2023 CASEM Podium Presentations

Activity and Concussion Management: Examining the Association Between 24-Hour Movement Behaviors and Concussion Outcomes Courtney M. Kennedy, HBK, G. Dip. Kine.,* Lauren N. Miutz, MSc, PhD,* Michaela K. Chadder, MKine.,* Carolyn A. Emery, BS, MSc, PhD,* Kathryn J. Schneider, PT, PhD, DipManiPT,* Jonathan D. Smirl, MSc, PhD,* Kelly Russell, MSc, PhD,* and Mike Ellis, MD, FRCSC,* Affiliations:*University of Calgary, Sports Injury Prevention Research Centre, SHRed Concussions, Calgary, AB, Canada. Objective: To examine the influence of 24-hour movement behaviors (physical activity [PA], sleep, and sedentary behavior [SB]) on postconcussion symptom burden and length of recovery (LOR). Study Design: Prospective cohort. Participants: Youth (aged 10-18 years) sport participants enrolled in the SHRed Concussions Study at the Calgary, Alberta, and Winnipeg, Manitoba sites with a diagnosed concussion. Intervention: Physician-diagnosed concussed participants were fitted with ActiGraphs (GT3x-waist and GT9x-wrist) to objectively quantify PA (Evenson algorithm) and sleep metrics (Sadeh algorithm) in the acute (1-week) injury recovery phase. Outcome Measures: Change in symptom score and severity from initial injury to 1-week postconcussion and LOR [time-to-medical clearance (days)]. Results: Low versus high volumes of SB were associated with a shorter LOR [26.00 vs 46.73 days (95% CI, 1.21 – 4.36; HR = 2.30; P = 0.008)]. Moderate versus low and high volumes of moderate PA elicited a shorter LOR [25.96 vs 44.71 (95% CI, 0.24-0.86; HR = 0.94; P = 0.01) and 39.33 days (95% CI, 0.91-3.51; HR = 1.80; P = 0.04), respectively]. High versus low TST elicited a shorter LOR [16.25 vs 41.40 days (95% CI, 0.03-1.63; HR = 0.22; P = 0.003)]. No significance was found between LOR and light (χ2 = 0.30, P = 0.74) and vigorous PA (χ2 = 1.70, P = 0.18), or frequency (χ2 = 0.20, P = 0.82) and duration (χ2 = 1.20, P = 0.31) of activity bouts. A higher vs lower number of activity bouts elicited a greater decline in symptom score [-6.09 vs -1.96 (95% CI, -8.01 to 0.24, P = 0.03; d = 0.73)]. Moderate vs low volumes of moderate PA elicited a greater decline in symptom severity [-23.43 vs -10.38 (95% CI = -23.53 to -0.58); P = 0.003; d = 0.75]. Conclusions: Daily movement behaviors within the acute phase of concussion recovery is associated with postconcussion symptom burden and LOR. Increasing TST and decreasing SB by breaking up the wakeful day with a higher number of activity bouts and increased MPA seem to elicit a positive effect on concussion recovery trajectories among concussed youth. Complex Motor Imagery in Elite Female Ice Hockey Players: Neural Basis Revealed by Magnetoencephalography Audrey A. Potts, MB, BCh, BAO,* Richard Wennberg, MD, PhD,*,† Luis Garcia Dominguez, PhD,* and Mary Pat McAndrews, PhD,‡ Affiliations:*Mitchell Goldhar MEG Unit, Toronto Western Hospital, Krembil Brain Institute, University of Toronto, Toronto, ON, Canada; †Department of Medicine (Neurology), University Health Network, University of Toronto, Toronto, ON, Canada; and ‡Department of Psychology (Neuropsychology), University Health Network, University of Toronto, Toronto, ON, Canada. Objective: Complex sports imagery, or visualization, is a well-known sports psychology tool used by athletes to improve performance. We sought to investigate the neurophysiologic effects of visualization, grounded in the concepts of functional equivalence and the PETTLEP (Physical, Environment, Task, Timing, Learning, Emotional, Perspective) approach, in a group of elite ice hockey players using magnetoencephalography (MEG). Study design: Observational study, original research. Subjects: Eight right-handed elite female ice hockey players who were familiar with visualization for sport performance. Intervention/observation technique: Athletes visualized a specific PETTLEP-guided 2-on-1 ice hockey play while their neural activity was recorded using MEG. Three minutes of baseline recording was followed by 10 trials of 30 seconds of imagery, alternated with 30 seconds of mental counting. Imagery and control (baseline and counting) conditions were segmented into 1-second epochs and power spectra of the different sets were compared. Outcome measures: A frequency-domain beamformer