Impaired motor control after sport-related concussion could increase risk for musculoskeletal injury: Implications for clinical management and rehabilitation

This review presents a conceptual framework and supporting evidence that links impaired motor control after sport-related concussion(SRC)to increased risk for musculoskeletal injury.Multiple studies have found that athletes who are post-SRC have higher risk for musculoskeletal injury compared to their counterparts.A small body of research suggests that impairments in motor control are associated with musculoskeletal injury risk.Motor control involves the perception and processing of sensory information and subsequent coordination of motor output within the central nervous system to perform a motor task.Motor control is inclusive of motor planning and motor learning.If sensory information is not accurately perceived or there is interference with sensory information processing and cognition,motor function will be altered,and an athlete may become vulnerable to injury during sport participation.Athletes with SRC show neuroanatomic and neurophysiological changes relevant to motor control even after meeting return to sport criteria,including a normal neurological examination,resolution of symptoms,and return to baseline function on traditional concussion testing.In conjunction,altered motor function is demonstrated after SRC in muscle activation and force production,movement patterns,balance/postural stability,and motor task performance,especially performance of a motor task paired with a cognitive task(i.e.,dual-task condition).The clinical implications of this conceptual framework include a need to intentionally address motor control impairments after SRC to mitigate musculoskeletal injury risk and to monitor motor control as the athlete progresses through the return to sport continuum.     

Ethical issues of behavior modification research in schools

Behavior modification research in the classroom was examined by the National Commission for the Protection of Human Subjects because of the increasingly widespread use of behavioral procedures in the schools, the effectiveness of these procedures in changing academic and social behavior, and the consequent concern about potential misuse. In order to foster the responsible use of behavior modification procedures in the schools on a practical as well as a research basis, the following ethical issues being considered by researchers and the involved public are discussed: informed consent, determination of classroom goals, legitimacy of rewards and aversive controls in the classroom, conceptions of behavior modification as manipulative and mechanistic, who can implement the procedures, research design, and accountability. The authors conclude that the issues regarding protection of human subjects in behavior modification research are no different from other treatment-oriented research with children. However, the high degree of parental and teacher involvement in both research and practice requires shared responsibility for the prevention of misuse of behavior modification procedures.