Uninjured Peers Research Articles

Driving characteristics of young adults prior to and following concussion

Objectives This study sought to examine whether young adults who sustain concussions have different driving histories and pre-injury driving styles than uninjured peers. In addition, we assessed whether modifications were made to driving behavior in the acute period following concussion. Methods Self-reported driving and demographic information was collected from 102 16- to 25-year-old drivers. Half of the sample had recently sustained concussions and the other half comprised a matched comparison group. Results The groups reported similar pre-injury driving behaviors and styles. However, the recently injured group had more driving citations, higher rates of psychiatric disorders, and greater likelihood of having sustained a prior concussion. Self-reported driving habits postconcussion suggested that most drivers did not modify their driving behavior following concussion, though they were less likely to drive at night or with others in the car. Conclusion Results highlight the need for postconcussion driving guidelines and support for returning to driving safely.

Youth With a Sport-Related Knee Injury Exhibit Significant and Persistent Knee-Related Quality-of-Life Deficits at 12-Month Follow-up Compared to Uninjured Peers.

OBJECTIVE: We aimed to compare knee-related quality of life (QOL) between youth with and without an intra-articular, sport-related knee injury at baseline (≤4 months postinjury), 6-month, and 12-month follow-up, and assess the association between clinical outcomes and knee-related QOL. DESIGN: Prospective cohort study. METHODS: We recruited 86 injured and 64 uninjured youth (similar age, sex, sport). Knee-related QOL was assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) QOL subscale. Linear mixed models (95% confidence interval [CI]; clustered on sex and sport) compared KOOS QOL between study groups over the study period, considering sex-based differences. We also explored the association of injury type (anterior cruciate ligament [ACL]/meniscus injury or other), knee extensor strength (dynamometry), moderate-to-vigorous physical activity (accelerometer), intermittent knee pain (Intermittent and Constant Osteoarthritis Pain [ICOAP] measure), and fear of reinjury (17-item Tampa Scale of Kinesiophobia) with knee-related QOL. RESULTS: Participant median (range) age was 16.4 (10.9-20.1) years, 67% were female, and 56% of injuries were ACL ruptures. Injured participants had lower mean KOOS QOL scores at baseline (-61.05; 95% CI: -67.56, -54.53), 6-month (-41.37; 95% CI: -47.94, -34.80), and 12-month (-33.34; 95% CI: -39.86, -26.82) follow-up, regardless of sex. Knee extensor strength (6- and 12-month follow-up), moderate-to-vigorous physical activity (12-month follow-up), and ICOAP (all time points) were associated with KOOS QOL in injured youth. Additionally, having an ACL/meniscus injury and higher Tampa Scale of Kinesiophobia scores were associated with worse KOOS QOL in injured youth. CONCLUSION: Youth with a sport-related knee injury have significant, persistent knee-related QOL deficits at 12-month follow-up. Knee extensor strength, physical activity, pain, and fear of reinjury may contribute to knee-related QOL. JOSPT 2023;53(8):1-10. Epub: 20 June 2023. doi:10.2519/jospt.2023.11611.

Change in Body Weight and Body Mass Index of Adolescents and Adults From Pre-Surgery to Post-Anterior Cruciate Ligament Reconstruction

