performance. Fifteen ODU baseball players (ages 18-22) volunteered to perform the running-based anaerobic sprint test (RAST) after ingesting 8oz. of water, Gatorade, or Red Bull energy drink. The fifteen players were randomly divided into three groups which were assigned a schedule of beverages to ingest on each day of the test. Each group started with one beverage each on the first day and rotated around the three drinks. Six days of testing were used to allow for each athlete to ingest each beverage twice so that performance increases from the general exercise would not be a factor. A RAST calculator was used to measure the peak, average, and minimum power output for each test along with a fatigue index. Four out of the original fifteen athletes completed the basic requirements with only one athlete completing the entire testing regimen by testing through both rounds of procedures while ingesting all three beverages for each round. After all tests were completed a repeated measures ANOVA was used on the fatigue indexes for each athlete for each beverage to determine statistical significance. Gatorade and Red Bull were found to have no significant endurance performance increase over water during an anaerobic sprint test (F (2,6)= 0.241, P > 0.05).

Committee:

Rebecca Rowoth, Dr. (Advisor); Valerie Staton, Dr. (Committee Chair); Viki Motz, Dr. (Advisor)

Subjects:

Anatomy and Physiology; Biochemistry; Food Science; Sports Medicine

Keywords:

caffeine; tauring; carbohydrates; carbs; exercise; endurance; pre-exercise drinks; Red Bull; Gatorade; RAST

Salameh, AhlamGraded Exercise Stress Testing: Treadmill Protocols Comparison Of Peak Exercise Times In Cardiac Patients
Master of Science, University of Akron, 2009, Physical Education-Exercise Physiology/Adult Fitness

Introduction and Purpose: Exercise is one of the frequent physiological stresses that can result in cardiovascular abnormalities that are not present at rest and it can help to establish a good idea on the sufficiency of cardiac function2. The Optimal exercise stress test protocol should consider the reason of the test, the results that are expected from the test, and the individuality of the population that is being tested18, 5 The duration of the optimal test should be approximately 10 to 12 minutes14.The purpose of this research was to compare a new protocol (ARP protocol) capability in categorizing patients into high or low functional capacity categories prior to exercise with Bruce and Modified Bruce protocols

Materials and Methods The study consisted of a sample of 73 Summa cardiac rehabilitation phase II patients from 1996 to date. Clinical and demographic data was abstracted from hard-copy and electronic cardiac rehab clinical files and were entered into a separate electronic Microsoft Access research database. Statistical analysis was conducted on SPSS version 16.0. Means, standard deviations and correlation matrices were generated. Multinomial Logistic Regression was incorporated to evaluate if there was a significant difference between treatments while controlling for peak estimated work output in METs and age at test administration.

Results: The study consisted of 73 patients, 29 female and 44 male. The sample has mean age of 67.06 years (SD = 10.37; range = 43.39 years). The ARP is predicted most accurately (75.8%), while the other protocol, Bruce 53.8% and Modified Bruce 35.7%, are predicted with less accuracy.

Conclusions The Accelerated Ramp Protocol (ARP) has higher accuracy in predicting the maximum work capacities in cardiac patients within the optimal time limit 8 – 12 minutes.

Committee:

Ronald Otterstetter (Advisor)

Subjects:

Health; Health Care; Public Health; Rehabilitation; Sports Medicine

Keywords:

Coronary Artery Disease; METs; Maximum Oxygen Consumption; VO2max; Stress Test; Energy Expenditure; Peak Stress Test Time

Kopec, Thomas J.Effects of Two Therapeutic Modalities on Acute Muscle Soreness
Master of Science, University of Akron, 2009, Physical Education-Exercise Physiology/Adult Fitness

Injuries hinder athletic performance. Athletic trainers must use every tool at their disposal to expedite recovery time from injury. Electrotherapy is one of the most common therapeutic modalities utilized. The purpose of this study was to examine standard Microcurrent Electrical Nerve Stimulation (MENS) protocol versus InterX with the Flexible Array attachment on the reduction of pain associated with delayed onset muscle soreness (DOMS). DOMS was initiated using eccentric bicep curls. Subjects completed a pain scale after exercise and then were randomly assigned to one of three treatments: InterX, MENS, or no treatment. Each subject was to complete the exercise bout and then receive one treatment. In six or seven days they would repeat this procedure until they received each of the three treatments. The subjects also filled out a pain scale 24 hours after respective treatment.

