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Zusammenfassung Einleitung Eine sport-assoziierte Concussion (saC) ist eine oftmals unterschätzte Hirnverletzung, die vor allem in Kontakt- und Kollisionssportarten häufig vorkommt. SaCs können zu einer Vielzahl an klinischen Symptomen führen. Akute und zum Teil die klinische Regeneration überdauernde parasympathische Inhibierung im Autonomen Nervensystem (ANS) wurde nach saC bereits häufig beschrieben. Über Veränderungen im sympathischen Nervensystem ist jedoch noch wenig bekannt. Diese wurden durch Messungen der elektrodermalen Aktivität (EDA) im Schlaf, der erheblich zur Regeneration nach saC beiträgt, sowie im Zusammenhang mit subjektiven Symptomen nach saC im Rahmen einer Pilotstudie untersucht. Methode 18 Sportler und Sportlerinnen mit diagnostizierter saC und 18 nach Alter, Geschlecht, Größe, Gewicht, Sportart und Leistungsklasse gematchte Kontrollathleten und -athletinnen trugen in den Nächten während der individuellen Return-to-Sport (RTS) Phase sowie drei Wochen nach Abschluss des RTS (postRTS) einen Handgelenkssensor (E4 Empatica Inc., Mailand, Italien). Anteile nächtlicher tonischer (meanEDA) und phasischer (EDRs, Schlafstürme) EDA wurden zwecks Gruppenvergleich ermittelt und mit saC-Symptomen (SCAT5) sowie dem subjektiven Erholungszustand nach Schlaf mittels Mann-Whitney U-Tests oder ungepaarten t-Tests verglichen. Ergebnisse Während und nach dem RTS konnten keine Gruppenunterschiede in den nächtlichen EDA-Parametern nachgewiesen werden. Eine höhere meanEDA während des RTS korrelierte mit einer höheren Anzahl an Symptomen (p=0,025, r=0,525) und eine erhöhte phasische EDA mit einem geringeren Anstieg des subjektiven Erholungszustands von vor zu nach Schlaf (EDRs: p=0,007, r=−0,642; EDRs/min: p>0,001, r=−0,762; Schlafstürme: p=0,011, r=−0,616). Fazit Die nächtliche EDA nach saC unterschied sich während und nach dem RTS nicht signifikant zu gematchten Kontrollsportlern und -sportlerinnen. Der Zusammenhang zwischen höherer EDA während des RTS und der Anzahl an saC-Symptomen sowie der geringeren subjektiven Erholung nach Schlaf könnte sowohl ursächlich für als auch Effekt der subjektiven Symptome sein und sollte durch Baseline-Messungen und in Kombination mit parasympathischen Markern künftig weiter untersucht werden.

Zusammenfassung Einleitung Motorische Symptome bei Morbus Parkinson lassen sich durch körperliche Aktivität modifizieren. Inwiefern dies auch für nicht-motorische, autonome Symptome gilt, ist weitaus weniger bekannt. Die Erkrankung weist zudem eine Vielzahl an geschlechterspezifischen Unterschieden auf. Epidemiologische Untersuchungen deuten zum Beispiel auf einen besseren primärpräventiven Effekt durch körperliche Aktivität bei Männern als bei Frauen hin. Daten zu geschlechterspezifischen Effekten auf das autonome Nervensystem sind jedoch limitiert. Im Rahmen der vorliegenden Pilotstudie sollen mögliche geschlechterspezifische Effekte einer Bewegungsintervention auf Störungen der hämodynamischen Regulation als Manifestation nicht-motorischer Symptome untersucht werden. Diese sind aufgrund ihrer oft gegensätzlichen hypo- und hypertonen Ausprägung schwierig medikamentös zu behandeln, lassen sich aber gegebenenfalls durch Bewegungsinterventionen modifizieren. Methodik Bei 42 Patienten und Patientinnen (Alter: 70,3 Jahre; 24 Männer; 18 Frauen) wurden vor und nach einer mehrwöchigen, stationären Parkinsonkomplexbehandlung hämodynamische Parameter in einem Schellongtest untersucht. Mittels anschließender Regressionsanalyse erfolgte eine Quantifizierung der Abhängigkeit von den Faktoren Alter, Body Mass Index, Krankheitsdauer, Vorerkrankungen, Sitzendblutdruck und hypotensiv wirkender Medikamente. Ergebnis Bei 44% der Männer und 46% der Frauen traten hämodynamische Regulationsstörungen im Stand und in Rückenlage mindestens einmal auf. Eine vor Therapiebeginn präsentierte Regulationsstörung im Stand zeigte sich in keiner Geschlechtergruppe durch die Parkinsonkomplexbehandlung verändert. Frauen zeigten zu Therapieende jedoch einen signifikant niedrigeren Blutdruck im Liegen (p=0,022*). Unabhängig von der Komplextherapie fiel der Blutdruck in Rückenlage bei Frauen nach Orthostasebelastung höher aus als davor (vor Therapie: p=0,015 *; nach Therapie: p=0,021*). Jedes Lebensjahr erhöhte das Risiko für eine hämodynamische Regulationsstörung in Rückenlage in der Gesamtgruppe um 12,4% (Regressionskoeffizient B=0,117; p=0,014 *; Exp(B)=1,124). Schlussfolgerung Systematische Effekte auf Blutdruckwerte im Rahmen von Orthostasereaktionen durch eine Parkinsonkomplexbehandlung konnten nicht nachgewiesen werden. Allerdings zeigte sich bei Frauen nach Parkinsonkomplexbehandlung eine Senkung der Blutdruckwerte in Rückenlage. Das scheinbar unsystematische, teils geschlechterspezifische Auftreten hämodynamischer Regulationsstörungen fordert ein individualmedizinisch angelegtes Vorgehen im therapeutischen Alltag.

