Objective: Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency ...transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators. We hypothesized that conditions with more football equipment would decrease chest compression and ventilation efficacy. Methods: Thirty-two certified athletic trainers were block randomized to participate in six different compression conditions and six different ventilation conditions using human patient simulators. Data for chest compression (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of adequate compressions) and ventilation (total ventilations, mean ventilation volume, and percentage of ventilations delivering adequate volume) conditions were analyzed across all conditions. Results: The fully equipped athlete resulted in the lowest mean compression depth (F
5,154
= 22.82; P < 0.001; Effect Size = 0.98) and delivery of adequate compressions (F
5,154
= 15.06; P < 0.001; Effect Size = 1.09) compared to all other conditions. Bag-valve mask conditions resulted in delivery of significantly higher mean ventilation volumes compared to all 1- or 2-person pocketmask conditions (F
5,150
= 40.05; P < 0.001; Effect Size = 1.47). Two-responder ventilation scenarios resulted in delivery of a greater number of total ventilations (F
5,153
= 3.99; P = 0.002; Effect Size = 0.26) and percentage of adequate ventilations (F
5,150
= 5.44; P < 0.001; Effect Size = 0.89) compared to one-responder scenarios. Non-chinstrap conditions permitted greater ventilation volumes (F
3,28
= 35.17; P < 0.001; Effect Size = 1.78) and a greater percentage of adequate volume (F
3,28
= 4.85; P = 0.008; Effect Size = 1.12) compared to conditions with the chinstrap buckled or with the chinstrap in place but not buckled. Conclusions: Chest compression and ventilation delivery are compromised in equipment-intense conditions when compared to conditions whereby equipment was mostly or entirely removed. Emergency medical personnel should remove the helmet and shoulder pads from all football athletes who require cardiopulmonary resuscitation, while maintaining appropriate cervical spine stabilization when injury is suspected. Further research is needed to confirm our findings supporting full equipment removal for chest compression and ventilation delivery.
Abstract Purpose The purpose was to compare head kinematics between the Eject Helmet Removal System and manual football helmet removal. Basic Procedures This quasi-experimental study was conducted in ...a controlled laboratory setting. Thirty-two certified athletic trainers (sex, 19 male and 13 female; age, 33 ± 10 years; height, 175 ± 12 cm; mass, 86 ± 20 kg) removed a football helmet from a healthy model under 2 conditions: manual helmet removal and Eject system helmet removal. A 6-camera motion capture system recorded 3-dimensional head position. Our outcome measures consisted of the average angular velocity and acceleration of the head in each movement plane (sagittal, frontal, and transverse), the resultant angular velocity and acceleration, and total motion. Paired-samples t tests compared each variable across the 2 techniques. Main Findings Manual helmet removal elicited greater average angular velocity in the sagittal and transverse planes and greater resultant angular velocity compared with the Eject system. No differences were observed in average angular acceleration in any single plane of movement; however, the resultant angular acceleration was greater during manual helmet removal. The Eject Helmet Removal System induced greater total head motion. Principal Conclusions Although the Eject system created more motion at the head, removing a helmet manually resulted in more sudden perturbations as identified by resultant velocity and acceleration of the head. The implications of these findings relate to the care of all cervical spine–injured patients in emergency medical settings, particularly in scenarios where helmet removal is necessary.
The Cuff Link is a closed kinetic chain rehabilitation apparatus for the upper extremity. Limited research has established its effectiveness to elicit muscle activation of the scapular muscles.
To ...determine if scapular muscle activation differs in response to 2 upper extremity closed kinetic chain exercises: Cuff Link and standard push-up.
A single-group, repeated-measures design.
Controlled laboratory.
Twenty-eight healthy individuals (13 women: age = 19.69 +/- 1.55 years, height = 167.44 +/- 9.52 cm, mass = 61.00 +/- 8.79 kg; 15 men: age = 22.00 +/- 3.91 years, height = 181.44 +/- 6.60 cm, mass = 82.36 +/- 13.23 kg) with no history of shoulder or low back injury volunteered to participate in this study.