The results found no statistical significance among the three treatments regarding reduction in pain scores. However InterX did reveal the greatest decline of pain scores compared to MENS and no treatment. A larger sample size may reveal a statistical significance between InterX and MENS on DOMS symptoms reduction.

Committee:

Ron Otterstetter, Ph. D. (Advisor)

Subjects:

Sports Medicine

Keywords:

therapeutic modalities; Inter X; InterX; microcurrent electrical nerve stimulation; MENS; delayed onset muscle soreness; DOMS

Duecker, Jody RMeasurement of Validity for Balance Assessments using a Modified CTSIB Sway Index Versus a Biodex Sway Index
Master of Science in Education, University of Akron, 2013, Physical Education-Exercise Physiology/Adult Fitness
The purpose of the study is to determine the relationship and validity of the Sway Index as measured by the Biodex Balance System (BBS) compared to the Sway Index as measured by the modified-Clinical Test of Sensory Interaction on Balance (m-CTSIB) during a balance assessment protocol. The BBS score is determined by a computer, where the m-CTSIB score is determined subjectively by an individual. Balance is an important consideration when it comes to post-concussion treatments of athletes. To understand deficits or relationships, it is important to understand balance deficits in individuals who have obtained a concussion to determine return to play protocols. It is known that balance is affected following a concussion but clinicians do not always rely on objective measurements to clear participants to return to competition. This study would provide an objective tool that can be incorporated with the other determinants to return to play decisions. It is hypothesized that the Biodex Balance System Sway Index score will positively correlate with the m-CTSIB Sway Index score. Research Questions: 1. Is there a significant difference in stability index scores when comparing different stances among different trials? 2. Is there a significant difference between overall stability index scores when comparing between trials? 3. What is the test-retest reliability of the m-CTSIB protocol on the BBS? 4. Is there a correlation of stability index scores of the four stances between trials? 5. Is there a correlation between the traditional m-CTSIB protocol scores (measured by time held in testing position seconds) and the m-CTSIB scores as measured by the BBS (measured by overall stability index)? Study participants were recruited from The University of Akron campus and any volunteers who participanted through email or sign up sheets. This study will employ all of the participants who consented to the study. All the participants agreed to the criteria in this study they must were tested three times with at least a one week between each trial to collect data. Participants were excluded from the study if they had received a concussion prior to data collection. Before participation all subject signed a consent form that was IRB approved and all assessments were completed within approximately 20 minutes. modified-Clinical Test of Sensory Interaction on Balance Before administering the m-CTSIB the individual scoring and collecting data must have a foam pad (Power Systems Airex Balance Pad 81000), stopwatch, additional spotter, and the m-CTSIB Testing Protocol. The m-CTSIB test is made-up of four 30-second conditions. The participants will stand and perform the following: 1) double leg stances on a solid surface with eyes open and 2) double leg stances on a solid surface with eyes closed, then double leg stances on a foam pad with eyes open and double leg stances on foam pad with eyes closed. Prior to testing, the participant must be instructed to remove shoes and any ankle tape. The individual conducting the test must use a rehearsed script for each participant and undergo extensive training and competency testing before the study begins. This script will provide specific directions for each participant to follow. The participant will be instructed to assume the required m-CTSIB stance by placing their hands on their opposite shoulder and keeping their head up and eyes closed (Onate, Beck, and Van Lunen, 2007). Each foot of the participant will be placed by the administer to ensure consistency. When assessing the stances the time will stop when the participant reaches 30 seconds or the participant opens their eyes, takes a step, lifts their heel off the platform, stumbles, falls, moves hands from shoulders, or grasps the railing. The time for each trial will be added up for measurement an assessed. The maximum time is 2 minutes for all stances. Biodex Balance System (m-CTSIB) The Biodex Balance System (Biodex Balance SD) (BBS) default test for assessing postural instability is the modified Clinical Test of Sensory Integration and Balance. As a result, the m-CTSIB is the protocol that will be utilized in this study. All participants will be tested on the BBS in order to obtain week 1, week 2, and week 3 measurements. Before any data collection is obtained the tester must have proper training and experience in operating the BBS. In addition, the tester must use a rehearsed script for each participant in order to keep all data collection consistent. The tester must first set all of the parameters according to the m-CTSIB protocol. For example, each participant will perform four 30-second trials in a double leg stance. Participants will be instructed to perform the first two trials on a stable surface with 1) eyes-opened and 2) eyes-closed. Next, participants will have to maintain balance on an unstable surface (foam pad) with 1) eyes-opened and then 2) eyes-closed. This data will be saved in the computer system and then printed out for objective measurement assessments. If the participant cannot complete the 30-second trial it is recorded as `fall’ (Biodex Medical Systems, Inc., 2011).

