The LIMBIC Military and Tactical Athletic Research Study (MATARS) framework was established to confirm and extend understanding of concussion with initial studies driven by clinical data collected ...between 2015 and 2020 in a collegiate sports setting. The LIMBIC MATARS framework will be leveraged to apply gold-standard and innovative research designs to advance the science of concussion. This manuscript provides the background, methodology, and initial demographic data associated with the LIMBIC MATARS.
Consensus-based common data elements were used to conduct a retrospective chart review, specific to collegiate athletes diagnosed with concussions between 2015 and 2020 at 11 universities.
A final sample of 1,311 (47.8% female) concussions were diagnosed during the five-year study period from athletes participating in a variety of National Collegiate Athlete Association (NCAA) sports. The LIMBIC MATARS demographic data, align with the NCAA and other pioneering multi-site concussion-related studies in terms of biological sex, race and ethnicity, and sport participation.
This pragmatic, methodological approach was used to address several a priori hypotheses related to concussion, align with other multi-site studies of concussion, and establish a consortium for future investigations.
Although scholars have begun to study face—to—face deliberation on public issues, “deliberation” has no clear conceptual definition and only weak moorings in larger theories. To address these ...problems, this essay integrates diverse philosophical and empirical works to define deliberation and place it in a broader theoretical context. Public deliberation is a combination of careful problem analysis and an egalitarian process in which participants have adequate speaking opportunities and engage in attentive listening or dialogue that bridges divergent ways of speaking and knowing. Placed in the meta—theoretical framework of structuration theory (Giddens, 1984), deliberation is theorized to exist at the center of a homeostatic loop, in which deliberative practice reinforces itself. A review of theory and research on the causes and effects of deliberation leads us to develop this structurational conceptualization into the self—reinforcing model of deliberation. This model posits that public deliberation is more likely to occur when discussion participants perceive potential common ground, believe deliberation is an appropriate mode of talk, possess requisite analytic and communication skills, and have sufficient motivation. Deliberation directly reinforces participants' deliberative habits and skills, and it indirectly promotes common ground and motivation by broadening participants' public identities and heightening their sense of political efficacy.
Headgear designed to protect girls' lacrosse athletes is widely available and permitted for voluntary use; however, it remains unknown how policies mandating headgear use may change the sport and, ...particularly regarding impacts during game-play. Therefore, this study compares the impact rates and game play characteristics of girls' high school lacrosse in Florida which mandates headgear use (HM), with states having no headgear mandate (NHM).BACKGROUND/OBJECTIVEHeadgear designed to protect girls' lacrosse athletes is widely available and permitted for voluntary use; however, it remains unknown how policies mandating headgear use may change the sport and, particularly regarding impacts during game-play. Therefore, this study compares the impact rates and game play characteristics of girls' high school lacrosse in Florida which mandates headgear use (HM), with states having no headgear mandate (NHM).Video from 189 randomly-selected games (HM: 64, NHM: 125) were analyzed. Descriptive statistics, Impact Rates (IR), Impact Rate Ratios (IRR), Impact Proportion Ratios (IPR), and 95% Confidence Intervals (CI) were calculated. IRRs and IPRs with corresponding CIs that excluded 1.00 were deemed statistically significant.MATERIALS AND METHODSVideo from 189 randomly-selected games (HM: 64, NHM: 125) were analyzed. Descriptive statistics, Impact Rates (IR), Impact Rate Ratios (IRR), Impact Proportion Ratios (IPR), and 95% Confidence Intervals (CI) were calculated. IRRs and IPRs with corresponding CIs that excluded 1.00 were deemed statistically significant.16,340 impacts (HM:5,821 NHM: 10,519; 86.6 impacts/game, CI: 88.6-93.3) were identified using the Lacrosse Incident Analysis Instrument (LIAI). Most impacts directly struck the body (n = 16,010, 98%). A minority of impacts directly struck a player's head (n = 330, 2%). The rate of head impacts was significantly higher in the HM cohort than NHM cohort (IRR = 2.1; 95% CI = 1.7-2.6). Most head impacts (n = 271, 82%) were caused by stick contact in both groups. There was no difference in the proportion of penalties administered for