Background:Physical activity (PA) participation can moderate weight status and body mass index (BMI), with reduced PA being associated with weight gain and elevated BMI. Previous studies have observed lower PA engagement among individuals with a history of anterior cruciate ligament reconstruction (ACLR) when compared to their uninjured peers. This reduction in PA may be due to activity limitations during rehabilitation and failure of some patients to return to sport. Limited evidence has also shown an increase in body weight and BMI following surgery that may remain elevated in adolescent patients up to 2 years post-ACLR. Overall, body weight and BMI changes from pre-surgery to post-ACLR for adolescents and adults are not well-understood.Purpose:The purpose of this study was to assess change in body weight and BMI from pre-surgery to 6 months post-ACLR in adolescent and adult patients.Methods:A retrospective chart review was conducted including adult (age ≥20) and adolescent (ages 13-19) patients who underwent primary, unilateral ACLR and were previously enrolled in a prospective cohort study. BMI was calculated [weight (kg)/ height (m2)] for all adult participants and BMI percentile was calculated for all participants under the age of 20 to account for changes in growth and maturation during adolescence. Pre-surgery to 6-months post-ACLR values for body mass, absolute BMI, and BMI percentile were compared using paired sample t-tests. Statistical significance was established a priori as α≤0.05.Results:One hundred and 16 adolescents with ACLR (67 female; age= 16.7 ± 1.6yrs, months since surgery= 6.2 ± 0.7) and 63 adults (29 female; age= 27.2 ± 7.4yrs, months since surgery= 6.4 ± 0.7) participated. Adolescent participants experienced a significant increase in body mass (pre-ACLR= 70.1 ± 15.1kg, post-ACLR= 72.4 ± 16.9kg; p<0.001) and BMI percentile (pre-ACLR= 65 ± 25, post-ACLR= 67 ± 25; p=0.02) from pre-surgery to 6 months post-ACLR. Adult patients also experienced a significant increase in body mass (pre-ACLR= 80.2 ± 19.9kg, post-ACLR= 82.1 ± 20.1kg; p<0.001) and BMI (pre-ACLR= 26.1 ± 4.5kg/m2, post-ACLR= 26.7 ± 4.9kg/m2; p=0.006).Conclusion:Adults and adolescents experienced an increase in body weight and BMI in the 6 months following ACLR. Revising rehabilitation to extend beyond traditional musculoskeletal strengthening to include focus on incorporation and maintenance of healthy lifestyle behaviors related to diet and PA should be considered to help patients with ACLR to minimize the potential for negative long-term effects of weight gain following surgery.

WHICH PARTICIPANT CHARACTERISTICS CONTRIBUTE TO KNEE-RELATED AND HEALTH-RELATED QUALITY OF LIFE 3-11 YEARS AFTER ACL INJURY? A COLLABORATIVE ANALYSIS OF COHORT STUDIES IN AUSTRALIA AND CANADA

Purpose: The incidence of anterior cruciate ligament reconstruction (ACLR) to replace a ruptured ACL is increasing globally. Many individuals after ACLR have prolonged knee symptoms, reduced function, weight gain, and early-onset post-traumatic osteoarthritis (OA). Individuals after ACLR report poorer quality of life (QOL) than their uninjured peers (short- and long-term), Knee-related QOL appears to be more impaired than health-related QOL after ACL tear. However, few studies have evaluated health-related QOL, particularly beyond the acute recovery period when health-related QOL may deteriorate.

39 Implementation of a Screening Tool for Wellbeing in the Burn Clinic for Patients &amp;lt; 5 Years

IntroductionPediatric burn survivors and their parents experience higher rates of psychological disorders compared to their uninjured peers. In the early years, children experience rapidly changing development, which can impact responses to psychological outcomes. Early identification of developmental delays is vital to recovery and coping with burn injury. As a quality improvement project, a survey tool was implemented in the burn clinic to screen for issues impacting pediatric burn survivors and their family’s coping, who may benefit from additional referrals.MethodsA free comprehensive tool, which screens for behavior, development and family stressors was chosen based on its high reliability, validity, and usability including being available in multiple languages. Prior to implementation and following the trial phase, staff completed qualitative and quantitative surveys regarding their input on the importance of screening and ease of execution. The Child Life Specialist (CLS) screened and scored children ages 12 to 65 months upon their initial visit and were rescreened two to four months later if they scored “Needs Review” in any category, indicating additional assessment was needed. Those who scored 50% of expected score for their age on initial assessment or a repeat “Needs Review” on the second assessment, were referred to additional resources by the CLS, social worker or physician team.ResultsOf the 43 children whose parents completed the survey (3 in Spanish), there were 25 males and 18 females. The median age was 2.6 years (IQR:2.0-3.52). The score of the survey determined that 42% (n=18) of children evaluated as “Needs Review” or ≤50% expected in one or more category on initial assessment. Only 5 children were already receiving services and two children scored ≤50% threshold score for immediate referral. Initial surveys demonstrated staff (n=9) strongly agreed assessing children’s need for support services was important. Majority (88%) of children were assessed upon their initial visit to the outpatient burn clinic. Most staff agreed the tool had been effectively implemented in the outpatient clinic.ConclusionsThe tool was effectively integrated into the burn clinic and identified children who needed referral for support services. Screening in the burn clinic provides an opportunity to identify critical factors related to children’s development and behavior, which can compound psychological responses to burn injury and addresses parental concerns for development.