Committee:

Ron Otterstetter, Dr. (Advisor); Carrie Fister, Mrs. (Committee Chair); Stacey Buser, Mrs. (Committee Chair)

Subjects:

Physiology; Rehabilitation; Sports Medicine

Keywords:

Biodex Balance System: m-CTSIB: Sway Index

Gray, Kimberly A.Validation of the Ottawa Ankle Rules for Acute Foot and Ankle Injuries
Master of Science (MS), Ohio University, 2013, Athletic Training (Health Sciences and Professions)
Context: The original and modified Ottawa Ankle Rules (OARs) were developed as clinical decision rules (CDRs) for the emergency department setting. However, these CDRs have not been validated as an acute clinical evaluation tool. Currently, there are no sport-specific CDRs relating to acute ankle injuries. Objective: The objectives of this study were: to test the validity of the OARs in acute foot or ankle injury in a sport related setting and to evaluate the measures of diagnostic accuracy of specific predictor variables. Patients or Other Participants: The participants were athletic trainers assigned to university athletics, club sports, and high schools. Conclusions: The OARs did not reduce the number of unnecessary radiographs referred. The OARs in an acute setting had a high sensitivity and are good predictors to rule out the presence of a fracture. Low specificity results led to a high number of false positives and low positive predictive values. Adding one or more predictor variables may improve the validity of the OARs in the acute setting.

Committee:

Chad Starkey (Advisor)

Subjects:

Demographics; Epidemiology; Health Care; Health Sciences; Sports Medicine

Keywords:

Ottawa Ankle Rules; Clinical Decision Rules; predictor variables; sensitivity; specificity; likelihood ratios; predictive values; diagnostic accuracy; validity

German, Rachael MINHIBITORY KINESIO® TAPE APPLICATION TO THE HAMSTRING MUSCLE GROUP: AN INVESTIGATION OF ACTIVE RANGE OF MOTION AND PERCEIVED TIGHTNESS OVER TIME
MS, Kent State University, 2013, College and Graduate School of Education, Health and Human Services / School of Health Sciences
Context: The purpose of this study was to determine the inhibition effects of Kinesio® tape on the hamstrings muscle group. Objective: Although liberal anecdotal support exists, there is a lack of scientific data reported relative to the use of Kinesio® tape. Design: Within subject – repeated measures design. Random counterbalanced design. Setting: The settings included Division I and high school athletic training facilities from varying Ohio schools. Patients: The subjects consisted of college and high school athletes who had limited range of motion as determined by straight leg raise and popliteal angle. There were a total of 29 subjects (21 males, mean age 17.191, SD= 1.750 and 8 females, mean age 17.750, SD= 2.493). Interventions: Subjects received both Kinesio® and sham taping methods with measures of dependent variables taken at baseline, immediate, 4 days, 8 days, and 12 days of taping. Tape was re-applied every 2 days. Main outcomes measures: A 2 way ANOVA was used to analyze the outcome variables of range of motion and perceived stiffness. Results: A main effect of time for both taping conditions was revealed across all dependent variables. Significant increases for straight leg raise (p <.001), popliteal angle (p <.001), and perceived stiffness were observed (p <.001). A condition by time interaction was present for straight leg raise between 8 and 12 days (p = .046). Significance was present in the Kinesio® group (p = .027). Conclusion: Everyone displayed improvements towards greater flexibility across time. Between 8 days and 12 days there was a greater improvement for straight leg raise for the Kinesio® group.