was calculated at the frequencies of interest (FOI) for the different conditions and the results were expressed as the relative change in power of control versus imagery. A cluster-based permutation test was subsequently applied to assess significance. Results: The FOI were determined to be in the beta frequency range from 15 to 21 Hz with a maximum at 18 Hz. At the FOI, prominent desynchronization during the imagery condition was identified in the region of the left intraparietal sulcus, extending to the inferior aspect of the superior parietal lobule and the superior aspect of the inferior parietal lobule (P < 0.01). Significant desynchronization was also present during the imagery condition in the left > right precentral and postcentral gyri. Conclusions: This is the first study to investigate the neural correlates of complex, PETTLEP-guided, ice hockey imagery in real-time. The results indicate that this type of visualization is predominantly associated with functional activation of dominant hemisphere parietal lobe areas involved in visuospatial processing, somatosensation, and multimodal sensory association, revealing a neuroanatomical basis for how this psychological tool may work to improve athletic performance. Sex Differences in High School Rugby Players’ Head Acceleration Events Based on Instrumented Mouthguard Data Kenzie B. Friesen, PhD,* Isla Shill, MSc,* Stephen West PhD,* Taylor Price,* Reed Ferber PhD,* Chris Dennison, PhD,† and Carolyn Emery, PhD.* Affiliation:*University of Calgary Sport Injury Prevention Research Center, Calgary, AB, Canada; and †University of Victoria, Victoria, BC, Canada. Objective: To determine head impact biomechanics and location for male and female adolescent club rugby players by sex and player position. Study Design: Cross-sectional study. Subjects: Twenty five adolescent club rugby players (9M/16F) fitted with instrumented mouthguards comprised 933 head acceleration events. Eighteen athletes were forwards and 7 were backs. Outcome Measures: Validated Prevent Biometrics instrumented mouthguards fixed with a triaxial accelerometer and gyroscope measured peak linear acceleration (PLA), peak angular acceleration (PAA), and impact location for every head acceleration event exceeding a 5 g threshold on a single-axis accelerometer. Data were sampled at 3.2 kHz over a 50-minute time frame (10-minute pretrigger and 40-minute post-trigger). Results: Mann–Whitney U tests revealed significant differences between males and females for PLA (U = 93.0, P < 0.001), PAA (U = 122.7, P < 0.001), and angular acceleration magnitude and duration (AAMxD) over a 50-minute period (U = 60.7, P < 0.001), with males demonstrating greater accelerations (median, range: PLA: 9.5 g, 48.4 g; PAA: 768 rad/s2; 7409 rad/s2; AAMxD: 13.4 krad/s2, 86.1 krad/s2) compared with females (median, range: PLA: 6.1 g, 46.3 g; PAA: 213 rad/s2; 4653 rad/s2; AAMxD: 7.0 krad/s2, 95.6 krad/s2). Mann–Whitney U tests also revealed female forwards experience greater AAMxD (U = 35.26, P < 0.001) compared with backs (median, range; Forwards: 6.0 krad/s2, 43.7 krad/s2; Backs: 6.2 krad/s2, 46.3 krad/s2). Impact frequency by location include front (M vs. F: 40% vs 40%), side (15% vs 7%), top (10% vs. 3%), and back impacts (34% vs 50%). Conclusions: Male rugby players accrue greater in-game PLA and PAA during head acceleration events. Males also exhibit greater AAMxD than females. Female forwards experience higher AAMxD than backs. Although more data and video-verification is needed to verify impact information, preliminary data reveal differences exist in impact magnitude and duration according to sex, and between female player positions with implications for potential injury propensity in rugby players. Acknowledgements: Thank you to members of the Sports Injury Prevention Research Centre for assistance with data collection and to the UCalgary Eyes High Postdoctoral Program and the WeTRAC program for funding. Predictors of Radiographic Osteoarthritis Following Anterior Cruciate Ligament Reconstruction at 5 Years Postoperatively Nicholas Mohtadi, MD, MSc,* Denise Chan, MBT, MSc,* Pablo Bertiche, MD,† Dana Hunter, MSc,* Hana Marmura, BSc (Hons), MPT/PhD Candidate,‡ and Dianne Bryant, PhD,‡ Affiliations: *University of Calgary Sport Medicine