Health and cognition among adults with and without Traumatic Brain Injury: A matched case–control study

ABSTRACT Objectives To evaluate associations between traumatic brain injury (TBI) and presence of health conditions, and to compare associations of health and cognition between TBI cases and controls. Methods This matched case–control study used data from the TBI Model Systems National Database (TBI cases) and Midlife in the United States II and Refresher studies (controls). 248 TBI cases were age-, sex-, race-, and education-matched without replacement to three controls. Cases and controls were compared on prevalence of 18 self-reported conditions, self-rated health, composite scores from the Brief Test of Adult Cognition by Telephone. Results The following conditions were significantly more prevalent among TBI cases versus controls: anxiety/depression (OR = 3.12, 95% CI: 2.20, 4.43, p < .001), chronic sleeping problems (OR = 2.76, 95% CI: 1.86, 4.10, p < .001), headache/migraine (OR = 2.61, 95% CI: 1.50, 4.54, p = .0007), and stroke (OR = 6.42, 95% CI: 2.93, 14.10, p < .001). The relationship between self-rated health and cognition significantly varied by TBI (p interaction = 0.002). Conclusion Individuals with TBI have greater odds of selected neurobehavioral conditions compared to their demographically similar uninjured peers. Among persons with TBI there was a stronger association between poorer self-rated health and cognition than controls. TBI is increasingly conceptualized as a chronic disease; current findings suggest post-TBI health management requires cognitive supports.

Vertical Drop Jump Biomechanics of Patients With a 3- to 10-Year History of Youth Sport-Related Anterior Cruciate Ligament Reconstruction.

Background:A better understanding of movement biomechanics after anterior cruciate ligament reconstruction (ACLR) could inform injury prevention, knee injury rehabilitation, and osteoarthritis prevention strategies.Purpose:To investigate differences in vertical drop jump (VDJ) biomechanics between patients with a 3- to 10-year history of youth sport–related ACLR and uninjured peers of a similar age, sex, and sport.Study Design:Cross-sectional study. Level of evidence III.Methods:Lower limb kinematics and bilateral ground-reaction forces (GRFs) were recorded for participants performing 10 VDJs. Joint angles and GRF data were analyzed, and statistical analysis was performed using 2 multivariate models. Dependent variables included sagittal (ankle, knee, and hip) and coronal (knee and hip) angles at initial contact and maximum knee flexion, the rate of change of coronal knee angles (35%-90% of the support phase; ie, slopes of linear regression lines), and vertical and mediolateral GRFs (normalized to body weight [BW]). Fixed effects included group, sex, and time since injury. Participant clusters, defined by sex and sport, were considered as random effects.Results:Participants included 48 patients with a history of ACLR and 48 uninjured age-, sex-, and sport-matched controls (median age, 22 years [range, 18-26 years]; 67% female). Patients with ACLR demonstrated steeper negative coronal knee angle slopes (β = –0.04 deg/% [95% CI, –0.07 to –0.00 deg/%]; P = .025). A longer time since injury was associated with reduced knee flexion (β = –0.2° [95% CI, –0.3° to –0.0°]; P = .014) and hip flexion (β = –0.1° [95% CI, –0.2° to –0.0°]; P = .018). Regardless of ACLR history, women displayed greater knee valgus at initial contact (β = 2.1° [95% CI, 0.4° to 3.8°]; P = .017), greater coronal knee angle slopes (β = 0.05 deg/% [95% CI, 0.02 to 0.09 deg/%]; P = .004), and larger vertical GRFs (landing: β = –0.34 BW [95% CI, –0.61 to –0.07 BW]; P = .014) (pushoff: β = –0.20 BW [95% CI, –0.32 to –0.08 BW]; P = .001).Conclusion:Women and patients with a 3- to 10-year history of ACLR demonstrated VDJ biomechanics that may be associated with knee motion control challenges.Clinical Relevance:It is important to consider knee motion control during activities such as VDJs when developing injury prevention and rehabilitation interventions aimed at improving joint health after youth sport–related ACLR.

