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The purpose of this study was to describe the mechanism of injury (MOI) and examine factors associated with greater risk for specific MOIs involving concussions in collegiate soccer players.Participants included 3,288 collegiate soccer players from 28 institutions across four competitive seasons, 2014-17. MOIs were documented for 262 soccer-related concussions during the study and placed into one of four categories: collisions, unintentional contact, aerial challenges, and others.70% of the concussions occurred in DI soccer players. Collisions and unintentional contact were the MOIs that resulted in 66.5% of all concussions. DI and DIII soccer players sustained more concussions by unintentional contact versus collisions and aerial challenges when compared to their DII counterparts. Defenders were more likely than midfielders to sustain concussions by aerial challenges than collisions. As expected, the field players experienced more concussions as a result of collisions, unintentional contact, and aerial challenges when compared to goalkeepers.Future research should explore preventive strategies for decreasing collisions, especially during aerial challenges while heading the soccer ball, and unintentional contacts from errant balls in soccer in order to decrease concussion risk.

Background Natural ankle quasi-stiffness (NAS) is a key metric used to personalize orthotic and prosthetic ankle-foot devices. NAS has traditionally been defined as the average slope (i.e. linear regression) of the net ankle moment vs. ankle angle curve during stance. However, NAS appears to have nonlinear characteristics. Characterizing nonlinear NAS across a wide range of tasks will enable us to incorporate these attributes into future orthotic and prosthetic ankle-foot device designs. Research question Does nonlinear NAS change across multiple intensities of walking, running, and load carriage tasks? Methods This observational study examined 22 young, healthy individuals as they walked, ran, and walked while carrying a load at three intensities (speed or load). Linear, quadratic, and cubic regressions were done on the net ankle moment vs. ankle angle curve over three phases of stance: impact, loading, and push-off. RMSE between regressions and measured data were computed to determine regression accuracy, and multilevel linear models (MLMs) were used to determine significant differences between coefficients across intensities. Results Quadratic and cubic regressions of NAS had significantly lower RMSE than linear NAS for all phases of stance. Because of diminishing reductions in RMSE between quadratic and cubic regressions, only quadratic regression coefficients were further analyzed. Most first (linear) and second (nonlinear) order coefficients of quadratic regressions exhibited clear trends with respect to changes in walking or running speed, but not to increases in load. Significance This was the first study to our knowledge to thoroughly characterize nonlinear NAS across multiple gait tasks and intensities. This study provides an advanced understanding of the characteristics of nonlinear NAS for the design of future prosthetic and orthotic ankle-foot devices.

The objective was to examine the efficacy of the Get aHEAD Safely in Soccer™ intervention on head impact kinematics and neck strength in female youth soccer players. The control group (CG) consisted of 13 players (age: 11.0 ± 0.4 yrs), while the experimental group (EG) consisted of 14 players (age: 10.6 ± 0.5 yrs). Head impact kinematics included peak linear acceleration (PLA), peak rotational acceleration (PRA), and peak rotational velocity (PRV). Pre- and post-season measures included strength measures of neck/torso flexion (NF/TF) and extension (NE/TE). Data were analysed using a multilevel linear model and ANOVA techniques. No differences in PLA, PRA, or PRV were observed between groups. The EG showed significant improvement in NF strength while the CG showed significant improvement in NE strength. Both groups significantly improved in TF pre- to post-season. The foundational strength components of the Get aHEAD Safely in Soccer program appear to show a benefit in youth soccer players beginning to learn the skill of purposeful heading.

Objective To develop a set of composite scores that can be used for interpreting quality of life (QOL) after traumatic brain injury (TBI) using 9 of the patient-reported outcomes measures from the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system. Design Participants completed 20 item banks from the TBI-QOL as part of a larger assessment. Composite index scores were created with normalized transformation with nonlinear area conversion using scores from 9 of the banks, and are expressed in index score units, with higher composite scores indicating better functioning. For descriptive purposes, associations among composites and individual banks were evaluated using regression, along with patterns of composite scores by injury severity groups using analysis of variance. Setting Three medical centers in the United States. Participants Community-dwelling adults (n=504) with a history of TBI. Interventions Not applicable. Main Outcomes Measure TBI-QOL. Results Five composite indices were generated: global QOL, physical health, emotional health, cognitive health, and social health. Lookup tables are provided herein. Composite scores were highly intercorrelated (all r>.60, P .50, P Conclusion Researchers and clinicians can use the TBI-QOL global QOL, physical health, emotional health, cognitive health, and social health composite scores to aggregate results from multiple TBI-QOL banks, which is anticipated to ease interpretation and reliability. This work additionally highlights the importance of considering nonphysical symptoms as outcomes variables for TBI research, as cognitive, social, and emotional domains were some of the most strongly correlated banks with the global QOL composite.

Rates of concussion in soccer are high, especially in female players. The primary aim of this study was to examine differences in self-reported concussion-related symptoms (CRS), balance (BESS), and neurocognitive performance (ImPACT) following an acute bout of soccer heading in a group of female collegiate players with and without a history of concussion. Eighty-seven players with 0 to 3+ previous concussions participated. The measurement variables were assessed before and after heading sessions; including one linear and one rotational bout. Players with concussion histories reported more CRS than their non-concussed teammates both before and after the heading sessions. Balance and neurocognitive scores were generally unaffected. This finding should heighten our awareness to carefully monitor soccer players who have experienced concussions and be aware that they may develop concussion-like symptoms, especially after acute bouts of heading either during practice or in matches. The long-term implications of this finding remain unknown.

Gait impairment often limits physical activity and negatively impacts quality of life. EMG-Biofeedback (EMG-BFB), one of the more effective interventions for improving gait impairment, has been limited to laboratory use due to system costs and technical requirements, and has therefore not been tested on a larger scale. In our research, we aimed to develop and validate a cost-effective, commercially available EMG-BFB device for home- and community-based use. We began by repurposing mTrigger® (mTrigger LLC, Newark, DE, USA), a cost-effective, portable EMG-BFB device, for gait application. This included developing features in the cellphone app such as step feedback, success rate, muscle activity calibration, and cloud integration. Next, we tested the validity and reliability of the mTrigger device in healthy adults by comparing it to a laboratory-grade EMG system. While wearing both devices, 32 adults walked overground and on a treadmill at four speeds (0.3, 0.6, 0.9, and 1.2 m/s). Statistical analysis revealed good to excellent test–retest reliability (r &gt, 0.89) and good to excellent agreement in the detection of steps (ICC &gt, 0.85) at all speeds between two systems for treadmill walking. Our results indicated that mTrigger compared favorably to a laboratory-grade EMG system in the ability to assess muscular activity and to provide biofeedback during walking in healthy adults.

