Steffen K, Myklebust G, Andersen TE, Holme I, Bahr R. Am J Sports Med. Each individual can present with a unique set of symptoms and aggravating or relieving factors following concussion.84 Individualized assessments are imperative to best understand the etiology of symptoms.37,78,102,106 A multifaceted, interdisciplinary approach to assessment and management is vital. Emotional Responses to Athletic Injury Questionnaire. A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and Causation: Clinical Journal of Sport Medicine 17, 215–219 (2007). Stage of the return to sport models In order to explain the psychological stages of the rehabilitation, stage models provide a succession of emotions and attitudes occurring following sport injury. 2008 Apr;36(4):700-8. doi: 10.1177/0363546507311598. BMC Public Health. In other cases, findings suggest that central vestibular involvement may be present. A dynamic, recursive model of etiology in sport injury. If symptoms recur, then the athlete should move back to the previous step. Headaches are the most frequent symptom following concussion. Current uses in sports ii. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial, Sport-related concussion induces transient cardiovascular autonomic dysfunction, Pediatric post-traumatic headaches and peripheral nerve blocks of the scalp: a case series and patient satisfaction survey, What tests and measures should be added to the SCAT3 and related tests to improve their reliability, sensitivity and/or specificity in sideline concussion diagnosis? The extent of the sports injury problem is often described by injury incidence and by indicators of the severity of sports injuries. Dizziness symptoms can be vertigo (ie, sensation of spinning of the environment or the person), light-headedness, presyncope, or a sense of disorientation. 11 When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. J. To address this issue, Meeuwisse et al9 developed a dynamic, recursive model for risk and causes of sports injuries, considering that the injury has a non-linear behavior. Each individual who participates in an activity brings a specific set of intrinsic and extrinsic factors (FIGURE 1). Regardless of the type of injury, it is often preceded by a chain of shifting circumstances that, when they come together, constitute sufficient cause to result in an injury. Interventions Can Mitigate Risk The protective effects of helmets in reducing the risk of more severe traumatic brain injury are well documented,76 as is the protective effect of mouthguards in reducing orofacial injury. Immediate removal from activity may improve outcomes.4, At the time of injury, screening for more severe injury (eg, intracranial bleeding, cervical spine fracture) is imperative. Of the children with convergence insufficiency, 46% had their symptoms resolve in the initial 4.5 weeks following injury, and another 41% reported recovery following vestibular rehabilitation that included convergence training.110 Deficits in smooth pursuit, saccades, near point of convergence, and accommodation also have been reported following concussion, often in the presence of vestibulo-ocular reflex deficits and altered balance.81 Thus, visual assessment should include smooth pursuit, saccades, near point of convergence, and accommodation, in combination with a vestibular and balance examination. An integrated model is illustrated which provides a synthesis of existing conceptual models depicting the dynamic process of psychological response to sport injury. Med Sci Sports Exerc. One frequently referenced models of injury prevention is the van Mechelen model.122 In this model, understanding the overall burden of injury in the population and identifying risk factors inform interventions aimed at injury prevention. Cervical spine pain may be accompanied by cervicogenic headache or cervicogenic dizziness.7,106 Cervical spine findings are common following concussion (eg, impairments following anterolateral strength, the head perturbation test, joint position to the left, or the cervical flexor endurance test).107 Many of the symptoms reported following whiplash are similar to those reported following concussion,51 suggesting that cervical spine injury might have occurred at the same time as the concussion. Pituitary dysfunction after traumatic brain injury: a clinical and pathophysiological approach, Hypopituitarism due to sports related head trauma and the effects of growth hormone replacement in retired amateur boxers, Pituitary function in subjects with mild traumatic brain injury: a review of literature and proposal of a screening strategy, Gender differences in head–neck segment dynamic stabilization during head acceleration, Dizziness, unsteadiness, visual disturbances, and sensorimotor control in traumatic neck pain, Comparison of sensorimotor disturbance between subjects with persistent whiplash-associated disorder and subjects with vestibular pathology associated with acoustic neuroma, Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: a prospective randomized study comparing three exercise programs, Comparison of psychological response between concussion and musculoskeletal injury in collegiate athletes, Incidence, severity, aetiology and prevention of sports injuries. Survival analysis i. A quick introduction to R b. Combining specific exercises with manual therapy is effective for treating cervical spine pain.54 