The study analysed unique data on anterior cruciate ligament (ACL) injuries among German professional male team sports over five consecutive seasons with the aim of improving medical outcomes in the future. Sport-specific differences in injury occurrence, concomitant injuries, timing of ACL reconstruction, graft type selection and short-term complications were examined.This retrospective study analysed trauma insurance data on all complete ACL tears from players with at least one competitive match appearance in the two highest divisions of German male basketball, ice hockey, football and handball. Each complete ACL tear registered by clubs or physicians between the 2014/15 and 2018/19 seasons with the German statutory accidental insurance for professional athletes (VBG) as part of occupational accident reporting was included.In total, 189 out of 7517 players (2.5%) sustained an ACL injury, mainly in handball (n = 82; 43.4%) and football (n = 72; 38.1%) followed by ice hockey (n = 20; 10.6%) and basketball (n = 15; 7.9%).Seventeen players (9.0%) also sustained a second ACL injury. Thus, 206 ACL injuries were included in the analysis. The overall match incidence of ACL injuries was 0.5 per 1000 h and was highest in handballs (1.1 injuries per 1000 h). A total of 70.4% of ACL injuries involved concomitant injury to other knee structures, and 29.6% were isolated ACL injuries. The highest rate of isolated ACL injuries was seen in ice hockey (42.9%). All ACL injuries, except for one career-ending injury, required surgery. In the four analysed team sports, hamstring tendons (71.4%) were the most commonly used grafts for ACL reconstruction; football had the highest percentage of alternative grafts (48.7%). During rehabilitation, 22.9% of all surgically treated ACL injuries (n = 205) required at least two surgical interventions, and 15.6% required revision arthroscopy. The main cause of revision arthroscopy (n = 32; 50.0%) was range-of-motion deficit due to arthrofibrosis or cyclops formation.The present study shows an overall high rate of revision arthroscopy after ACLR (15.6%), which should encourage surgeons and therapists to evaluate their treatment and rehabilitation strategies in this specific subpopulation. Hamstring tendon grafts are most commonly used for ACL reconstruction but have the highest revision and infection rates. Handball shows the highest ACL injury risk of the four evaluated professional team sports. Concomitant injuries occur in the majority of cases, with the highest share of isolated ACL injuries occurring in ice hockey.Level III.