Participants performed 10 trials of complete revolutions on the Cuff Link and 10 full-weight-bearing push-ups. We controlled trial velocity and randomized order. Trunk and shoulder positions were normalized to the participant's height. Using surface electromyography, we recorded muscle activity of the serratus anterior, middle trapezius, and lower trapezius. Rectified and smoothed electromyography data for the serratus anterior, middle trapezius, and lower trapezius were normalized as a percentage of the maximal voluntary isometric contractions (%MVIC).
Mean muscle activity of the serratus anterior, middle trapezius, and lower trapezius. We used paired-samples t tests to analyze the mean data for each condition. The alpha level was adjusted to .016 to avoid a type I error.
Middle trapezius %MVIC was greater during push-ups (27.01 +/- 20.40%) than during use of the Cuff Link (11.49 +/- 9.46%) (P = .001). Lower trapezius %MVIC was greater during push-ups (36.07 +/- 18.99%) than during use of the Cuff Link (16.29 +/- 8.64%) (P = .001). There was no difference in %MVIC for the serratus anterior between conditions.
The push-up demonstrated greater middle trapezius and lower trapezius activation levels compared with the Cuff Link. However, the push-up had a high participant failure rate. Because serratus anterior activation levels were similar, the Cuff Link may be an appropriate alternative for individuals lacking the upper body strength to perform a push-up.
Helmet removal may be indicated for cervical spine injuries. It is unknown whether removing the facemask before helmet removal is beneficial. Head acceleration, time, and difficulty were compared ...during helmet removal of two different helmet types (Riddell 360 and VSR4; Riddell Inc., Elysia, OH) with and without facemask removal. For all planes of acceleration, the 360 was greater than the VSR4 (5.19 ± 1.6 and 3.1 ± 0.67 m/sHelmet removal may be indicated for cervical spine injuries. It is unknown whether removing the facemask before helmet removal is beneficial. Head acceleration, time, and difficulty were compared during helmet removal of two different helmet types (Riddell 360 and VSR4; Riddell Inc., Elysia, OH) with and without facemask removal. For all planes of acceleration, the 360 was greater than the VSR4 (5.19 ± 1.6 and 3.1 ± 0.67 m/s
2
, respectively, sagittal; 4.87 ± 1.6 and 2.8 ± 0.78 m/s
2
, respectively, transverse; 2.71 ± 0.92 and 1.94 ± 0.43 m/s
2
, respectively, frontal). For sagittal and transverse planes of acceleration, facemask-on was greater than facemask-off (4.76 ± 1.1 and 3.52 ± 0.80 m/s
2
, respectively, sagittal; 4.33 ± 1.1 and 3.34 ± 0.93 m/s
2
, respectively, transverse). The VSR4 (91.2 ± 18.8 sec) took longer than the 360 (50.2 ± 11.1 sec). Facemask-off (82.5 ± 13.8 sec) took longer than facemask-on (59.0 ± 15.0 sec). The VSR4 was more difficult (2.67 ± 0.83) than the 360 (2.31 ± 0.73). Facemask removal limited acceleration at the head. The removal process increased the time for the task for both helmets (360 and VSR4) and increased difficulty with the VSR4. Research analyzing induced motion is warranted.
Athletic Training & Sports Health Care.
2015;7(6):224–231.