Centre, Calgary, AB, Canada; †Department of Sport Medicine and Arthroscopic Surgery, Sanatorio Allende, Cordoba, Argentina; and ‡Western University, Faculty of Health Sciences, London, ON, Canada. Objective: To evaluate the predictive factors of post-traumatic knee osteoarthritis (OA) in the medial, lateral, and patellofemoral compartments at 5 years post-ACL reconstruction. Study Design: Predictive analysis within a prospective, randomized clinical trial. Subjects: 330 patients (14-50 years) randomized to ACL reconstruction with a patellar tendon, single-bundle semitendinosus/gracilis tendon, or double-bundle semitendinosus/gracilis tendon autograft (110/group). Intervention/Observation Technique: Standardized radiographs at baseline, 2 and 5 years were used to assess radiographic OA at 5 years postoperatively. For each knee compartment, individual predictor variables with P < 0.1 in a bivariate regression analysis were added to a multivariable logistic regression model. Odds ratios (OR) and 95% confidence intervals (95% CI) were reported. Outcome Measures: Dependent Outcome Variable: Radiographic OA in each compartment, using the International Knee Documentation Committee scale. An independent, fellowship-trained orthopedic surgeon graded the radiographs for absence (A–Normal, B–Nearly Normal) or presence (C–Abnormal, D–Severely Abnormal) of OA. Independent Predictor Variables: age, sex, knee alignment, Lachman, pivot shift, meniscal treatment and chondral condition at surgery, graft type, graft failure, reinjury, and secondary surgery. Results: Grades were available for 302 patients (91.5%) at 5 years. Medial OA was assessed in 35 patients (10.6%). Meniscectomy (OR, 5.8; 95% CI, 2.7-12.6; P < 0.01) and varus knee alignment (OR, 2.4; 95% CI, 1.1-5.1; P = 0.03) significantly predicted medial OA. Lateral OA was assessed in 67 patients (20.3%). Patellar tendon graft (OR, 2.4; 95% CI, 1.2-4.8; P = 0.02), meniscectomy (OR, 2.6; 95% CI, 1.3-5.2; P≤ 0.01), meniscal repair (OR, 3.3; 95% CI, 1.5-7.4; P≤ 0.01), and chondral damage (OR 2.0; 95% CI, 1.0-3.9, P = 0.04) significantly predicted lateral OA. Based on a bivariate analysis with 9 patients (2.7%) with patellofemoral OA, chondral damage (OR, 5.7; 95% CI, 1.5-21.8; P = 0.01) was a significant predictor of OA. Graft failure, traumatic reinjury, and secondary surgery were not predictive of OA. Conclusions: Varus alignment and medial meniscectomy significantly increase the risk of developing medial OA. Use of a patellar tendon graft, lateral meniscectomy, meniscus repair, and chondral damage significantly increase the risk of developing lateral OA. Graft failure, traumatic re-injury, or secondary surgery were not predictive of radiographic OA in any compartment. Higher proportions of patients with OA are required to increase confidence in these associations. High Rates of Bodychecking, Head Contacts, and Suspected Injuries Found in Youth Ringette Through Video Analysis Emily E. Heming, MSc,* Ash T. Kolstad, MSc,*,† Stephen W. West, PhD,*,‡ Rylen A. Williamson, BSc,* Alexandra J. Sobry, BSc,* Jean-Michel Galarneau, PhD,*,§ Kelly Russell, PhD,¶,‖ Claude Goulet, PhD,** and Carolyn A. Emery, PT, PhD,*,†,‡,††,‡‡, §§,¶¶ Affiliations:*Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; †Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; ‡O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; §Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada; ¶Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; ‖Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada; **Department of Physical Education, Faculty of Education, Université Laval, Québec City, QC, Canada; ††Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; ‡‡McCaig I. for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; §§Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and ¶¶Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. Objective: Ringette is a popular team ice sport in Canada, primarily played by females. Bodychecking is prohibited at all levels of play. This study used video analysis to evaluate physical contact (PC), head contact (HC), and suspected injury and concussion incidence rates (IR) in youth ringette. Study Design: Cross-sectional. Subjects: Youth ringette players from the 2021 to 2022 season playing