Committee:

Kimberly Peer, Ed.D, AT, FNATA (Committee Chair); Jeffrey Huston, MS, AT (Committee Member); Jacob Barkley , Ph.D (Committee Member)

Subjects:

Sports Medicine

Keywords:

"Kinesio tape; hamstrings; straight leg raise"

Hentkowski, Brandon SComparison of Barefoot and Shod Rehabilitation Exercises For Increasing Balance and Intrinsic Foot Strength For Chronic Ankle Instability
MS, Kent State University, 2013, College and Graduate School of Education, Health and Human Services / School of Health Sciences
Although most ankle sprains are resolved with conservative treatment, persistent symptoms might remain and a number of them may develop into Chronic Ankle Instability (CAI). The purpose of this study was to observe whether barefoot training exercises would increase balance and intrinsic foot strength in chronic ankle instability as opposed to shod rehabilitation or no rehabilitation. 20 volunteers (height = 173.85 ± 10.75, weight = 80.16 ± 23.17, age = 21.05 ± 2.39) were recruited and placed into 3 separate rehabilitation protocols. A 3-week rehab protocol focusing on balance training and intrinsic foot muscle strength was performed and measurements were taken for the Athletic Single Leg Test, modified Clinical Test of Sensory Interaction & Balance, Functional Ability and Ankle Measure (FAAM), and Intrinsic Foot Muscle Test (IFMT). Change scores for FAAM were significant between participants who were shod during rehabilitation and control (p = 0.032) and for barefoot rehabilitation and control (p = 0.001). SLO (Single Leg Overall Stability) was significant between barefoot and control (p = 0.02) and trending toward significance for shoes and control (p = 0.051). No difference was seen between barefoot and shod conditions during rehabilitation. Balance training and intrinsic foot muscle strengthening significantly improved self-reported functional and static postural control for CAI and was not dependent on footwear.

Committee:

Kimberly Peer (Advisor); Angela Ridgel (Committee Member); Huston Jeffery (Committee Member)

Subjects:

Rehabilitation; Sports Medicine

Lopez, Lisa B.Training College Staff to Recognize and Respond to Concussions
Specialist in Education (Ed.S.), University of Dayton, 2016, School Psychology
This study utilized a quasi-experimental survey design to: a) examine the current level of knowledge of and training on concussion among college staff members, b) evaluate the efficacy of a one-hour training program on concussion recognition and management skills, and c) explore the impact of ongoing programming on college staff members' ability to meet the needs of students who sustained a concussion. Participants (N = 263) received the training as well as ongoing resources provided by email during a four to nine month period following the training. Prior and attained knowledge were measured by pre- and post-training questionnaires. A follow-up questionnaire was administered four to nine months post-training to assess if and how participants utilized knowledge gained from training in working directly with students who had sustained a concussion. Results indicated a 7% percent increase in knowledge across participants from the pre- to post-test questionnaire; however, results were not significant. Implications for college student personnel and college students are discussed.