Context Approximately 72% of patients with an ankle sprain report residual symptoms 6 to 18 months later. Although 44% of patients return to activity in less than 24 hours after experiencing a sprain, residual symptoms should be evaluated in the long term to determine if deficits exist. These residual symptoms may be due to the quality of ligament tissue and motion after injury. Objective To compare mechanical laxity of the talocrural joint and dorsiflexion range of motion (DFROM) over time (24 to 72 hours, 2 to 4 weeks, and 6 months) after an acute lateral ankle sprain (LAS). Design Cross-sectional study. Setting Athletic training research laboratory. Patients or Other Participants A total of 108 volunteers were recruited. Fifty-five participants had an acute LAS and 53 participants were control individuals without a history of LAS. Main Outcome Measure(s) Mechanical laxity (talofibular interval and anterior talofibular ligament length) was measured in inversion (INV) and via the anterior drawer test. The weight-bearing lunge test was conducted and DFROM was measured. The data were analyzed using repeated-measures analysis of variance, independent-samples t tests, and 1-way analysis of variance. Results Of the 55 LASs, 21 (38%) were grade I, 27 (49%) were grade II, and 7 (13%) were grade III. Increases were noted in DFROM over time, between 24 and 72 hours, at 2 to 4 weeks, and at 6 months (P < .05). The DFROM was less in participants with grade III than grade I LASs (P = .004) at 24 to 72 hours; INV length was greater at 24 to 72 hours than at 2 to 4 weeks (P = .023) and at 6 months (P = .035) than at 24 to 72 hours. The anterior drawer length (P = .001) and INV talofibular interval (P = .004) were greater in the LAS group than in the control group at 6 months. Conclusions Differences in range of motion and laxity were evident among grades at various time points and may indicate different clinical responses after an LAS.

IntroductionComputerized neuropsychological testing is a cornerstone of sport-related concussion assessment. Female soccer players are at an increased risk for concussion as well as exposures to repetitive head impacts from heading a soccer ball. Our primary aim was to examine factorial validity of the Automated Neuropsychological Assessment Metrics (ANAM) neuropsychological test battery in computing the multiple neurocognitive constructs it purports to measure in a large cohort of interscholastic female soccer players.MethodsStudy participants included 218 interscholastic female soccer players (age = 17.0±0.7 year; mass = 55.5±6.8 kg; height = 164.7±6.6 cm) drawn from a large (850+) prospective database examining purposeful heading from four area high schools over a 10-year period. The ANAM-2001 measured neurocognitive performance. Three methods were used to identify integral constructs underlying the ANAM: (a) exploratory factor analysis (EFA), (b) first-order confirmatory factor analysis (CFA), and (c) hierarchical CFA.ResultsNeuropsychological phenomena measured by the ANAM-2001 were best reproduced by a hierarchical CFA organization, composed of two lower level factors (Simple Reaction Time, Mental Efficiency) and a single, general composite. Although the ANAM was multidimensional, only the composite was found to possess sufficient construct dimensionality and reliability for clinical score interpretation. Findings failed to uphold suppositions that the ANAM measures seven distinct constructs, or that any of its seven tests provide unique information independent of other constructs, or the composite, to support individual interpretation.ConclusionsOutcomes infer the ANAM possesses factorial-validity evidence, but only scores from the composite appear to sufficiently internally valid, and reliable, to support applied use by practitioners.

Background: Early sport specialization has been associated with an increased risk of musculoskeletal injuries and unfavorable psychological outcomes; however, it is unknown whether sport specialization is associated with worse cognitive, postural, and psychological functions in first-year collegiate student-athletes. Methods: First-year collegiate multisport (MA) and single-sport (SA) student-athletes were identified using a pre-collegiate sport experience questionnaire. The cognitive, postural, and psychological functions were assessed by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and Brief Symptom Inventory 18 (BSI-18). Results: MA student-athletes performed higher in cognitive outcomes (e.g., higher ImPACT visual memory composite scores [ß = 0.056, p < 0.001]), but had higher psychological distress (e.g., higher BSI-18 global severity index [ß = 0.057, p < 0.001]) and no difference in postural stability (p > 0.05) than SA student-athletes. Conclusions: This study indicated first-year collegiate athletes with a history of sport specialization demonstrate lower cognitive performance but decreased psychological distress and no differences in static postural stability as compared to their MA counterparts. Future studies should consider involving different health measures to better understand the influence of sport specialization on overall physical and mental health.

The purpose of this study was to examine the effect of purposeful heading in football on measures of cognitive function in a large cohort of female interscholastic football players over the course ...

Context: Lateral ankle sprains are the most common injuries in high school sports. While ankle taping is a preferred method of external prophylactic support, its restrictive properties decline during exercise. The Under Armour® Highlight cleat is marketed on the premise that it provides added support without the need for additional ankle taping. Objective: To determine if differences in ankle joint laxity and postural control exist between football players wearing the Under Armour® Highlight cleat (Under Armour Inc, Baltimore, MD) as compared to a low/mid-top cleat with ankle tape. Design: Crossover trial. Setting: Athletic training room and football practice field sideline. Patients: 32 interscholastic football players (15.8 ± 1.0 y; 178.9 ± 7.4 cm; 87.1 ± 21.4 kg). Interventions: Ankle laxity was assessed using an instrumented ankle arthrometer (Blue Bay Research Inc, Milton, FL), while postural control testing was performed on the Tekscan MobileMat™ Balanced Error Scoring System (BESS; South Boston, MA). The 2 treatments included Under Armour® Highlight cleats and a low/mid-top cleat with ankle tape applied to the nondominant ankle only. Measurements were taken before and immediately after practice. Main Outcome Measures: The independent variable was treatment (Highlight vs low/mid-top cleat with ankle tape). Dependent variables included ankle arthrometry measures of anterior displacement (mm), inversion/eversion rotation (deg), and the modified BESS error scores. A linear mixed-effects model was used for analysis. Results: The low/mid-top cleat with tape condition had significantly higher inversion range-of-motion (ROM) and inversion/eversion rotation postexercise when compared to the Highlight cleat (P Conclusions: The results of this study provide some evidence that the Under Armour® Highlight cleat restricts ankle ROM following a training session better than the taped low/mid-top cleat. Further study is warranted to determine if this high-top style of football cleat can reduce the incidence of ankle sprains and how it might compare to spat taping.