in the U16 (ages 14-15) or U19 (ages 16-18) age or were from and Technique: were using Validated were used to assess = levels = type = = suspected injury and Outcome Measures: regression for by by were used to and suspected injury and concussion ratios were used to age levels of and of and were reported. Results: were = U19 = A = = season = = = The was (95% CI, (95% CI, suspected injury (95% CI, and suspected concussion (95% CI, (95% CI, of and (95% CI, of were No differences were found in or suspected injury and concussion between age or levels of play. Bodychecking were = 95% CI, higher in and = 95% CI, higher in than season A = 95% CI, lower of was in compared with Bodychecking was the for concussion and with associated with Conclusions: Bodychecking and were high among youth ringette to and to injury and concussion in youth ringette. of the in and PT, PhD,† and of Physical Medicine and Faculty of Medicine, Université of Faculty of Medicine, Université Objective: The first was to assess the of that the of the tendon in by with The was to determine the tendon change correlates with tendon and to Study Design: Prospective study. Subjects: by diagnosed and with who were for more than and than 2 years. Intervention/Observation Technique: for and the for were at and to the tendon a that participants used to data their tendon according to the and data their Outcome Measures: The at each of the in the were the and and in the were the and by and and Results: the study, the from to (P = 0.02), and the increased from to (P < in the tendon The also in the not significant The was low for the and the compared with the or the treatment Conclusions: The tendon in to improve over time according to and the were the and the A greater or treatment not into a superior tendon to the A. MSc,* and K. Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. Objective: To concepts that the are their while Study design: using Subjects: female athletes = or Technique: The on impact on and during and Outcome Measures: their as and on for by and A grounded was used to Results: from individual and team identified by participants the impact of their on and the impact of on and the between the and injury for symptom and the of team in playing a positive the to of the phase. The of their was a from male and low also that not their sport Conclusions: identified by athletes as are with to examine between the and and injury play a in for Sport for athletes and is to athletes to their is to a more for female Acknowledgements: The the athletes for their in this University of Calgary study. We from and the Injury and in Youth Ice Hockey MSc,*,† PhD,* Stephen W. West M. Carolyn A Emery, PT, and PT, MSc,*,† PhD,* Stephen W. West M. Carolyn A Emery, PT, and PT, Affiliations:*Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, AB, Canada; Sport Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; for Health, and Injury Prevention in for Health, University of Children's Hospital Research Institute, University of Calgary, AB, Canada; I. for Public Health, University of Calgary, AB, Canada; Brain Institute, University of Calgary, AB, Canada; **Department of Medicine, Faculty of Medicine and Sports Medicine University of Alberta, Edmonton, AB, Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada; of Pediatrics, Cumming School of Medicine, University of Calgary, AB, Canada; I. for Bone and Joint Health, University of Calgary, AB, Canada; Research of Sports Medicine, Institute, Objective: To injury and risk factors in youth ice hockey players 10 to during and Study Design: study. Subjects: individual players this and were reported. Outcome Measures: Injury data were from to or baseline and and injury were and injury rates with 95% CI were using An multivariable effects regression by team and by and for risk Injury specific data for females was not of low = Results: The injury was (95% CI, and (95% CI, The injury were = and = associated with contact was the = during = vs 10 of = in days of and more than = in days of An lower of injury was associated with compared with (95% CI, A higher injury was for who a of any injury or concussion in the compared with with (95% CI, sex, of and were not associated with injury Conclusions: in more than of factors for injury in a and of injury