After concussion, include neuromotor control, sensorimotor control, manual therapy, and soft tissue techniques, in combination with vestibular rehabilitation.106 A sequential approach to addressing headaches and cervical spine findings (including neuromotor control) as an initial step of rehabilitation is appropriate, given the connections between the upper cervical spine and the vestibular and visual systems. as well as cognitive, emotional. per 1000 hours of sports participation) in order to facilitate the comparability of research results. @article{Meeuwisse2007ADM, title={A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Integrated model of psychological response to the sport injury and rehabilitation Psychological Responses Having discussed the integrated model that depicts how the psycho- logical consequences of sport injury relate to the overall injury experi- This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. Extrinsic Risk Factors for Concussion The environment in which an athlete plays includes factors that can influence the risk of concussion, many of which may be modifiable. The purpose of this manuscript is to outline a new model representing a dynamic approach that incorporates the consequences of repeated participation in sport, both with and without injury. Once again, literature on health and disease outcomes has a large influence as the source of the ‘web of determinants’ concept (Philippe and Mansi, 1998). This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes cancer mortality). The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Integrated model of psychological response to the sport injury and rehabilitation process (adapted from Weise-Bjornstal et al., 1998). Findings of convergence insufficiency have been identified in children following concussion; however, further research is needed to identify whether these deficits are pre-existing or have their onset following trauma. cancer mortality). One such dynamic model is described by Meeuwisse.27 This model describes how multiple factors interact to produce injury (fig 1). as well as cognitive, emotional. the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. Use standardized tools when screening for mood and mental health problems.13, Up to 1 in 2 individuals with concussion report sleep problems (insomnia, difficulty falling asleep, difficulty staying asleep).17,82 In the early postinjury phase, individuals may be more fatigued than normal and require more sleep.96 Individuals with pain may also require more sleep.64,112 Addressing sleep difficulties is important to improve recovery.92. A dynamic model of etiology in sports injury: the recursive nature of risk and causation . In part 1 of this commentary, we address etiology, risk factors, and detection of concussion. The Journal of Sport Rehabilitation (JSR) is your source for the latest peer-reviewed research in the field of sport rehabilitation.All members of the sports-medicine team will benefit from the wealth of important information in each issue. Use case 2: Injury prediction based on exposure records a. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. A dynamic, recursive model of etiology in sport injury. In many cases, medical management is required; for some headache types, such as cervicogenic headaches, physical therapy may be of benefit.54,125 Botulinum toxin injection can be considered for posttraumatic chronic migraine headaches.24 Repetitive transcranial magnetic stimulation may be effective in the treatment of posttraumatic headache.60,69,70 Often, a multimodal approach to headache management includes both acute and prophylactic medication.  |  Front Psychol. In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. The article then focuses on the dynamic core of the integrated response to sport injury and rehabilitation model. Discussion among the health care team and with the individual and his or her family can facilitate appropriate return-to-sport and return-to-school decisions. There may be alterations in gait, reduced gait velocity, and increased sway when dividing attention following concussion.38,59 Further research to better understand changes in the ability to divide attention while accounting for growth and development is warranted. In this section, we summarize the key intrinsic and extrinsic risk factors for concussion. Diagnosis directs appropriate management. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Bittencourt et al. During sport, athletes are exposed to different events in which no concussion or injury occurs. The questions - how do I get better and how do I stay healthy - are part a dynamic and constantly changing system. Unsteadiness or imbalance may also be reported (suggesting difficulty with maintaining an upright position in space, possibly related to dysfunction of vestibulospinal function, proprioception, vision, or other systems that contribute to upright balance) and should be assessed. If an injury does occur, withdrawal from further the basis of the interaction of the event attributes and pre-exposure may be the result; more often, recovery will facilitate existing risks. Once a concussion is suspected, the player should be removed from play and further assessed by a qualified health care professional (FIGURE 2). An integrated model is illustrated which provides a synthesis of existing conceptual models depicting the dynamic process of psychological response to sport injury. When the 2 injuries occur concurrently, they must be treated appropriately. Address correspondence to Dr Kathryn J. Schneider, Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Limit naps to less than 1 hour, and prior to mid afternoon. 16. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment, Risk factors for sports concussion: an evidence-based systematic review, Vestibular rehabilitation for dizziness and balance disorders after concussion, Exercise prescription patterns in patients treated with vestibular rehabilitation after concussion, Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes, Hypopituitarism in pediatric survivors of inflicted traumatic brain injury, Pituitary dysfunction after blast traumatic brain injury: the UK BIOSAP study, A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program, Clinical practice guideline: benign paroxysmal positional vertigo (update), Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada, Risk factors associated with sustaining a sport-related concussion: an initial synthesis study of 12,320 student-athletes, Vestibular rehabilitation for unilateral peripheral vestibular dysfunction, Peripheral vestibular disorders in children and adolescents with concussion, National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements version 1.0 recommendations, Football players' head-impact exposure after limiting of full-contact practices, Systematic review of return to work after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis, The epidemiology of new versus recurrent sports concussions among high school athletes, 2005–2010, Prevalence and consequences of sleep disorders in traumatic brain injury, An exploratory study of the potential effects of vision training on concussion incidence in football, Neck strength: a protective factor reducing risk for concussion in high school sports, Tackling concussion in professional rugby union: a case–control study of tackle-based risk factors and recommendations for primary prevention, The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): background and rationale, Descriptive epidemiology of collegiate men's football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2003–2004. A widely referenced model in the area of sport injury research has proposed that multiple factors influence the etiology of sport injury.88 Various etiological factors can vary over time and change the risk that is associated with injury.88 The literature in the area of concussion is evolving and, as such, enables adaptation of this model to better understand the etiology of concussion. Identifying these factors is part of an individualized, patient-centered approach to prevention, assessment, and management of concussion. Recursive Models of Dynamic Linear Economies Lars Hansen University of Chicago Thomas J. Sargent New York University and ... agent model. Integrated Model of Psychological Responses to Sport Injury. Adapting the dynamic, recursive model of sport injury to concussion: an individualized approach to concussion prevention, detection, assessment, and treatment - Schneider KJ, Emery CA, Black A, Yeates KO, Debert CT, Lun V, Meeuwisse WH. AN LNTEGRATED MODEL OF RESPONSE TO SPORT INJURY 49 Figure I. process. USA.gov. The return-to-sport strategy includes 6 steps: (1) symptom-limited activity, (2) light aerobic exercise, (3) sport-specific exercise, (4) noncontact training drills, (5) full-contact practice, and (6) return to sport (FIGURE 3).29,84 Medical clearance to return to sport occurs once the individual is able to complete the return-to-sport protocol with no symptom exacerbation and when no other clinical assessment findings suggest ongoing problems that would preclude returning to sport.84, Return-to-work recommendations are based on similar principles as those of return to school and return to sport.91 Gradually and progressively increase activities, provided there is no increase in symptoms. Pessimistic Inter-pretation. It is important for sports professionals to know why certain athletes may be at risk of injury risk factors and how injuries occur (i… A concussion should be suspected after a direct blow to the head or following trauma to the body by which force has been transmitted to the head.84 Some of the observable signs of concussion are lying motionless, clutching the head, unsteadiness, or appearing dazed or confused immediately following a concussion (see the Concussion Recognition Tool Fifth Edition28). The Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary is one of eleven International Research Centres supported by the International Olympic Committee for Prevention of Injury and Protection of Athlete Health. In sports with similar rules, women may be at greater risk of concussion than men.1,16,43,71,79 Risk may differ due to physical characteristics or because women may be more likely to report symptoms.23,117, As age increases through adolescence, the risk of concussion increases, before declining in the early twenties.1,34,43,50, History of attention deficit hyperactivity disorder or learning disability may increase the risk of concussion and/or detection of concussion in youth and collegiate athletes.10,42, Pre-existing symptoms of dizziness, neck pain, and headache may increase the risk of concussion in male youth ice hockey players.105 Possible explanations for the increased risk