Context: Heading, an integral component of soccer, exposes athletes to a large number of head impacts over a career. The literature has begun to indicate that cumulative exposure may lead to long-term functional and psychological deficits. Quantifying an athlete's exposure over a season is a first step in understanding cumulative exposure. Objective: To measure the frequency and magnitude of direct head impacts in collegiate women's soccer players across impact type, player position, and game or practice scenario. Design: Cross-sectional study. Setting: National Collegiate Athletic Association Division I institution. Patients or Other Participants: Twenty-three collegiate women's soccer athletes. Main Outcome Measure(s): Athletes wore Smart Impact Monitor accelerometers during all games and practices. Impacts were classified during visual, on-field monitoring of athletic events. All direct head impacts that exceeded the 10g threshold were included in the final data analysis. The dependent variable was linear acceleration, and the fixed effects were (1) type of impact: clear, pass, shot, unintentional deflection, or head-to-head contact; (2) field position: goalkeeper, defense, forward, or midfielder; (3) playing scenario: game or practice. Results: Shots (32.94g ± 12.91g, n = 38; P = .02) and clears (31.09g ± 13.43g, n = 101; P = .008) resulted in higher mean linear accelerations than passes (26.11g ± 15.48g, n = 451). Head-to-head impacts (51.26g ± 36.61g, n = 13; P < .001) and unintentional deflections (37.40g ± 34.41g, n = 24; P = .002) resulted in higher mean linear accelerations than purposeful headers (ie, shots, clears, and passes). No differences were seen in linear acceleration across player position or playing scenario. Conclusions: Nonheader impacts, including head-to-head impacts and unintentional deflections, resulted in higher mean linear accelerations than purposeful headers, including shots, clears, and passes, but occurred infrequently on the field. Therefore, these unanticipated impacts may not add substantially to an athlete's cumulative exposure, which is a function of both frequency and magnitude of impact.

There is increasing societal concern about the long-term effects of repeated impacts from soccer heading, but there is little information about ways to reduce head impact severity. The purpose of this study was to identify factors that contribute to head acceleration during soccer heading. One-hundred soccer players completed 12 controlled soccer headers. Peak linear (PLA) and rotational (PRA) accelerations were measured using a triaxial accelerometer and gyroscope. Head acceleration contributing factors were grouped into 3 categories: size (head mass, neck girth), strength (sternocleidomastoid, upper trapezius) and technique [kinematics (trunk, head-to-trunk range-of-motion), sternocleidomastoid and upper trapezius activity]. Multiple regression analyses indicated size variables explained 22.1% of the variance in PLA and 23.3% of the variance in PRA; strength variables explained 13.3% of the variance in PLA and 17.2% of the variance in PRA; technique variables did not significantly predict PLA or PRA. These findings suggest that head and neck size and neck strength predict PLA and PRA. Anthropometric and neck strength measurements should be considered when determining an athlete's readiness to begin soccer heading.

Objective To determine the acute effects of repetitive soccer heading on postural control. Design Prospective study; participants were divided into 2 groups: a soccer heading group and a control group. Setting Biomechanics laboratory. Participants One hundred sixty participants, including youth (age = 13.0 ± 0.8 years), high school (age = 17.2 ± 1.0 years), and collegiate (age = 20.2 ± 1.3 years) male and female soccer players, participated in this study. Interventions Participants in the soccer heading group performed 12 soccer headers (initial velocity = 11.2 m/s). Postural control testing was performed both before (PRE) and immediately after (POST) the purposeful soccer headers. Control participants performed postural control testing PRE and POST a 15-minute wait period. During postural control testing, participants were asked to stand on the MobileMat (Tekscan Inc, Boston, Massachusetts) for two 2-minute intervals with their hands on their hips and their feet together with one eyes-open and one eyes-closed trial. Main outcome measures Using the center-of-pressure data, 95% area, sway velocity, and ApEn were calculated. Multilevel linear models were used to analyze the effects of age, sex, group, condition, and concussion history simultaneously. Results Participants in the soccer heading group had significantly higher sway velocity POST than participants in the control group after controlling for age, sex, concussion history, condition, and PRE (t = -3.002; P = 0.003; 95% confidence interval, -0.482 to -0.100). There were no significant differences from PRE to POST for 95% area, M/L ApEn, and A/P ApEn. Conclusions Repetitive soccer heading does not affect most postural control measures, even among youth athletes. However, sway velocity increased after heading relative to control participants independent of age, sex, and concussion history.

Context: Lateral ankle sprains commonly occur in an athletic population and can lead to chronic ankle instability. Objective: To compare ankle strength measurements in athletes who have mechanical laxity and report functional instability after a history of unilateral ankle sprains. Design: Retrospective cohort. Setting: Athletic Training Research Lab. Participants: A total of 165 National Collegiate Athletic Association Division I athletes, 97 males and 68 females, with history of unilateral ankle sprains participated. Main Outcome Measures: Functional ankle instability was determined by Cumberland Ankle Instability Tool scores and mechanical ankle instability by the participant having both anterior and inversion/eversion laxity. Peak torque strength measures, concentric and eccentric, in 2 velocities were measured. Results: Of the 165 participants, 24 subjects had both anterior and inversion/eversion laxity and 74 self-reported functional ankle instability on their injured ankle. The mechanical ankle instability group presented with significantly lower plantar flexion concentric strength at 30°/s (139.7 [43.7] N·m) (P = .01) and eversion concentric strength at 120°/s (14.8 [5.3] N·m) (P = .03) than the contralateral, uninjured ankle (166.3 [56.8] N·m, 17.4 [6.2] N·m, respectively). Conclusion: College athletes who present with mechanical laxity on a previously injured ankle exhibit plantar flexion and eversion strength deficits between ankles.