Background: Long-term effects of playing soccer (football) on the brain structure and function of the brain are vividly debated. While some studies showed differences in neurocognitive performance and structural brain changes in retired male players, data on female players are scarce. The present study compares cortical thickness and neurocognitive performance in former high-level female soccer (SOC) and non-contact sport athletes (CON). Methods: 3 T T1-weighted 3D MPRAGE MRI was performed, and vertex-wise cortical thickness was analyzed using FreeSurfer (v. 6.0.0). Neurocognitive performance in seven domains of SOC and CON was assessed. A multivariate linear model was used to analyze interactions with respect to heading frequency and a history of concussion. Results: SOC (n = 15, mean age 38.3 ± 5.1 years) and CON (n = 16, mean age 36.6 ± 5.8 years) had a similar cortical thickness and performed similarly in the neurocognitive tests except for verbal memory and psychomotor speed, where SOC performed significantly worse than CON. Moderate headers had a significantly larger cortical thickness than rare headers in the right inferior parietal region. Visual memory and cortical thickness were positively correlated in the group of frequent headers and negatively correlated in CON, but not in the other header groups. Perspective: In contrast to previous reports in male soccer players, female players did not reveal cortical thinning in comparison with control athletes, whereas neurocognitive profiles of female soccer players might not significantly differ from male athletes. Small sample sizes, subjective header assessment, and the case–control study design require a cautious interpretation.

Liebe Leser*innen,Sport und Bewegung sind elementare Bestandteile der Gesundheit jedes Einzelnen und der Gesellschaft. Davon müssen wir Sie als Leser*innen dieser Zeitschrift sicherlich nicht überzeugen. So sind bewegungstherapeutische Interventionen sowohl bei neurologischen, orthopädischen als auch onkologischen Krankheitsbildern zentrale und zum Teil bereits gut mit klinischer Evidenz belegte Elemente der Therapie. Auch in Hinblick auf die Prävention von Erkrankungen hat regelmäßige körperliche Aktivität einen hohen Stellenwert.

Classification of physiological data provides a data driven approach to study central aspects of motor control, which changes with age. To implement such results in real-life applications for elderly it is important to identify age-specific characteristics of movement classification. We compared task-classification based on EEG derived activity patterns related to brain network characteristics between older and younger adults performing force tracking with two task characteristics (sinusoidal; constant) with the right or left hand. We extracted brain network patterns with dynamic mode decomposition (DMD) and classified the tasks on an individual level using linear discriminant analysis (LDA). Next, we compared the models' performance between the groups. Studying brain activity patterns, we identified signatures of altered motor network function reflecting dedifferentiated and compensational brain activation in older adults. We found that the classification performance of the body side was lower in older adults. However, classification performance with respect to task characteristics was better in older adults. This may indicate a higher susceptibility of brain network mechanisms to task difficulty in elderly. Signatures of dedifferentiation and compensation refer to an age-related reorganization of functional brain networks, which suggests that classification of visuomotor tracking tasks is influenced by age-specific characteristics of brain activity patterns. In addition to insights into central aspects of fine motor control, the results presented here are relevant in application-oriented areas such as brain computer interfaces.

Wearable devices and mobile health software applications have a great potential for improving epilepsy-related health outcomes and contributing to personalized medical care for persons with epilepsy. With limitations and challenges, they can be used for tracking seizure occurrence and for seizure detection, prediction, and forecasting in hospital and ambulatory settings. They can also help promote self-monitoring and self-management and thereby contribute to patient empowerment. In this review, we provide an overview of current wearable devices and mobile health software applications for epilepsy. We focus on clinically validated devices, their clinical applications, the challenges faced when using these devices in real-world settings, and how these devices may be optimized in the future.

To provide detailed epidemiological data on situations with a propensity of head injuries due to heading in professional football. In a prospective cohort study including the four highest professional football leagues in Germany, headers carried out in 1244 official matches and critical situations (CI) with a potential risk for injuries over one season were assessed by video analysis and a standardised video protocol. Results: 154,766 headers in 111,960 match minutes were recorded (1.4 headings/min). Video analysis showed a mean of 6.2 headers per field player and match (SD: 2,9; min: 0; max: 19) in the entire study population with a peak in the third league (7.1 per player and match). Headers were predominantly carried out with the forehead (78.5%), and nearly two-thirds occurred during defence (64.3%). 49.9% of all headers occurred during tackling, of which 78.3% involved body contact with an opponent. Video analysis yielded 848 CI. 74.5% of all critical incidents occurred during heading duels as a part of tackling (odds ratio: 3.6, 95%-CI: 2.4-5.2), and 99.4% involved body contact (odds ratio: 5.9, 95%-CI: 2,8-12,7). This study is the first to provide detailed epidemiological data on heading and critical incidences with high risk for head injuries in professional football. Heading duels bear a high risk of head injury and thus represent a key target for prevention strategies. The impacts of headers should be critically investigated regarding neurological consequences in further studies, by including the mean heading rate per mal field player and match.