Context: The presence or absence of biomechanical differences between the sexes before puberty may provide clues about the onset of adult landing pattern differences, which may help to explain the ...greater number of anterior cruciate ligament injuries in females than in males and provide the basis for interventions to reduce those injuries.Objective: To identify developmental sex-related and biomechanical differences during vertical jump landings.Design: A 2 x 2 developmental stage (prepubescent or postpubescent) x sex (male or female) between-subjects design.Setting: Controlled laboratory setting.Patients or Other Participants: Thirty prepubescent subjects (15 boys, age = 9.63 +/- 0.95 years; 15 girls, age = 9.19 +/- 1.00 years) and 28 postpubescent subjects (14 men, age = 23.57 +/- 3.23 years; 14 women, age = 24.22 +/- 2.27 years).Intervention: Subjects performed a vertical jump to a target set at 50% of their maximum vertical jump height ability.Main Outcome Measure(s): Hip and knee kinematics of the dominant lower extremity and vertical ground reaction forces during impact were analyzed.Results: We found significant main effects for developmental stage. Children demonstrated greater knee valgus and less hip flexion at initial contact and at maximum vertical force, less knee flexion at maximum vertical force, greater maximum vertical force and impulse, and a shorter time to maximum vertical force than the adults. No sex differences were found among the biomechanical variables measured.Conclusions: The presence of significant biomechanical differences between children and adults suggests that physical development influences landing patterns. Sex does not appear to influence landing patterns during a 50% maximum vertical jump landing. These findings add to the body of knowledge regarding developmental and sex comparisons in a functional landing task.
Background: Researchers have investigated the performance of face mask removal tools for spine injury management in football but not
the effects of football equipment design.
Hypotheses: Various ...styles or designs of football helmet equipment (helmets, face masks, loop straps) affect face mask removal efficiency.
A cordless screwdriver performs more efficiently than do cutting tools.
Study Design: Controlled laboratory study.
Methods: Nineteen certified athletic trainers were randomly assigned to group 1 (cordless screwdriver and the FM Extractor) or group
2 (cordless screwdriver and the Trainerâs Angel). Subjects randomly performed face mask removal for 6 conditions composed
of helmet (3), face mask (3), and loop strap (5) combinations. Time, head movement, perceived difficulty, and success rates
were measured.
Results: Multiple significant differences were found in time, movement, and perceived difficulty between the 6 helmet equipment conditions.
The Shockblocker loop strap was consistently superior in all variables regardless of the tool used or the helmet it was attached
to. The cordless screwdriver created less movement (mean range from any one plane, 2.8°â13.3°), was faster (mean range, 42.1â68.8
seconds), and was less difficult (mean rating of perceived exertion range, 1.4â2.9) compared to cutting tools (ranges, 4.4°â18.4°
in any one plane, 71â174 seconds, rating of perceived exertion, 2.8â7.7). Trial failure was more common with cutting tools
than with the screwdriver.
Conclusion: Differences in football helmet equipment affect face mask removal. The cordless screwdriver is more efficient than the FM
Extractor and Trainerâs Angel.
Clinical Relevance: Professionals responsible for the care of football athletes must be knowledgeable in the types of equipment used and the
best option available for effective airway access.
Keywords:
cervical spine injury
emergency management
airway access
football injury
To describe frequency and characteristics of emergency medical services (EMS) activations by certified athletic trainers (ATs) and effects of pre-season planning meetings on interactions between ATs ...and EMS both generally and specifically during football head/neck emergencies.
Retrospective cross-sectional survey.
2009 Web-based survey.
Athletic trainers (n = 1884; participation rate, 28%) in high school and collegiate settings.
Athletic trainer work setting, AT demographics, history of pre-season planning meetings.
Proportions and 95% confidence intervals (CIs) estimated the prevalence of EMS activation, planning meetings, and characteristics of AT-EMS interactions (eg, episodes of AT-perceived inappropriate care and on-field disagreements). Chi square tests tested differences (P < 0.05) in proportions. Associations (odds ratio = OR and 95% CI) between work setting, demographics, preseason meetings and fall 2008 1) episodes of AT-perceived inappropriate care, and 2) on-field disagreements were assessed using multivariate logistic regression.
High school ATs activated EMS more frequently than collegiate ATs (eg, fall 2008 EMS activation for football injury, 59.9% vs 27.5%; P < 0.01) and reported fewer pre-season planning meetings (eg, met with EMS to practice, 38.1% vs 55.8%; P < 0.01). During the Fall 2008 football season, high school ATs perceived more episodes of inappropriate care (10.4% vs 3.9%; P < 0.01) and on-field disagreements (5.4 vs 2.2%; P < 0.01) than collegiate ATs. High school work setting was independently associated with episodes of AT-perceived inappropriate care (adjusted OR = 2.76; 95% CI, 1.65-4.62) and on-field disagreements (adjusted OR = 2.33; 95% CI, 1.17-4.64).