In this quantitative study, correlational and multiple regression analyses were conducted to examine the technological pedagogical content knowledge (TPACK) development of 299 preservice teachers in response to the technology preparation they received during their initial teacher licensure program. Survey data were analyzed to determine the extents to which preservice teachers' knowledge increased in response to technology preparation and to determine the contribution of individual knowledge components, including technological knowledge, pedagogical knowledge, and technological pedagogical knowledge, to the development of TPACK. Findings revealed that individual knowledge components made statistically significant and unique contributions to preservice teachers' TPACK. Findings from this work help explicate the significant contributions of individual knowledge components to TPACK development and have implications for teacher preparation programs on the use of technology.

Prevalence rates for bullying victimization among children with disabilities have varied greatly in the research literature. Two reasons for such variability were the focus of this study: (a) rates vary as a function of disability type, and (b) rates vary based on the bullying measure and criteria used to classify students as bullying victims. The sample consisted of 1,027 parents or guardians of children with disabilities and 11,500 parents or guardians of children without disabilities who reported the frequency with which their children experienced bullying in general and 12 specific behaviors associated with verbal, physical, and social–relational bullying. Prevalence rates and odds ratios (ORs) differed considerably based not only on disability type but also on the classification criteria used. For both conceptual and practical reasons, it is recommended that bullying victims be considered those who experience bullying-related behaviors frequently and repetitively as opposed to only sometimes.

Awareness of sport-related concussions in soccer has gained recent attention in the medical community. Interestingly, purposeful heading-a unique yet strategic and inherent part of soccer-involves repeated subconcussive blows to the head. We divided 210 female interscholastic soccer players into control (CON [never concussed]) and experimental (EXP [previously concussed]) groups. We assessed neurocognitive performance using the Automated Neuropsychological Assessment Metrics computer program before and after the players' competitive season. Headers were recorded at all sanctioned matches. Data were analyzed using a series of one-way analyses of covariance and t tests. Both groups essentially played in the same number of games (EXP = 16.1 vs. CON = 16.1) and had an equal number of total headers (EXP = 24.9 vs. CON = 24.3). Additionally, headers per game were surprisingly low in both groups (1.4 in EXP vs. 1.3 in CON). Unexpectedly, there were no significant differences between the EXP and CON groups across all dependent variables measured (p .05). This study suggests that although previously concussed players involve themselves in purposeful heading (i.e., subconcussive insults) throughout a competitive season, there appear to be no negative consequences on neuropsychological test performance or concussion-related symptoms. Additional research is needed to determine what may result during the course of a playing career.

Differences in head–neck segment mass, purposeful heading technique, and cervical strength and stiffness may contribute to differences in head accelerations across sex and age. The purpose of this study was to compare head acceleration across sex and age (youth [12–14 years old], high school and collegiate) during purposeful soccer heading. One-hundred soccer players (42 male, 58 female, 17.1 ± 3.5 years, 168.5 ± 20.3 cm, 61.5 ± 13.7 kg) completed 12 controlled soccer headers at an initial ball velocity of 11.2 m/s. Linear and rotational accelerations were measured using a triaxial accelerometer and gyroscope and were transformed to the head centre-of-mass. A MANOVA revealed a significant multivariate main effect for sex (Pillai’s Trace = .165, F(2,91) = 11.868, p

Several previous studies have found that Chinese students perceive teacher-student relationships and student-student relationships more favorably than American students. In this study we examined if the same holds true with respect to teachers' perceptions. Also examined were both students' and teachers' perceptions of conduct problems. The sample included 3,253 students and 345 teachers in China and 2,192 students and 540 teachers in the United States. Results of a multivariate analysis of variance revealed the greatest differences in mean scores between countries were in teachers' and students' perceptions of student-student relationships and student conduct problems. American students perceived their schools much less favorably, and particularly so in middle school and high school. Students tended to report less favorable relationships and greater conduct problems than their teachers, especially in the United States compared with China. Cultural differences are discussed that may account for the findin...

When exploring missing data techniques in a realistic scenario, the current literature is limited: most studies only consider consequences with data missing on a single variable. This simulation study compares the relative bias of two commonly used missing data techniques when data are missing on more than one variable. Factors varied include type of missingness (MCAR, MAR), degree of missingness (10%, 25%, and 50%), and where missingness occurs (one predictor, two predictors, or two predictors with overlap). Using a real dataset, cells are systematically deleted to create various scenarios of missingness so that parameter estimates from listwise deletion and multiple imputation may be compared to the - true- estimates from the full dataset. Results suggest the multiple imputation works well, even when the imputation model itself is missing data.

Objective This cohort study aimed to report the compliance of young athletes with nonoperative treatment and to clarify the role of sports modification on clinical outcome of symptomatic spondylolysis. Design This study included patients with a chief complaint of low back pain participating in regular sports activity, having spondylolysis, and being treated and followed up between 1990 and 2002 in the authors' hospital. Results One hundred thirty-two athletes were included in this study: 78 males and 54 females. The mean age of the patients was 13 yrs (range, 7-18 yrs). Only 56 patients (42.4%) were compliant to nonoperative treatment. Eighty-six patients (65%) stopped all sports activities for at least 3 mos, and 46 patients (35%) stopped exercising for a variable period of less than 3 mos. The grading of clinical outcome after nonoperative treatment was as follows: excellent in 48 patients (36.4%), good in 74 patients (56.1), fair in 6 patients (4.5%), and poor in 4 patients (3%). The patients who stopped sports for at least 3 mos were 16.39 times more likely to have an excellent result than those who did not stop sports. Bony healing on radiographs did not correlate with clinical outcome. Conclusions Timely cessation of sports activity for 3 mos is considered an effective method of nonoperative treatment for young athletes with symptomatic lumbar spondylolysis.