head impacts caused by stick contact between the HM and NHM cohorts (IPR IRRHM/NHM = 0.98; CI = 0.79-1.16). However, there was a significantly greater proportion of head impacts caused by player contact that resulted in a penalty administered in the HM cohort (IPR = 1.44 CI = 1.17-1.54).RESULTS16,340 impacts (HM:5,821 NHM: 10,519; 86.6 impacts/game, CI: 88.6-93.3) were identified using the Lacrosse Incident Analysis Instrument (LIAI). Most impacts directly struck the body (n = 16,010, 98%). A minority of impacts directly struck a player's head (n = 330, 2%). The rate of head impacts was significantly higher in the HM cohort than NHM cohort (IRR = 2.1; 95% CI = 1.7-2.6). Most head impacts (n = 271, 82%) were caused by stick contact in both groups. There was no difference in the proportion of penalties administered for head impacts caused by stick contact between the HM and NHM cohorts (IPR IRRHM/NHM = 0.98; CI = 0.79-1.16). However, there was a significantly greater proportion of head impacts caused by player contact that resulted in a penalty administered in the HM cohort (IPR = 1.44 CI = 1.17-1.54).These findings demonstrate that mandating headgear use was associated with a two-fold greater likelihood of sustaining a head impact during game play compared to NHM states. A majority of head impacts in both HM and NHM states were caused by illegal stick contact that did not result in penalty.CONCLUSIONThese findings demonstrate that mandating headgear use was associated with a two-fold greater likelihood of sustaining a head impact during game play compared to NHM states. A majority of head impacts in both HM and NHM states were caused by illegal stick contact that did not result in penalty.
The Child Sport Concussion Assessment Tool, fifth edition (Child SCAT5), is among the most widely used international pediatric concussion evaluation tools. However, the tool's English-only aspect may ...limit its use for patients who speak different languages. Prior researchers have suggested one's preferred language (ie, home language) could be associated with concussion assessments in adults, yet how this might affect pediatric athletes is not well understood.
To compare baseline Child SCAT5 assessment outcomes between middle school athletes whose home language was Spanish and matched control athletes whose home language was English.
Case-control study.
Middle school athletics.
Athletes self-reported their home language (ie, language spoken at home). Those indicating their home language was Spanish were individually matched to athletes who spoke English at home on age, sex, sport, school, and pertinent comorbidities (eg, concussion history). The final sample consisted of 144 athletes (Spanish home language = 72, English home language = 72).
We used Mann-Whitney U tests to compare the Child SCAT5 component scores of the home language groups (ie, Spanish versus English).
Athletes in the Spanish home language group scored lower on the Standardized Assessment of Concussion-Child version (P < .01, r = -0.25), Immediate Memory (P < .01, r = -0.45), and total modified Balance Error Scoring System scores (P < .01, r = -0.25) than the English home language group.
Matched athletes whose home language was Spanish versus English scored differently on baseline Child SCAT5 assessment components. Those with the home language of Spanish scored lower on cognitive and balance tasks than those whose home language was English. These findings may serve as a rationale for the development of future concussion assessment tools to properly capture clinically relevant data regarding language differences among pediatric athletes.
To explore diverse stakeholders' perceptions of headgear use in collegiate women's lacrosse.
189 collegiate women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32).
...Participants completed online open-ended qualitative questions surrounding headgear use in the sport. Responses were coded by the research team via inductive reasoning.
Stakeholders felt that incorporating headgear use into women's lacrosse would increase aggression and change the nature of the sport. Some felt that headgear was important for injury risk mitigation and invoked a need for research and development. Stakeholders raised the need for coaching and officiating improvement as primary injury prevention measures. Players were concerned about esthetics and performance limitations. Finally, many felt that it should be left to player choice to wear headgear or not.
Most stakeholders invoke concerns of risk compensation and changing the nature of the sport of women's lacrosse, and are in favor of headgear remaining optional.
To compare Child Sport Concussion Assessment Tool Fifth Edition (Child SCAT5) performance between uninjured children with attention-deficit/hyperactivity disorder (ADHD) and precisely matched ...controls without ADHD.