Athletic trainer-EMS interactions are common and sometimes involve AT-perceived episodes of inappropriate care and on-field disagreements between emergency care providers.
The relative incidence of catastrophic cervical spine injury in sports is low compared to other injuries. However, the potential catastrophic and life-altering consequences of spine injury cause ...understandable concern regarding the prehospital management and care of the cervical-spine-injured athlete. This is complicated when injured athletes participate in equipment-intensive sports, such as football, where helmets and facemasks are potential barriers to obtaining immediate access to the athlete's airway. Cervical spine injuries in these cases necessitate delicate and precise management, often involving the combined efforts of multiple health-care providers. The outcome of a catastrophic cervical spine injury is dependent on the efficiency of this management process and timeliness of transfer to a controlled environment for diagnosis and treatment.
Abstract Purpose This study evaluated the effectiveness of a 5-day mind-body exercise (MBE) program on measures of quality of life, balance, balance confidence, mobility and gait in ...community-dwelling women. Methods The MBE program was a 5-day retreat where multiple sessions of Feldenkrais® -based sensorimotor movement training and walking were performed daily. Forty-six women aged 40–80 years old participated in either the MBE program or maintained normal daily activity. Two-footed eyes-closed balance, gait characteristics, mobility via the Timed Up and Go test, balance confidence and quality of life were assessed before and after the intervention. Results Women in the MBE group experienced improvements in mobility (6%; p = 0.01), stride length (3%; p = 0.008), single limb support time (1.3%; 0.006), balance confidence (5.2%; p < 0.001) and quality of life ( p < 0.05) while the control group did not change. Conclusion This short-term intensive program may be beneficial to women at risk of mobility limitations.
Football helmet face-mask attachment design changes might affect the effectiveness of face-mask removal.
To compare the efficiency of face-mask removal between newly designed and traditional football ...helmets.
Controlled laboratory study.
Applied biomechanics laboratory.
Twenty-five certified athletic trainers.
The independent variable was face-mask attachment system on 5 levels: (1) Revolution IQ with Quick Release (QR), (2) Revolution IQ with Quick Release hardware altered (QRAlt), (3) traditional (Trad), (4) traditional with hardware altered (TradAlt), and (5) ION 4D (ION). Participants removed face masks using a cordless screwdriver with a back-up cutting tool or only the cutting tool for the ION. Investigators altered face-mask hardware to unexpectedly challenge participants during removal for traditional and Revolution IQ helmets. Participants completed each condition twice in random order and were blinded to hardware alteration.
Removal success, removal time, helmet motion, and rating of perceived exertion (RPE). Time and 3-dimensional helmet motion were recorded. If the face mask remained attached at 3 minutes, the trial was categorized as unsuccessful. Participants rated each trial for level of difficulty (RPE). We used repeated-measures analyses of variance (α = .05) with follow-up comparisons to test for differences.
Removal success was 100% (48 of 48) for QR, Trad, and ION; 97.9% (47 of 48) for TradAlt; and 72.9% (35 of 48) for QRAlt. Differences in time for face-mask removal were detected (F(4,20) = 48.87, P = .001), with times ranging from 33.96 ± 14.14 seconds for QR to 99.22 ± 20.53 seconds for QRAlt. Differences were found in range of motion during face-mask removal (F(4,20) = 16.25, P = .001), with range of motion from 10.10° ± 3.07° for QR to 16.91° ± 5.36° for TradAlt. Differences also were detected in RPE during face-mask removal (F(4,20) = 43.20, P = .001), with participants reporting average perceived difficulty ranging from 1.44 ± 1.19 for QR to 3.68 ± 1.70 for TradAlt.
The QR and Trad trials resulted in superior results. When trials required cutting loop straps, results deteriorated.
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