Context: Functional ankle instability (FAI) is a debilitating condition that has been reported to occur after 20% to 50% of all ankle sprains. Landing from a jump is one common mechanism of ankle injury, yet few researchers have explored the role of visual cues and anticipatory muscle contractions, which may influence ankle stability, in lateral jumping maneuvers. Objective: To examine muscle-activation strategies between FAI and stable ankles under a lateral load and to evaluate the differences in muscle activation in participants with FAI and participants with stable ankles when they were unable to anticipate the onset of lateral loads during eyes-open versus eyes-closed conditions. Design: Case-control study. Setting: Controlled laboratory setting. Patients or Other Participants: A total of 40 people participated: 20 with FAI and 20 healthy, uninjured, sex- and age-matched persons (control group). Intervention(s): Participants performed a 2-legged lateral jump off a platform onto a force plate set to heights of 35 cm or 50 cm and then immediately jumped for maximal height. They performed jumps in 2 conditions (eyes open, eyes closed) and were unaware of the jump height when their eyes were closed. Main Outcome Measure(s): Amplitude normalized electromyographic (EMG) area (%), peak (%), and time to peak in the tibialis anterior (TA), peroneus longus (PL), and lateral gastrocnemius (LG) muscles were measured. Results: Regardless of the eyes-open or eyes-closed condition, participants with FAI had less preparatory TA (t158 = 2.22, P = .03) and PL (t158 = 2.09, P = .04) EMG area and TA (t158 = 2.45, P = .02) and PL (t158 = 2.17, P = .03) peak EMG than control-group participants. Conclusions: By removing visual cues, unanticipated lateral joint loads occurred simultaneously with decreased muscle activity, which may reduce dynamic restraint capabilities in persons with FAI. Regardless of visual impairment and jump height, participants with FAI exhibited PL and TA inhibition, which may limit talonavicular stability and intensify lateral joint surface compression and pain.

This study examined the construct validity of the Survey of Preservice Teachers’ Knowledge of Teaching and Technology through an exploratory factor analysis using responses from 365 preservice teachers enrolled in an educational technology course in the United States. The participants were completing methods courses and field experience concurrent to the educational technology course, allowing them to contextualize the content they learned during the semester. The survey, grounded in the framework of Technological Pedagogical Content Knowledge (TPACK), is designed to measure seven domains associated with technological, pedagogical, and content knowledge. Although the influence of the TPACK framework on teacher education programs continues to grow, research indicates the need for clearer distinctions between the domains. Results from this study revealed that participants did not always make conceptual distinctions between the TPACK domains. Specifically, factors were congruent across only technolog...

Background Dynamic postural stability is defined as the ability to transition from a dynamic movement to a stable condition over one's base of support. Measures of dynamic stability have been used extensively to classify ankle instability status and assist clinicians with ankle injury interventions. Therefore, the purpose of this study was to determine if current methods of quantifying dynamic stability are accurate in differentiating among healthy, coper, and unstable ankles. Methods One hundred ninety four Division-I collegiate athletes (football, volleyball, field hockey, men's/women's soccer, men's/women's lacrosse, men's/women's basketball) volunteered for this study. Participants were categorized into healthy, coper, and stable groups by a self-reported questionnaire and previous history of ankle injuries. Dynamic postural stability was assessed using the Multi-Directional Dynamic Stability Protocol by jumping and landing single-legged onto a force platform from four different directions. Receiver operator curves were used to analyze the accuracy of current techniques of calculating dynamic stability among groups. Findings None of the existing methods were found to be accurate in differentiating ankle instability status in any of the jump landings. Interpretation Researchers have commonly used these existing methods to quantify dynamic postural stability. None of the current calculation techniques worked with our jump landing protocol. Researchers need to pay attention to the protocol and calculation technique pairings in that using inaccurate measures of dynamic postural stability makes any findings of that research ineffective. Therefore, this challenges researchers to develop a more accurate calculation to quantify dynamic postural stability, or develop a jump landing protocol that exposes sensorimotor deficits in the more able-bodied population.

Soccer athletes at all levels of play are keenly aware of their equipment needs including cleat wear, and want to be protected from injury but without impeding on-field performance. Ankle injury is a common disorder that is prevalent in the sport of soccer and recent improvements in ankle prophylaxis interventions have proven effective. The aim of this study was to determine if the use of elastic taping or a neoprene sleeve alters performance, stability, and cleat comfort/support in soccer players compared to wearing a soccer cleat without any external support. Twenty male collegiate club soccer players were recruited and randomly assigned to the three conditions (untaped control, taped, neoprene sleeve). Performance testing and comfort/support assessment for each condition took place in one on-field test session, while stability testing was completed during a separate laboratory session. The only significant finding was improved inversion/eversion stability in both the tape and sleeve conditions as compared to the cleated condition. The addition of tape or a sleeve did not have an adverse effect on performance or comfort during functional and stability testing, and should therefore be considered as a method to decrease ankle injuries in soccer athletes as external supports provide increased stability in inversion/eversion range of motion.

Hamstrings strain injuries (HSIs) are among the most commonly occurring injuries in sport and are top causes of missed playing time. Lingering symptoms, prolonged recovery, and a high reinjury rate (12%–34%) make HSI management a frustrating and challenging process for the athletic trainer (AT). The clinical practice patterns and opinions of ATs regarding HSI treatment and rehabilitation are unknown.Context: To examine the frequency of method use and opinions about current HSI management among ATs.Objective: Cross-sectional study.Design: Survey administered to registrants at the 2013 National Athletic Trainers' Association Clinical Symposia and AT Expo.Setting: A total of 1356 certified ATs (691 men, 665 women; age = 35.4 ± 10.5 years, time certified = 11.92 ± 9.75 years).Patients or Other Participants: A survey was distributed electronically to 7272 registrants and on paper to another 700 attendees. Validity and reliability were established before distribution. Participants reported demographic information and rated their frequency of treatment and rehabilitation method use and agreement with questions assessing confidence, satisfaction, and desire for better clinical practice guidelines. Exploratory factor analysis and principal axis factor analysis were used. We also calculated descriptive statistics and χ2 tests to assess practice patterns.Data Collection and Analysis: The response rate was 17% (n = 1356). A 2-factor solution was accepted for factor analysis (r = 0.76, r = 0.70), indicating that ATs follow either a contemporary or traditional management style. Various practice patterns were evident across employment settings and years of clinical experience. Satisfaction with the current HSI management plan was high (73.6%), whereas confidence in returning an athlete to play was lower (62.0%). Rates of use were associated with belief in effectiveness for all methods assessed (P < .001). Higher confidence levels were associated with high use of several methods; we observed increased satisfaction ( = 22.5, P = .002) but not increased confidence levels in more experienced ATs.Results: Our study demonstrated the lack of consensus in HSI treatment and rehabilitation and the ATs' desire for better clinical practice guidelines. Future research in which multimodal strategies, including both traditional and contemporary methods, are studied is warranted for effective management of HSI.Conclusions