Should we rely on the limb symmetry index to evaluate functional performance after anterior cruciate ligament injury and reconstruction?

Introduction: A limb symmetry index (LSI) >90% on hop tests is a widely advocated benchmark for functional recovery and return-to-sport clearance after ACL injury. Yet, the LSI assumes the contralateral limb is the “gold standard” and immune to decline. Due to the bilateral functional deficits evident after ACL injury and ACLR, other assessment methods such as comparing performance of both limbs to age, sex and activity-level matched uninjured peers may be required. Our primary aim was to describe the functional performance changes in the ACL-injured and contralateral limbs 1- to 5-years post-ACL reconstruction (ACLR) to determine the influence on LSI. Our secondary aim was to compare the ACLR group results to uninjured healthy controls. Methods: 59 participants (38 men) aged 29±16 years completed three hop-tests and a one-leg rise 1- and 5-years post-ACLR. Mean(±SD) scores for the ACLR and contralateral limbs, and LSI at 1- and 5-years were reported. Linear mixed-effects models evaluated the difference in change between the ACLR and contralateral limbs. Participants were classified with stable, improving or worsening function relative to previously published minimal detectable change thresholds. Healthy controls completed the hop-tests (n=41) and one-leg rise (n=31) at a single time-point to provide reference data. Linear regression models (adjusted for age and body mass index), assessed the differences in functional performance at 1- and 5-years between the ACLR group and the healthy control group. Results: The contralateral limb had a significantly (p<0.05) greater decrease in functional performance between 1- and 5-years for the three hop-tests, compared to the ACLR limb. Worsening was more common in the contralateral limb than the ACLR limb; resulting in significant improvements in the LSI for the single-hop (mean 87% at 1-year to 95% at 5-years), side hop (77% to 86%) and one-leg rise (76% to 85%). The LSI on all four tests at 1-year post-ACLR was significantly lower than healthy controls, but did not generally differ between groups at 5-years. Discussion: Although the LSI significantly improved between 1- and 5-years post-ACLR, this was mostly due to worsening function in the contralateral limb. The LSI should not be used in isolation to evaluate functional performance changes after ACLR, as it may overestimate functional improvement. Exercise-based interventions may need to continue beyond the typical rehabilitation period of 6-12 months to improve or maintain function in both limbs, considering the deficits at 1-year post-ACLR compared to healthy controls, and minimal improvement over the proceeding 4-years. Conflict of Interest: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract

Reduced 2-D Frontal Plane Motion During Single-Limb Landing Is Associated With Risk of Future Anterior Cruciate Ligament Graft Rupture After Anterior Cruciate Ligament Reconstruction and Return to Sport: A Pilot Study.

To evaluate the association between 2-D frontal plane movement and second anterior cruciate ligament (ACL) injury risk in young athletes at return to sport (RTS) after ACL reconstruction. Prospective cohort. Forty-nine participants who had ACL reconstruction (mean ± SD age, 16.5 ± 3.0 years) performed a single-leg drop landing from a 31-cm box at the time of their RTS. Frontal plane trunk, pelvis, and knee angles were measured using 2-D video analysis at the point of maximum depth during landing. Summated frontal plane angles were calculated by adding trunk, pelvis, and knee angles. Participants were grouped based on whether or not they sustained an ACL graft rupture over the 24 months after RTS. Seven participants (14%) sustained an ipsilateral graft rupture within 24 months after RTS. Participants who suffered a second ACL injury had a significant reduction in the summated frontal plane angle of the trunk, pelvis, and knee (P = .018) and of the trunk and knee (P = .02) compared to those who did not suffer a second injury. For every 5° increase in the summated trunk, pelvis, and knee angle (odds ratio [OR] = 0.54; 95% confidence interval [CI]: 0.31, 0.94) and the summated trunk and knee angle (OR = 0.48; 95% CI: 0.25, 0.94), the athletes were 46% to 52% less likely to sustain a graft rupture. Athletes who suffered an ACL graft rupture within 24 months of RTS had a more rigid posture when landing compared to their uninjured peers. The results of this pilot study should be replicated in a larger sample to determine whether this method has merit as a screening tool to identify athletes at high risk for second ACL injury. J Orthop Sports Phys Ther 2021;51(2):82-87. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9302.