Background Subjective Memory Complaints (SMC) in elderly people due to preclinical Alzheimer’s Disease may be associated with dysregulation of the Kynurenine Pathway (KP), with an increase in neurotoxic metabolites that affect cognition. Golf is a challenging sport with high demands on motor, sensory, and cognitive abilities, which might bear the potential to attenuate the pathological changes of preclinical AD. This trial investigated the feasibility of learning to play golf for elderly with cognitive problems and its effects on cognitive functions and the KP. Methods In a 22-week single-blinded randomized controlled trial, elderly people with SMC were allocated to the golf (n = 25, 180 min training/week) or control group (n = 21). Primary outcomes were feasibility (golf exam, adherence, adverse events) and general cognitive function (Alzheimer’s Disease Assessment Scale). Secondary outcomes include specific cognitive functions (Response Inhibition, Corsi Block Tapping Test, Trail Making Test), KP metabolites and physical performance (6-Minute-Walk-Test). Baseline-adjusted Analysis-of-Covariance was conducted for each outcome. Results 42 participants were analyzed. All participants that underwent the golf exam after the intervention passed it (20/23). Attendance rate of the golf intervention was 75 %. No adverse events or drop-outs related to the intervention occurred. A significant time*group interaction (p = 0.012, F = 7.050, Cohen’s d = 0.89) was found for correct responses on the Response Inhibition task, but not for ADAS-Cog. Moreover, a significant time*group interaction for Quinolinic acid to Tryptophan ratios (p = 0.022, F = 5.769, Cohen’s d = 0.84) in favor of the golf group was observed. An uncorrected negative correlation between attendance rate and delta Quinolinic acid to Kynurenic acid ratios in the golf group (p = 0.039, r=-0.443) was found as well. Conclusions The findings indicate that learning golf is feasible and safe for elderly people with cognitive problems. Preliminary results suggest positive effects on attention and the KP. To explore the whole potential of golfing and its effect on cognitive decline, a larger cohort should be studied over a longer period with higher cardiovascular demands. Trial registration The trial was retrospectively registered (2nd July 2018) at the German Clinical Trials Register (DRKS00014921).

Objectives The purpose of our study was to investigate the association between repetitive head impact (RHI) exposure and postural control. Design Systematic review. Methods PubMed, Embase and PsycInfo were searched using a self-developed search term including the keywords balance OR postural control AND repetitive OR sub-concussive head impacts. Twenty-one studies excluding non-peer reviewed studies, secondary studies, cross-sectional studies, animal studies, and studies investigating concussion were included for further analyses. We rated Level of Evidence and quality using the Centre for Evidence-Based Medicine tool, the Quality Assessment for the Systematic Review of Effectiveness, and the Sub-concussion Specific Tool. Results All included studies were grouped into Category I and II studies. Category I included trials investigating the effects of controlled soccer heading on postural control (n = 8) and Category II studies were cohort studies investigating on-the-field changes between preseason and postseason assessments on postural control measures (n = 13). Findings were heterogeneous, with a tendency towards no effects of RHI on clinical postural control measures. Most laboratory studies in Category I used instrumented assessments whereas on-the-field studies in Category II used both instrumented and non-instrumented assessments. Conclusions Due to heterogeneous findings, future studies aiming to investigate the effects of RHI on different athlete populations are needed on other participant cohorts. Furthermore, the combination of objective clinical balance measures may be a promising approach to accurately measure how, and to what degree, postural control may be affected by RHI.