OBJECTIVES: To examine the effects of guided relaxation and imagery (GRI) on improvement in falls self-efficacy in older adults who report having a fear of falling. DESIGN: Randomized, controlled trial with allocation to GRI or guided relaxation with music of choice. SETTING: General community. PARTICIPANTS: Ninety-one men and women aged 60 to 92. INTERVENTION: Participants were randomized to listen to a GRI audio compact disk (intervention group) or a guided relaxation audio compact disk and music of choice (control group) twice a week for 6 weeks for 10 minutes per session. MEASUREMENTS: Primary outcome measure was the Short Falls Efficacy Scale-International (FES-I). Secondary outcome measures were the Leisure Time Exercise Questionnaire (LTEQ) and the Timed Up and Go (TUG) mobility test. RESULTS: GRI participants reported greater improvements on the Short FES-I (P = .002) and LTEQ (P = .001) scores and shorter time on the TUG (P = .002) than the guided relaxation and music-of-choice group. CONCLUSION: GRI was more effective at increasing falls self-efficacy and self-reported leisure time exercise and reducing times on a simple mobility test than was guided relaxation with music of choice. GRI is an effective, simple, low-cost tool for older adults to improve falls self-efficacy and leisure time exercise behaviors. Language: en

The purpose of this study was to examine the effects of a 6-wk intervention that used guided relaxation and exercise imagery (GREI) to increase self-reported leisure-time exercise behavior among older adults. A total of 93 community-dwelling healthy older adults (age 70.38 ± 8.15 yr, 66 female) were randomly placed in either a placebo control group or an intervention group. The intervention group received instructions to listen to an audio compact disk (CD) containing a GREI program, and the placebo control group received an audio CD that contained 2 relaxation tracks and instructions to listen to music of their choice for 6 wk. Results revealed that listening to a GREI CD for 6 wk significantly increased self-reported leisure-time exercise behaviors (p = .03). Further exploration of GREI and its effects on other psychological variables related to perceived exercise behaviors may substantiate its effectiveness.

Children's symbolic number sense was examined at the beginning of first grade with a short screen of competencies related to counting, number knowledge, and arithmetic operations. Conventional mathematics achievement was then assessed at the end of both first and third grades. Controlling for age and cognitive abilities (i.e., language, spatial, and memory), number sense made a unique and meaningful contribution to the variance in mathematics achievement at both first and third grades. Furthermore, the strength of the predictions did not weaken over time. Number sense was most strongly related to the ability to solve applied mathematics problems presented in various contexts. The number sense screen taps important intermediate skills that should be considered in the development of early mathematics assessments and interventions.

The purposes of this study were to investigate the reliability and construct validity of measures of reading component skills with a sample of adult basic education (ABE) learners, including both native and nonnative English speakers, and to describe the performance of those learners on the measures. Investigation of measures of reading components is needed because available measures were neither developed for nor normed on ABE populations or with nonnative speakers of English. The study included 486 students, 334 born or educated in the United States (native) and 152 not born or educated in the United States (nonnative) but who spoke English well enough to participate in English reading classes. All students had scores on 11 measures covering five constructs: decoding, word recognition, spelling, fluency, and comprehension. Confirmatory factor analysis (CFA) was used to test three models: a two-factor model with print and meaning factors; a three-factor model that separated out a fluency factor; and a five-factor model based on the hypothesized constructs. The five-factor model fit best. In addition, the CFA model fit both native and nonnative populations equally well without modification, showing that the tests measure the same constructs with the same accuracy for both groups. Group comparisons found no difference between the native and nonnative samples on word recognition, but the native sample scored higher on fluency and comprehension and lower on decoding than did the nonnative sample. Students with self-reported learning disabilities scored lower on all reading components. Differences by age and gender were also analyzed.

Using a longitudinal design, children were given a brief number sense screener (NSB) screener (N 204) over six time points, from the beginning of kindergarten to the middle of first grade. The NSB is based on research showing the importance of number competence (number, number relations, and number operations) for success in mathematics. Children's mathematics achievement on a validated high-stakes state test was measured 3 years later, at the end of third grade. Test-retest reliability estimates were obtained for the NSB. Two criterion groups were then formed on the basis of the third-grade achievement test (chil- dren who met and who did not meet mathematics standards). Diagnostic validity analyses for the NSB were completed using repeated measures analyses of variance and receiver operator curve analyses. Results from all analyses revealed that scores on the NSB in kindergarten and first grade predicted mathematics proficiency in third grade. Areas under the receiver operator curve indicated that the NSB has high diagnostic accuracy (areas under the receiver operator curve 0.78-0.88). Findings suggest that kindergarten and first-grade performance on the NSB is meaningful for predicting which children experience later mathematics difficulties.

Objective: The objective of this study was to determine the risk factors of hypercoagulability in children. We explored the interaction of multiple risk factors with the incidence of thrombosis. Our hypothesis was that as the number of risk factors for thrombosis increased the actual incidence of thrombosis would also increase. Design: Retrospective review from 2003 through 2006 based on a search using two electronic medical record databases. Setting: Pediatric Tertiary Care Children’s Hospital. Patients: Two hundred twenty-six patients were identified and analyzed. Measurements: Search terms included factor V Leiden polymerase chain reaction, prothrombin gene 20210A mutation, methylene tetrahydrofolate reductase mutation, antithrombin III, and protein C and S levels. Clinical data were compiled for regression analysis. Main Results: The presence of one risk factor was not significant. Two risk factors increased the risk of thrombosis (p = 0.005; OR 3.128). Three or more risk factors further increased the risk of thrombosis (p = 0.003; OR 4.861). Older age (>11 yrs) was protective against thrombosis (p = 0.007; OR 0.995), and the presence of a central venous catheter when analyzed against accumulating risk factors showed a higher risk than that found during the regression analysis (p = 0.001; OR 3.638). Conclusions: The population at our institution is reflective of the previously reported standards for the genetic predispositions toward thrombosis. Although older age is associated with a lower incidence of thrombosis, the presence of a central venous access device is detrimental. Accumulation of factors results in an increased risk of thrombosis. This article suggests that when inserting a central venous access device, consideration of a hypercoagulation workup should occur. Those with any two or more risk factors, genetic or acquired, and the comorbidity of a CVL may warrant consideration for the institution of anticoagulation with an agent like low molecular weight heparin.