Committee:

Susan Davies, Ed.D. (Committee Chair); Elana Bernstein, Ph.D. (Committee Member); Molly Schaller, Ph.D. (Committee Member)

Subjects:

Higher Education; Inservice Training; Recreation; Sports Management; Sports Medicine

Keywords:

concussion; college students; campus residence life; campus recreation center; head injury; traumatic brain injury

Reneker, Jennifer ChristineDifferential Diagnosis of Dizziness Following a Sports-Related Concussion
PHD, Kent State University, 2015, College of Public Health
Aim 1: Synopsis The primary goal of Aim 1 was to determine if subjects’ dizziness descriptors cluster in a manner that enables differentiation by anatomical location. Latent Class Analysis (LCA) was used to identify latent traits present in a structured symptom history questionnaire including 15 descriptors and 11 triggers of dizziness. The separate analyses of the two components of the subjective history; the descriptors of dizziness and triggers of dizziness, revealed that three classes emerged for each set of variables. Although three classes were identified through LCA within the descriptors, conclusions regarding the ability of these classes to identify a specific anatomical location were unable to be drawn. Similarly, the three classes of triggers were unable to be definitively linked to a specific type of dizziness. Established patterns of dizziness description associated with specific types of dizziness in other populations (i.e. subjects without a concussion) were not observed with this sample of subjects with SRC. The conclusion drawn from this study is that the use of the patient description of dizziness to base the direction of the objective examination may not be a reliable method to approach a patient with a SRC and dizziness. Aim 2: Synopsis The primary goal of Aim 2 was to utilize research and clinical expertise of an invited respondent group to identify objective tests with high clinical utility that should be included in a physical examination to differentiate between the different subtypes of dizziness after a SRC. Specifically, the question posed to the group was: What clinical tests and measures could be included in an assessment to differentiate between cervicogenic and other causes of dizziness in concussed athletes? Through a three round process, including 25 experts from various medical disciplines, 10 tests were identified to have strong clinical utility and 7 were identified as having weak clinical utility. The clinical tests included in the final list of measures with strong clinical utility were tests to identify vestibular and ocular impairments leading to dizziness. Unfortunately, none of the clinical tests used to identify cervical dizziness were regarded as having strong clinical utility. Even though a majority of the respondents were physical therapists, those therapists who were not orthopaedic / manual therapists did not indicate strong clinical utility for any of the cervically-oriented tests. It was concluded that many medical professionals are unfamiliar with tests of the cervical spine and the diagnosis of cervicogenic dizziness. The results of this study highlight the current absence of well-defined, universally understood clinical tests to diagnose cervicogenic dizziness in the presence of concussion. Aim 3: Synopsis Aim 3 used the results of the Delphi from round 2 (in part) to construct and utilize a physical examination of subjects with dizziness after SRC. Each of the 16 clinical tests was regarded as positive or negative, based standard interpretation of the test (e.g. indications of a positive finding). Here, positive findings provided indication of the anatomical location(s) contributing to dizziness. The primary purpose of Aim 3 was to describe the results of this differential objective physical examination in subjects with dizziness after a SRC and determine the relationships between various types of dizziness as identified by the objective examination. Multiple Correspondence Analysis (MCA) was used to graphically represent the results. Within MCA, five dimensions were required to adequately describe the relationships between the response profiles and accounted for > 70% of the inertia. The exploratory MCA revealed that while some tests clustered and identified a common etiology of dizziness, some clusters identified more than one anatomical area within the positive findings. The results of this study indicate that after SRC, an athlete’s dizziness is often multifactorial, potentially originating from multiple anatomical locations, each independently sufficient to cause dizziness.

Committee:

Vinay Cheruvu, PhD (Committee Co-Chair); Mark James, PhD (Committee Co-Chair); Jingzhen Yang, PhD (Committee Member); Chad Cook, PT, PhD, MBA (Committee Member)

Subjects:

Epidemiology; Neurology; Physical Therapy; Public Health; Sports Medicine

Keywords:

Concussion; traumatic brain injury; dizziness; differential diagnosis; Latent Class Analysis; Delphi Method; Multiple Correspondence Analysis

Next Page