Cardiorespiratory fitness was found to influence age-related changes of resting state brain network organization. However, the influence on dedifferentiated involvement of wider and more unspecialized brain regions during task completion is barely understood. We analyzed EEG data recorded during rest and different tasks (sensory, motor, cognitive) with dynamic mode decomposition, which accounts for topological characteristics as well as temporal dynamics of brain networks. As a main feature the dominant spatio-temporal EEG pattern was extracted in multiple frequency bands per participant. To deduce a pattern’s stability, we calculated its proportion of total variance among all activation patterns over time for each task. By comparing fit (N = 15) and less fit older adults (N = 16) characterized by their performance on a 6-min walking test, we found signs of a lower task specificity of the obtained network features for the less fit compared to the fit group. This was indicated by fewer significant differences between tasks in the theta and high beta frequency band in the less fit group. Repeated measures ANOVA revealed that a significantly lower proportion of total variance can be explained by the main pattern in high beta frequency range for the less fit compared to the fit group [F(1,29) = 12.572, p = .001, partial η2 = .300]. Our results indicate that the dedifferentiation in task-related brain activation is lower in fit compared to less fit older adults. Thus, our study supports the idea that cardiorespiratory fitness influences task-related brain network organization in different task domains. Supplementary information The online version of this article (10.1007/s11571-020-09656-9) contains supplementary material, which is available to authorized users.

As the proportion of people over 60 years of age rises continuously in westernized societies, it becomes increasingly important to better understand aging processes and how to maintain independence in old age. Fine motor tasks are essential in daily living and, therefore, necessary to maintain. This paper extends the existing literature on fine motor control by manipulating the difficulty of a force maintenance task to characterize performance optima for elderly. Thirty-seven elderly (M = 68.00, SD = 4.65) performed a force control task at dynamically varying force levels, i.e. randomly changing every 3 s between 10%, 20%, and 30% of the individual’s maximum voluntary contraction (MVC). This task was performed alone or with one or two additional tasks to increase task difficulty. The force control characteristics accuracy, variability, and complexity were analyzed. Lowest variability was observed at 20%. Accuracy and complexity increased with increasing force level. Overall, increased task difficulty had a negative impact on task performance. Results support the assumption, that attention control has a major impact on force control performance in elderly people. We assume different parameters to have their optimum at different force levels, which remain comparably stable when additional tasks are performed. The study contributes to a better understanding of how force control is affected in real-life situations when it is performed simultaneously to other cognitive and sensory active and passive tasks.

Zusammenfassung Einleitung Im Rahmen der Demenz vom Alzheimer-Typ (DAT) zeigt sich eine gestörte neuronale Netzwerkorganisation, welche sich unter anderem auch im Default Mode Netzwerk (DMN) widerspiegelt. Multimodale Interventionen, wie zum Beispiel Golf, können einen positiven Einfluss auf die funktionelle Integrität der Netzwerke haben. Methodik Im Rahmen einer Pilotstudie wurde der Einfluss des Erlernens der Sportart Golf bei sieben älteren Menschen (> 60 Jahre) mit subjektiven Gedächtnisbeschwerden auf die funktionelle Konnektivität des DMN untersucht. Die Probanden haben 22 Wochen unter Anleitung eines professionellen Golftrainers dreimal wöchentlich je 60 min trainiert. Vor (Messzeitpunkt 0, MZP0) und nach der Intervention (Messzeitpunkt 1, MZP1) wurde eine Elektroenzephalografie (EEG)-Messung unter Ruhebedingungen (resting-state) durchgeführt. Die EEG-Daten wurden mit einem Magnetresonanztomographie-Template koregistriert. Die Konnektivitätsanalyse wurde in 15 Regionen des DMN durchgeführt und im Längsschnitt verglichen. Dabei wurden die Frequenzbänder beta (14–29 Hz) und theta (5–7 Hz) berücksichtigt. Ergebnisse Nach der Intervention wurde eine höhere funktionelle Konnektivität im gesamten DMN bei 5 / 7 Teilnehmenden im beta Frequenzband bzw. bei 6 / 7 Probanden im theta Frequenzband zu MZP1 im Vergleich zu MZP0 gemessen. Im anterioren DMN war bei allen Probanden und Probandinnen die funktionelle Konnektivität im beta Frequenzband zu MZP1 im Vergleich zu MZP 0 höher, während sie im theta-Band bei 6 von 7 Teilnehmenden niedriger war. Im posterioren DMN war bei 6 von 7 (beta), bzw. 5 von 7 (theta) Probanden und Probandinnen die funktionelle Konnektivität zu MZP1 höher als zu MZP0. Spearman-Korrelationsanalysen zeigen zudem einen Zusammenhang zwischen der Teilnahmehäufigkeit und der prozentualen Veränderung der funktionellen Konnektivität im gesamten DMN des beta Frequenzbandes (r = 0,786, p = 0,036) und im anterioren DMN des theta Frequenzbandes (r = –0,821, p = 0,023). Fazit Auf Basis der vorliegenden Daten lässt sich vermuten, dass das Erlernen der Sportart Golf einen Einfluss auf das DMN haben könnte. Die Ergebnisse bilden die Grundlage für die Planung einer Studie mit einer größeren Kohorte und randomisierten kontrollierten Design.

