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.     

Effects of purposeful soccer heading on circulating small extracellular vesicle concentration and cargo

BackgroundConsidering the potential cumulative effects of repetitive head impact (HI) exposure, we need sensitive biomarkers to track short- and long-term effects. Circulating small extracellular vesicles (sEVs) (<200 nm) traffic biological molecules throughout the body and may have diagnostic value as biomarkers for disease. The purpose of this study was to identify the microRNA (miRNA) profile in circulating sEVs derived from human plasma following repetitive HI exposure.MethodsHealthy adult (aged 18–35 years) soccer players were randomly assigned to one of 3 groups: the HI group performed 10 standing headers, the leg impact group performed 10 soccer ball trapping maneuvers over 10 min, and the control group did not participate in any soccer drills. Plasma was collected before testing and 24 h afterward, and sEVs were isolated and characterized via nanoparticle tracking analysis. Next-generation sequencing was utilized to identify candidate miRNAs isolated from sEVs, and candidate microRNAs were analyzed via quantitative polymerase chain reaction. In silico target prediction was performed using TargetScan (Version 7.0; targetscan.org) and miRWalk (http://mirwalk.umm.uni-heidelberg.de/) programs, and target validation was performed using luciferase reporter vectors with a miR-7844-5p mimic in human embryonic kidney (HEK) 293T/17 cells.ResultsPlasma sEV concentration and size were not affected across time and group following repetitive HI exposure. After 24 h, the HI read count from next-generation sequencing showed a 4-fold or greater increase in miR-92b-5p, miR-423-5p, and miR-24-3p and a 3-fold or greater decrease in miR-7844-5p, miR-144-5p, miR-221-5p, and miR-22-3p. Analysis of quantitative polymerase chain reaction revealed that leg impact did not alter the candidate miRNA levels. To our knowledge, miR-7844-5p is a previously unknown miRNA. We identified 8 miR-7844-5p mRNA targets: protein phosphatase 1 regulatory inhibitor subunit 1B (PPP1R1B), LIM and senescent cell antigen-like domains 1 (LIMS1), autophagy-related 12 (ATG12), microtubule-associated protein 1 light chain 3 beta (MAP1LC3B), integrin subunit alpha-1 (ITGA1), mitogen-activated protein kinase 1 (MAPK1), glycogen synthase kinase 3β (GSK3β), and mitogen-activated protein kinase 8 (MAPK8).ConclusionCollectively, these data indicate repetitive HI exposure alters plasma sEV miRNA content, but not sEV size or number. Furthermore, for the first time we demonstrate that previously unknown miR-7844-5p targets mRNAs known to be involved in mitochondrial apoptosis, autophagy regulation, mood disorders, and neurodegenerative disease.     

Health education for Somali Bantu refugees via home visits

Background: Somali Bantu refugees, with unique health information needs, created challenges for health and social service providers. Objectives: A service innovation was developed (i) to raise awareness, especially among local health and social service providers, about the Bantu refugees’ presence in the community, their culture, and their information needs and (ii) to deliver needed health information, emphasizing child health, to the Bantu mothers in their homes. Methods: The project consisted of: (i) a community conference targeting local health and social service providers, describing the refugees’ presence in the community, their culture, and information needs. (ii) Focus groups conducted with members of the Bantu population elicited additional information needs. (iii) Curriculum was developed based on identified needs, and (iv) the curriculum was delivered to the refugees in their homes. A clinical informationist and MP3 technology enhanced the project. Findings: Conference attendees’ evaluation responses indicated improved understanding of Bantu culture. Focus groups’ identification of health information needs provided a framework for the health education curriculum. A project website made educational materials available to other healthcare providers. Conclusions: The project raised awareness of the Bantus’ presence, culture, and information needs. Identification of other unmet needs demonstrated that additional support for refugees is required.     

A Detection Scheme for Dependent Noise Processes

In this paper the problem of memoryless discrete time detection of a constant signal in additive φ-mixing noise is considered. The fidelity criterion is taken to be the asymptotic relative efficiency. The optimal detector nonlinearity is approximated by a polynomial, and the statistical knowledge required for the design of the detector is the family of joint moments of the noise, resulting in a very simple design procedure for the detector. It is shown that the performance of this detector can be made arbitrarily close to that of the optimal memoryless detector for a large class of noises.