Soccer participation, especially among females, is growing in popularity in the United States. Purposeful heading, an important soccer skill, has recently been scrutinized for safety reasons. The purpose of this study was to determine whether there was a relationship between purposeful heading and scores on cognitive function and balance in high-school and collegiate female soccer players. Prior to and following the soccer season, all players and members of the control group were given a battery of neuropsychological and balance tests. There were no significant correlations found between the total number of game headers and performance on either balance or neuropsychological testing. Differences were noted in adjusted balance scores postseason between the collegiate players and the other two groups. However, no differences were revealed in neurocognitive performance between the three groups.

We hypothesized the extent of involvement of the proximal femoral growth plate in Perthes disease determined the final radiographic outcome after containment by shelf acetabuloplasty. We retrospectively evaluated the extent of growth plate involvement using a modified version of the method described by Yasuda and Tamura. In our modification, we used only the epiphyseal border for measurements, which was clearly visible as a thin white line, unlike Yasuda and Tamura who used the metaphyseal and epiphyseal borders. We could not clearly demarcate the metaphyseal border in the radiographs of our patient population between 1944 and 1998, which consisted of 69 patients who had surgery at a mean age of 9 years (range, 6.0-14.1 years). From these measurements, we formulated an index termed "growth plate involvement." Radiographic results were classified as described by Stulberg et al A growth plate involvement index less than 0.25 resulted in a good radiographic outcome. We found 93.2% sensitivity and 100% specificity in predicting Stulberg's outcomes. The growth plate involvement index is a reliable and reproducible measurement method and may be used prospectively as a useful prognostic factor to predict radiographic outcomes after containment acetabuloplasty.

Fiorello et al. (this issue) asserted that as subtest or factor-score variability increases, the overall ability score becomes a less viable predictor of achievement—and that this is especially the case for clinical populations. The present study tested the contention that global IQ scores are invalid predictors of achievement in the presence of significant variability among constituent factors. It did so using three samples of participants: (a) 412 from the WISC-III/WIAT linking sample, (b) 460 enrolled in special education programs, and (c) 136 from the WISC-IV/WIAT-II linking sample. In each sample, participants with and without statistically significant factor score variability were matched on Full Scale IQ (FSIQ), age, gender, and race/ethnicity. The special education sample was also matched on disability category. For all samples, the FSIQ was a significant predictor of performance on reading and mathematics tests, but neither factor score variability nor the interaction of the FSIQ and factor score...

This study employed observed factor index scores as well as latent ability constructs from the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV; Wechsler, 2003) in estimating reading and mathematics achievement on the Wechsler Individual Achievement Test—Second Edition (WIAT-II; Wechsler, 2002). Participants were the nationally stratified linking sample ( N = 498) of the WISC-IV and WIAT-II. Observed scores from the WISC-IV were analyzed using hierarchical multiple regression analysis. Although the factor index scores provided a statistically significant increment over the Full Scale IQ, the size of the improvement was too small to be of clinical utility. Observed WISC-IV subtest scores were also subjected to structural equation modeling (SEM) analyses. Subtest scores from the WISC-IV were fit to a general factor ( g) and four ability constructs corresponding to factor indexes from the WISC-IV (Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed). For both reading and mathematics, only g (.55 and .77, respectively) and Verbal Comprehension (.37 and .17, respectively) were significant influences. Thus, when using observed scores to predict reading and mathematics achievement, it may only be necessary to consider the Full Scale IQ. In contrast, both g and Verbal Comprehension may be required for explanatory research.

Objective To investigate whether the combination of standard medical care (SMC) and short-term cognitive-behavioral family treatment (CBT) in the treatment of recurrent abdominal pain (RAP) was more effective than SMC alone. Methods Children recently diagnosed with RAP via physician examination were randomized into SMC (n = 29) and SMC plus CBT (n = 40) groups. Outcome measures included multiple dimensions of child and parent reported child pain, somatization, and functional disability, and school absences and physician contacts. Results Children and parents participating in the combined SMC + CBT intervention reported significantly less child and parent reported child abdominal pain than children in the SMC intervention immediately following the intervention and up to 1 year following study entry, as well as significantly fewer school absences. Significant differences in functional disability and somatization were not revealed. Conclusions These results, in combination with previous studies, add support to the effectiveness of CBT intervention in reducing the sensory aspects of RAP. Results are discussed with respect to the cost-benefit of integrated medical and short-term psychological services.

The authors hypothesized that children with allergy or pulmonary conditions and their parents would be aware of some, but not all of the ill effects of environmental tobacco smoke (ETS) and would have negative attitudes about smoking and smoke exposure. In the waiting or examining rooms of the Pulmonology and Allergy clinics at a tertiary care children's hospital, voluntary closed-question, written surveys were administered to a convenience sample of 100 children and 200 parents attending a routine visit. Surveys measured knowledge and attitudes about smoking and ETS using a five-point Likert scale. Demographic information and personal smoking status was also ascertained. Fifteen percent of parents were current smokers (n = 30). In all, 31% of children were exposed to ETS in the household. Overall, both parents and children had basic knowledge about ETS health risks, but some gaps were found. Both had negative attitudes about smoking in general and most supported a ban on smoking in public places. Parents...

This study investigated the differential validity of the Wide Range Intelligence Test, which is a new, brief measure of ability. Participants (N= 744) ranged in age from 5 through 85 years (M = 26.7 years, SD = 21.4 years) and varied by the demographic variables of gender, race/ethnicity (Anglo, African American, Hispanic), and education level (less than high school degree, high school degree, some postsecondary training, college and beyond). General, Verbal, and Visual IQs from the WRIT were used to predict Reading, Mathematics, and Spelling criteria on the Wide Range Achievement Test-Third Edition. Differences in prediction were evaluated among demographic subgroups via Potthoff s technique. Of the 90 simultaneous tests, 65 revealed no statistically significant between-group differences. The majority of statistically significant differences were found to have little practical influence when measures of effect size were considered. Results are discussed in the context of other ability measures that were previously investigated for differential validity, as well as educational implications for clinicians.