People with epilepsy (PWE) are less fit and have an increased risk of sudden cardiac death. Imbalances within the autonomic nervous system (ANS) are believed to mediate some of those effects. However, results are mostly derived from patients whose seizures are refractory to medical therapy. In this study, an exhaustive bicycle ergometer test was delivered to 25 PWE (19 seizure free in the last 6 months) recruited in a community-based setting and 25 age-, sex-, and BMI-matched healthy controls. During the exercise test a 12-channel ECG was recorded and spirometry was carried out to determine the maximal oxygen uptake (VO

Introduction: Heading is an integral part of football and frequent media reports and previous studies about potential danger of heading and head trauma in football fuelled discussions. Epidemiological data and video analyses regarding the frequency of headings and associated head injuries are still missing in adult elite football. Methods: In a prospective cohort study in the fourth German football league, 100 official matches of the 2015-2016 season were assessed by means of video analysis and a standardized protocol. Head injuries were documented and confirmed by standardised epidemiological injury reports of the teams. Results: Overall, 11,514 headings were analysed in detail. Video analysis yielded a mean of 5.7 headings per player and match (SD: 1.2; min: 0; max: 15). Heading was predominantly performed with the frontal part of the head (76.8%), and nearly two thirds of all headings occurred during defending (65.8%). 71.0% of all headings occured during tacklings, of which 71.9% involved body contact with the opponent player. Video analysis yielded 31 critical incidents (CI) on the head due to heading (incidence: 1.02 per 1000 h match exposure and player). 29 CIs occurred during heading duels (Odds ratio: 5.91), 30 CIs with body contact (odds ratio: 28.8) and 6 CIs with elbow contact (odds ratio: 6.13). Conclusion: Heading duels, especially with body contact and high elbow, are important risk factors for head injuries and key factor for prevention strategies. The impact of 5.7 headings per match on players` brain should be investigated in further research.

Purpose of ReviewThe incidence of sport-related concussion (SRC) has been increasing in different sports and its impact on long-term cognitive function is increasingly recognized. In this study, we review the epidemiology, neuropathophysiology, clinical symptoms, and long-term consequences of SRC with a specific focus on cognition.Recent FindingsRepeated concussions are associated with an increased risk of several neurologic diseases and long-term cognitive deficits. To improve cognitive outcomes in athletes with SRC, standardized guidelines for the assessment and management of SRC are vital. However, current concussion management guidelines lack procedures for rehabilitating acute and long-term cognitive symptoms.SummaryIncreased awareness for the management and rehabilitation of cognitive symptoms in SRC is needed in all clinical neurologists treating professional and amateur athletes. We propose cognitive training as a prehabilitation tool to alleviate the severity of cognitive symptoms and as a rehabilitative tool to improve cognitive recovery postinjury.

In sport science, athlete tracking and motion analysis are essential for monitoring and optimizing training programs, with the goal of increasing success in competition and preventing injury. At present, contact-free, camera-based, multi-athlete detection and tracking have become a reality, mainly due to the advances in machine learning regarding computer vision and, specifically, advances in artificial convolutional neural networks (CNN), used for human pose estimation (HPE-CNN) in image sequences. Sport science in general, as well as coaches and athletes in particular, would greatly benefit from HPE-CNN-based tracking, but the sheer amount of HPE-CNNs available, as well as their complexity, pose a hurdle to the adoption of this new technology. It is unclear how many HPE-CNNs which are available at present are ready to use in out-of-the-box inference to squash, to what extent they allow motion analysis and if detections can easily be used to provide insight to coaches and athletes. Therefore, we conducted a systematic investigation of more than 250 HPE-CNNs. After applying our selection criteria of open-source, pre-trained, state-of-the-art and ready-to-use, five variants of three HPE-CNNs remained, and were evaluated in the context of motion analysis for the racket sport of squash. Specifically, we are interested in detecting player’s feet in videos from a single camera and investigated the detection accuracy of all HPE-CNNs. To that end, we created a ground-truth dataset from publicly available squash videos by developing our own annotation tool and manually labeling frames and events. We present heatmaps, which depict the court floor using a color scale and highlight areas according to the relative time for which a player occupied that location during matchplay. These are used to provide insight into detections. Finally, we created a decision flow chart to help sport scientists, coaches and athletes to decide which HPE-CNN is best for player detection and tracking in a given application scenario.