include altered neuromuscular control, sensorimotor control, balance, or cervical spine strength.101, High school athletes with lower neck strength may have a greater risk of concussion.19 In youth ice hockey players, an increased risk of concussion has been reported in players who did not meet the Canadian recommendations for daily physical activity (1 hour of daily physical activity) in the 6 weeks prior to study entry.9 Player skills and strategy of sport-specific techniques may also influence concussion risk. A systematic review, Risk of injury associated with body checking among youth ice hockey players, Injury rates, risk factors, and mechanisms of injury in minor hockey, Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice, What domains of clinical function should be assessed after sport-related concussion? Previous history of concussion is a risk factor for future concussion.1 The exact mechanism by which this occurs is not yet well understood and may be related to genetics, epigenetics, sensorimotor or neuromuscular control, and other factors. eCollection 2020. Injury, Illness, and Training Load in a Professional Contemporary Dance Company: A Prospective Study. In this paper, the authors build on Meeuwisse’s dynamic, recursive model but argue a complex system approach is necessary to understand the nature of injury aetiology. The stress-injury model also proposed a number of factors, such as personality, history of stress, and coping resources, that may moderate a stress response, but there was less clarity and exposition of mediating pathways, particularly those related to stress physiology, by which stress response may increase risk of injury. J Athl Train. For instance, the skills required of a volleyball player will differ from those expected of an ice hockey player. The initial management of concussion involves both cognitive and physical rest for the first 24 to 48 hours following injury.84,103 After this time, gradually and progressively increase activities of daily living, as long as symptoms do not increase.84,103 Once concussion-related symptoms have resolved with typical activities, gradually resume physical and cognitive activities (FIGURE 2). 2020 Jul 10;11:1452. doi: 10.3389/fpsyg.2020.01452. Cognitive behavioral therapy may be beneficial for insomnia.36 Melatonin may have benefits for sleep following concussion, but is not currently recommended for sleep onset or maintenance problems.100 In the presence of ongoing sleep difficulties, refer to a sleep specialist to further investigate potential underlying causes. Clipboard, Search History, and several other advanced features are temporarily unavailable. A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and Causation: Clinical Journal of Sport Medicine 17, 215–219 (2007). and behavioral Get the latest public health information from CDC: https://www.coronavirus.gov. Return-to-sport and return-to-school strategies include a gradual return to activities, which may vary depending on the environment to which the athlete returns. Epub 2008 Apr 7. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment Journal of Orthopaedic & Sports Physical Therapy, Vol. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Evidence has shown that physical factors such as over-training, equipment and playing conditions are the major contributors towards an athlete’s injuries. Understanding the impact that these factors may have on assessment, management, and return to activity/sport helps to ensure a well-balanced and evidence-informed approach to care. A dynamic model of etiology in sports injury: the recursive nature of risk and causation . If we are to truly understand the etiology of injury and target appropriate prevention strategies, we must look beyond the initial set of risk factors that are thought to precede an injury and take into consideration how those risk factors may have changed through preceding cycles of participation, whether associated with prior injury or not. Consider occupation-specific activities (eg, cognitive and physical demands, safety requirements) in any return-to-work recommendations.15,91 Positive health outcomes have been reported with return to work or staying at work.99 However, reintroduction of risk and timing in the early recovery period must be carefully monitored.91. These factors may change over time. Junge A, Engebretsen L, Alonso JM, Renström P, Mountjoy M, Aubry M, Dvorak J. Br J Sports Med. This integrated model encompasses personal and situational moderating factors. NIH A model originally described by Meeuwisse (1994) and adapted and expanded upon by Barr and Krosshaug (2005)may guide sports professionals. In youth rugby players, there was a reduction in overall risk of game-related concussion when a neuromuscular training program was performed at least 3 times weekly.49 A vision training program may reduce the risk of concussion in collegiate football players.18 There was a 67% reduction in the risk of concussion in youth ice hockey following rule changes to disallow bodychecking.32 Tackle training and rules related to tackling in rugby as a way of decreasing risk of concussion are areas of ongoing evaluation.47 Finally, restricting the number of collision practices in youth football may reduce the frequency of head impacts in games and practice.14.

dynamic, recursive model of sport injury

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