A nested case-control study was conducted within a cohort of middle school athletes (age 11-12 years) who completed preseason testing. Students with ADHD were individually matched to students without ADHD based on age, sex, language spoken at home, number of prior concussions, sport, and school they attended. The final sample included 54 students (27 with ADHD and 27 controls), 38 (70.4%) boys and 16 (29.6%) girls (average age: 11.7 years, SD = 0.5).
Children with ADHD reported more symptoms (M = 13.33, SD = 5.69, P < .001) and greater symptom severity (M = 22.59, SD = 1 1.60, P < .001) compared with controls (total symptoms: M = 6.44, SD = 4.96; symptom severity: M = 8.04, SD = 6.36). Children with ADHD performed similarly to controls on the Child SCAT5 cognitive tests. Children with ADHD committed 3 times as many total balance errors (median = 6) than children without ADHD (median = 2) and committed twice as many errors on single leg stance (ADHD median = 4; No ADHD median = 2) (P values < .001).
Children with ADHD endorsed more concussion-like symptoms and performed worse on balance testing during preseason Child SCAT5 assessment compared with matched controls without ADHD. These findings highlight the challenges of interpreting Child SCAT5 performance in children with ADHD following a concussion or suspected concussion and illustrate the value of administering the measure to children to document their pre-injury performance.
OBJECTIVE:Examine lifetime history of concussions in middle school student athletes who have attention-deficit/hyperactivity disorder (ADHD).
DESIGN:Cross-sectional study.
SETTING:Nine middle schools ...in Virginia, USA.
PARTICIPANTS:A sample of 1037 middle school students (ages 11-14 years, M = 12.6, SD = 0.93; 45.8% girls) underwent baseline/preseason assessments during the 2017 to 2018 academic year and self-reported their health history, including whether or not they had been diagnosed with ADHD. Athletes were divided into 2 groups, those with ADHD (n = 71; 6.8%) and control subjects (n = 966).
INDEPENDENT VARIABLES:Self-reported diagnosis of ADHD and self-identified sex.
MAIN OUTCOME MEASURES:Self-reported concussion history.
RESULTS:In the total sample, boys were more likely to report a previous history of concussion than girls χ(1) = 10.81, P = 0.001; odds ratio (OR) = 1.92; 95% confidence interval (CI), 1.30-2.85. The rate of previous concussion in children with ADHD (23.9%) was twice the rate of previous concussion among children without ADHD (11.4%) χ(1) = 9.70, P = 0.002; OR = 2.45; 95% CI, 1.37-4.38. Approximately 1 in 4 boys with ADHD (24.5%) and 1 in 5 girls with ADHD (22.2%) reported having sustained one or more previous concussions.
CONCLUSIONS:Attention-deficit/hyperactivity disorder is associated with a greater prevalence of previous concussion in middle school children. Further research is needed to understand the risk of sustaining concussion for young athletes with ADHD, as well as short- and long-term outcomes of concussion among young athletes with ADHD.
Controversy exists among collegiate lacrosse about the use of headgear and whether its use will facilitate greater risk compensation by players and thus contribute to unsafe gameplay. We aimed to ...characterize the attitudes of headgear among women's collegiate lacrosse stakeholders. A total of 190 women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32) participated in this study. Participants completed a survey surrounding attitudes of headgear in women's lacrosse. Descriptives, multiple regressions, and Kruskal-Wallis analyses compared attitudes surrounding headgear among stakeholder groups. Scales of Headgear Affects Play (β = -0.38, p < 0.001) and Sports Development and Safety Practices (β = 0.26, p < 0.05) significantly predicted endorsement on Headgear Safety Attitudes Scale. Among players, Aesthetics (β = 0.51, p < 0.001) and Intention to Wear Headgear (β = 0.31, p < 0.05) predicted endorsement on Headgear Safety Attitudes Scale. Stakeholders did not agree if headgear should be worn in women's lacrosse. Items related to sports development, safety and potential changes in gameplay predicted attitudes to headgear safety among all participants.