The present study aimed to investigate time trends of head injuries and their injury mechanisms since a rule change as monitoring may help to identify causes of head injuries and may advance head injury prevention efforts. Based on continuously recorded data from the German football magazine “kicker Sportmagazin®” as well as other media sources, a database of head injuries in the 1st German male Bundesliga was generated comprising 11 seasons (2006/07–2016/17). Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) were calculated. Time trends were analysed via linear regression. Two hundred thirty-eight match head injuries occurred (IR 1.77/1000 match hours, 95% CI 1.56–2.01). There were no significant seasonal changes, expressed as annual average year-on-year change, in IRs over the 11-year period for total head injuries (p=0.693), facial/head fractures (p=0.455), lacerations/abrasions (p=0.162), and head contusions (p=0.106). The annual average year-on-year increase for concussion was 6.4% (p=0.004). Five head injury mechanisms were identified. There were no seasonal changes in injury mechanisms over the study period. The concussion subcategory increased slightly over the seasons, which may either be a result of increasing match dynamics or raised awareness among team physicians and players.

A seizure is a strong central stimulus that affects multiple subsystems of the autonomic nervous system (ANS), and results in different interactions across ANS modalities. Here, we aimed to evaluate whether multimodal peripheral ANS measures demonstrate interactions before and after seizures as compared to controls to provide the basis for seizure detection and forecasting based on peripheral ANS signals.Continuous electrodermal activity (EDA), heart rate (HR), peripheral body temperature (TEMP), and respiratory rate (RR) calculated based on blood volume pulse were acquired by a wireless multi-sensor device. We selected 45 min of preictal and 60 min of postictal data and time-matched segments for controls. Data were analyzed over 15-min windows. For unimodal analysis, mean values over each time window were calculated for all modalities and analyzed by Friedman's two-way analysis of variance.Twenty-one children with recorded generalized tonic-clonic seizures (GTCS), and 21 age- and gender-matched controls were included. Unimodal results revealed no significant effect for RR and TEMP, but EDA (p = 0.002) and HR (p 0.001) were elevated 0-15 min after seizures. The averaged bimodal correlation across all pairs of modalities changed for 15-min windows in patients with seizures. The highest correlations were observed immediately before (0.85) and the lowest correlation immediately after seizures. Overall, average correlations for controls were higher.Multimodal ANS changes related to GTCS occur within and across autonomic nervous system modalities. While unimodal changes were most prominent during postictal segments, bimodal correlations increased before seizures and decreased postictally. This offers a promising avenue for further research on seizure detection, and potentially risk assessment for seizure recurrence and sudden unexplained death in epilepsy.

SARS‐CoV‐2 infection has emerged as not only a pulmonary but also potentially multi‐organ disease, which may cause long‐term structural damage of different organ systems including the lung, heart, vasculature, brain, liver, kidney, or intestine. As a result, the current SARS‐CoV‐2/COVID‐19 pandemic will eventually yield substantially increased numbers of chronically diseased patients worldwide, particularly suffering from pulmonary fibrosis, post‐myocarditis, chronic heart failure, or chronic kidney disease. Exercise recommendations for rehabilitation are complex in these patients and should follow current guidelines including standards for pre‐exercise medical examinations and individually tailored exercise prescription. It is of utmost importance to start exercise training at an early stage after COVID‐19 infection, but at the same time paying attention to the physical barriers to ensure safe return to exercise. For exercise recommendations beyond rehabilitation programs particularly for leisure time and elite athletes, more precise advice is required including assessment of sports eligibility and specific return‐to‐sports exercise programs. Because of the current uncertainty of long‐term course of SARS‐CoV‐2 infection or COVID disease, long‐term follow‐up seems to be necessary., publishedVersion