in the study of specific to the may in youth ice the of the of the PhD,*,† MSc,* PhD,*,† Sport Institute Victoria, BC, Canada; and Physical and Health Education, University of Victoria, Victoria, BC, Canada. Objective: To assess a of in Sport in female and male to elite of the for the International Committee 2 Study design: Cross-sectional Subjects: to female and male athletes = data collection in or Intervention/observation technique: Cross-sectional study Outcome measures: sex sleep, low in females and males sex We a severity risk of and light on the of differences were using analysis of with significance at P < Odds ratios (OR) were calculated to determine for Results: The this into and and light (P < and lower (P = were more among higher female P = (P = 0.001) and (P = were lower and (P < and (P = 0.001) higher with (P < and (P = were lower and of (P < higher with increased in females and was associated with higher incidence of low (OR, low (OR, and (OR, low was associated with (OR low (OR, low (OR, and (OR, with clinical of for individual This to and of for Head Impact and in University MSc,* PhD,† BSc,* MD, PhD,‡ and B. PhD, of Medicine, University, Canada; †Department of University, Faculty of Medicine, Canada; of University Health Centre, Health Canada; and of Medicine, Faculty of Medicine, University, Canada. Objective: To examine the between concussion and in players. Study Design: Prospective study. Subjects: male players 18 to Technique: Head impacts were during 2 of using Athletes with diagnosed and impacts that a impact to assess within of and initial athletes were also and Athletes with diagnosed concussion were with symptom on the to Outcome Measures: The were head impacts and their with diagnosed concussion. and of and at Results: A of impacts were from impacts were recorded by the front and in the The impact was by of were diagnosed with a concussion by team was a of diagnosed in the study symptom score concussion was athletes in the 2022 = more impacts vs P = and impacts vs P = compared with all players = athletes = = and injury = not significantly between Conclusions: This work the of a to and study concussion and High magnitude and impacts were in concussed work with this investigate of and measured and with concussion Examining the of Use in by MSc,* MSc,* MSc,* MSc,* MSc,* and MD, PhD,* Affiliation:*University of BC, Canada. Objective: To determine using in with while in Study Design: Subjects: Eight 2 diagnosed with using Intervention: 30 minutes of at of peak on a test in conditions each by a The conditions and were randomized to of a design: Outcome Measures: The and of and and and were measured 30 minutes and between the conditions were compared using change from to graded were measured to and were measured 5 minutes and minutes into be the to assess for Results: was a significant between the and for and a in these was with No differences were between and a in for was significant differences between during was not in any of the We found in the acute in with in and not increase as by and Injury in and and PhD, PhD, PhD,† M. and PhD, PhD, PhD,† M. and of Physical and University, †Department of University, Winnipeg, MB, Canada; of Kinesiology, University of Calgary, Calgary, AB, Canada; and Medicine, School of Medicine, University, To assess sleep by sleep sleep sleep and sleep in and players. To examine the between sleep metrics and injury risk in players. Study Design: Cross-sectional. Subjects: and players age of Technique: a to players during the to injury and sleep was determined on the sleep score of on 5 sleep sleep sleep sleep during the of the and of sleep sleep metrics sleep, as were from the Outcome Measures: The study was knee and injury the Knee and were using a of a Sports Research sleep metrics were using and were using multivariable logistic regression Results: (95% CI, of players sleep (95% CI, sleep (95% CI, sleep and (95% CI, with sleep significantly higher for knee and injury risk (OR, 95% CI, P = No (OR, 95% CI, P = was found between sleep and Conclusions: in 5 players a sleep and in players a sleep and not predicted injury a sleep in and players and that players are and Acknowledgements: Study was by the Health Research Program at

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