In this study, the authors used structural equation modeling to investigate relationships between ability constructs from the Wechsler Intelligence Scale for Children—Third Edition (WISC-III; Wechsler, 1991) in explaining reading and mathematics achievement constructs on the Wechsler Individual Achievement Test (WIAT; Wechsler, 1992). Participants comprised the nationally stratified Linking sample ( N = 1,116) of the WISC-III and WIAT. Relating the latent ability variables to the latent achievement variables showed that psychologists must go beyond g in order to meaningfully understand children's trait performance on the WISC-III. Results for reading indicated psychologists must pay attention to the constructs of g and Verbal Comprehension, and for mathematics, that they are obliged to consider g and Freedom From Distractibility. Results are discussed in terms of their theoretical, applied, and treatment-related implications.

To analyze the effect of lower-limb rotation on foot pressure distribution, 16 patients (23 feet) with neuromuscular diseases who received derotation osteotomy of lower limbs without concomitant foot-ankle procedures were included in this retrospective study. The cross-correlation analysis showed that the interval change of the foot progression angle was correlated with the interval change of the medial-lateral foot pressure impulse distribution. The externally rotated foot progression angle tends to introduce higher loading on the medial foot, and the internally rotated foot progression angle shifts the loading to lateral side of the foot. This study provides evidence that the rotational profile of the lower limb has a substantial impact on foot pressure distribution.

Examined discriminative validity of the Parent Rating Scale (PRS) of the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992, Circle Pines, MN: American Guidance Services). Two groups were compared: a cohort with recurrent abdominal pain (RAP) (n= 49) and children from the BASC-PRS standardization sample (n = 49) matched on the background characteristics of age, race/ethnicity, and gender. A multivariate, two-group discriminant function analysis was used to compare groups across standard scores from the nine clinical scales of the PRS. Results demonstrated that children with RAP could be differentiated (Wilks λ = .642, F = 6.45, df (9, 88), p < .001), and demonstrated higher scores on the Somatization, Depression, Anxiety, Attention Problems, and Withdrawal scales. Subsequent jackknifed classification analysis, diagnostic efficiency statistics, and an odds ratio for the classification analysis added to the overall validity of results. The practical utility of the BASC-PRS is further supported in light of expanding roles for school psychologists in the assessment and treatment of children with health problems. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 145–154, 2003.

One hundred ninety-seven patients with unilateral Legg-Calve-Perthes disease (LCPD) were followed-up to skeletal maturity. According to the lateral pillar classification, 142 hips were classified as group B and 55 hips as group C. Radiographs were evaluated for percent of collapse of the femoral head, Waldenstrom stage of disease at diagnosis, Mose sphericity, hinge abduction, lateral acetabular shape, and limb-length discrepancy. The hips were treated either by bedrest and traction in abduction (76), Petrie cast (21), abduction brace (74), or by pelvic or femoral osteotomy (26). One hundred twenty-five hips had less than a 2-mm difference in Mose sphericity at followup. According to the classification of Stulberg et al., 89 hips (45%) were class I, 57 (29%) were class II, 35 (18%) were class III, 12 (6%) were class IV, and 4 (2%) were class V. Analyses revealed statistically significant differences between group B versus group C with regard to the classifications of Stulberg et al. and Mose, lateral acetabular shape, age at onset, and limb-length discrepancy. There was no significant statistical difference with regard to the types of treatment. Containment treatment of a deformed femoral head from LCPD improves the sphericity of the hip and gives 63% satisfactory results according to the Mose classification and 74% satisfactory results according to the Stulberg et al. classification.

Past literature has largely ignored the population frequency of multivariate factor and subtest score discrepancies. Another limitation has been that statistical models imperfectly model the clinical assessment process, whereby significant discrepancies between both factors and subtests are included in predictions about an individual’s academic achievement. The present study examined these issues using a nationally representative sample (N = 1,185) completing the Differential Ability Scales. Results indicate that approximately 80% of children in a nonreferred sample show at least one statistically significant ability discrepancy. In addition, the global estimate of cognitive ability was the most parsimonious predictor of academic achievement, whereas information about ability discrepancies did not significantly improve prediction. Findings suggest that when predicting academic achievement, there is little value in interpreting cognitive scores beyond the global ability estimate.

This study obtained construct (factorial) validity, internal consistency reliability, and 1-year criterion coefficients for scores from the College Attention-Deficit/Hyperactivity Disorder (ADHD) R...

Objective To compare linear and rotational acceleration across age and gender in controlled purposeful soccer heading. Design Prospective study. Setting Biomechanics laboratory. Participants One-hundred soccer players (42 male, 58 female, 17.1±3.5 years, 168.5±20.3 cm, 61.5±13.7 kg) classified as collegiate, high school (HS), or youth (12–14 years) male (MS) or female (FS) soccer players. Exclusionary criteria history of neurologic disorder, cervical spine injury, or head injury in the past 6 months. Interventions We implemented a unique soccer heading paradigm that allows for precise control of head impact magnitude, direction, and frequency to model repetitive head impacts in sport. This model consists of controlled soccer heading (12 headers at 11.2 m/s from a JUGS machine) while measuring linear and rotational accelerations using a triaxial accelerometer and gyroscope affixed to the back of the head. Linear accelerations were transformed to the head center-of-gravity using 3D motion capture data and standard rigid body dynamics equations. Outcome measures Linear and rotational accelerations at the head center-of-gravity. Main results [Average±Standard Deviation (95% Confidence Interval)] Collegiate [42.4±11.5 g (36.8–47.9); 3.35±0.87 krad/s 2 (2.9–3.8)], HS [38.5±13.1 g (32.2–44.8); 3.16±1.01 krad/s 2 (2.7–3.7)], and youth [40.5±14.9 g(33.1–47.9); 3.20±1.24 krad/s 2 (2.6–3.8)] FS produced higher linear and rotational accelerations than both the collegiate [26.1±9.5 g(21.7–30.6); 2.13±1.07 krad/s 2 (1.6–2.6)] (linear: p 2 (2.0–2.4)] (linear: p=0.002, p=0.045, p?= 0.012; rotational: p=0.011, p=0.052, p=0.040, respectively) MS. Conclusions Collegiate and HS FS have higher head accelerations than their male counterparts, but at the youth level, there are no differences across gender. These data suggest that FS may be exposed to greater cumulative head accelerations from repeated heading of a soccer ball over a career than MS. Competing interests None.