OBJECTIVE Daytime and nighttime patterns affect the dynamic modulation of brain and body functions and influence the autonomic nervous system response to seizures. Therefore, we aimed to evaluate 24-hour patterns of electrodermal activity (EDA) in patients with and without seizures. METHODS We included pediatric patients with (a) seizures (SZ), including focal impaired awareness seizures (FIAS) or generalized tonic-clonic seizures (GTCS), (b) no seizures and normal electroencephalography (NEEG), or (c) no seizures but epileptiform activity in the EEG (EA) during vEEG monitoring. Patients wore a device that continuously recorded EDA and temperature (TEMP). EDA levels, EDA spectral power, and TEMP levels were analyzed. To investigate 24-hour patterns, we performed a nonlinear mixed-effects model analysis. Relative mean pre-ictal (-30 min to seizure onset) and post-ictal (I: 30 min after seizure offset; II: 30 to 60 min after seizure offset) values were compared for SZ subgroups. RESULTS We included 119 patients (40 SZ, 17 NEEG, 62 EA). EDA level and power group-specific models (SZ, NEEG, EA) (h = 1; P

A better understanding of the early detection of seizures is highly desirable as identification of an impending seizure may afford improved treatments, such as antiepileptic drug chronotherapy, or timely warning to patients. While epileptic seizures are known to often manifest also with autonomic nervous system (ANS) changes, it is not clear whether ANS markers, if recorded from a wearable device, are also informative about an impending seizure with statistically significant sensitivity and specificity. Using statistical testing with seizure surrogate data and a unique dataset of continuously recorded multi-day wristband data including electrodermal activity (EDA), temperature (TEMP) and heart rate (HR) from 66 people with epilepsy (9.9 ± 5.8 years; 27 females; 161 seizures) we investigated differences between inter- and preictal periods in terms of mean, variance, and entropy of these signals. We found that signal mean and variance do not differentiate between inter- and preictal periods in a statistically meaningful way. EDA signal entropy was found to be increased prior to seizures in a small subset of patients. Findings may provide novel insights into the pathophysiology of epileptic seizures with respect to ANS function, and, while further validation and investigation of potential causes of the observed changes are needed, indicate that epilepsy-related state changes may be detectable using peripheral wearable devices. Detection of such changes with wearable devices may be more feasible for everyday monitoring than utilizing an electroencephalogram.

Background For many years, people with epilepsy were advised not to engage in sports. In this systematic review, we investigated whether persons with epilepsy exercise less than the general population, and what effect physical activity has on epilepsy. Methods A literature search was carried out in PubMed and the Web of Science, and 14 269 studies were entered into the selection process. The selected studies were assessed for their methodological quality and accordingly assigned an evidence level. Results 42 studies were included in the review; 10 were classified as evidence level 3, 27 as evidence level 2-, 2 as evidence level 2+, and 3 as evidence level 1-. Persons with epilepsy are less physically active and less physically fit than the general population. Reduced physical activity is associ- ated with a higher frequency of comorbidities and lower quality of life. Physical interventions can improve quality of life. In most cases, physical exercise did not increase seizure frequency. Conclusion There is no reason to forbid persons with epilepsy to participate in sports; they should, rather, be encour- a particular type of sport should, however, be taken individually in each case.

Trail running places specific physiological demands on the human body due to its uphill and downhill running sections. We developed and investigated a more sport-specific trail exercise test protocol (inclination and speed incremental protocol), and compared it to two standard exercise test protocols (horizontal step and ramp protocol) in thirteen highly trained trail runners (age 31±6 years, height 179±6.4 cm, weight 69.2±7.9 kg, BMI 21.6±2.1 kg/m2). The maximum oxygen uptake (VO2max) measured during the trail test (62.5±5.9 ml·kg−1·min−1, [95% CI: 59.0-66.1]) was significantly higher compared to both the step test (60.1±5.3 ml·kg−1·min−1, [95% CI: 56.8-63.3], p=0.024) and the ramp test (59.7±5.5 ml·kg−1·min−1, [95% CI: 56.4-63.0], p=0.028). Time to task failure was significantly shorter in the trail test (557±73 s, [95% CI: 512-601]) compared to both the step test (1378±152 s, [95% CI: 1286-1470], p