Can Talented Youth Soccer Players Who Have Undergone Anterior Cruciate Ligament Reconstruction Reach the Elite Level?

Background: Anterior cruciate ligament (ACL) ruptures are common in soccer players, and reconstructive surgery is often performed to restore knee stability and enable a return to play. Purpose: To investigate whether an ACL reconstruction for talented youth soccer players affects their potential to become elite players at the senior level. Study Design: Cohort study; Level of evidence, 3. Methods: All soccer players who participated in the Swedish National Elite Camp for 15-year-old players between 2005 and 2011 (N = 5285 players; 2631 boys and 2654 girls) were matched with the Swedish National Knee Ligament Registry to identify the players who had undergone ACL reconstruction. Information on player participation in Swedish league games and level of play was collected from the Swedish Football Association’s administrative data system. The players with an ACL reconstruction who were injured at the ages of 15 to 19 years were compared with the rest of the players who participated in the National Elite Camp to see whether an early ACL reconstruction affected whether they remained active as soccer players and their chance to play at the elite level as seniors. Results: A total of 524 (9.9%) players had undergone an ACL reconstruction, and 292 (5.5%; 75 male and 217 female) had sustained their injury at age 15 to 19 years. During the follow-up period, 122 (23.3%) players underwent ACL reconstruction: revision (11.5%; n = 60) or contralateral (11.8%; n = 62). Male and female soccer players undergoing an ACL reconstruction at age 15 to 19 years experienced no significant effect on being active or playing at the elite level in the season that they turned 21 years old. Of the youth players who underwent ACL reconstruction, 12% of the male players and 11.5% of the female players progressed to the elite level at the age of 21 years compared with 10.3% of the men and 11.1% of the women among the uninjured players. Conclusion: ACL reconstructive surgery in talented youth soccer players offers them the opportunity to become elite players as seniors and permits an activity level on a par with that of their uninjured peers. However, almost 1 in 4 requires further ACL surgery, so the players’ future knee health should be considered when deciding on a return to play.

Effect of Age at Menarche on Anterior Cruciate Ligament Injury Incidence and Anterior Knee Laxity in Collegiate Athletes

Female athletes suffer painful, costly, and career-limiting non-contact anterior cruciate ligament (ACL) injuries more often than males. Previous research suggests that pubertal neuromusculoskeletal development contributes to this sex-bias, but the manner in which variation in pubertal development affects injury risk within females is poorly understood. Age at menarche is a variable, significant pubertal developmental event, signaling the onset of estrogen cycling and affecting musculoskeletal development. Earlier menarche may increase injury risk, possibly by increasing anterior knee laxity through prolonged estrogen exposure. The purpose of this case-control study was to test the primary hypothesis that collegiate athletes with previous ACL injuries have earlier age at menarche than their uninjured peers, and to test the secondary hypothesis that earlier menarche is related to greater anterior knee laxity in injured and uninjured athletes. The study sample consisted of female NCAA Division-I varsity athletes (N=14 injured, N=120 uninjured). Outcome measures included: menstrual history and ACL injury details (injury age, activity at time of injury, contact vs. non-contact), assessed by questionnaire; and anterior knee laxity assessed by KT-1000 arthrometer. Correlation, t-tests, and regression analysis were used to test for associations between age at menarche, injury incidence, and knee laxity. Fourteen athletes reported ≥1 non-contact ACL injury, and had significantly earlier menarche than uninjured athletes (12.6±1.3 y vs. 13.4±1.4 y; P=0.05). Earlier menarche also significantly predicted injury status (Wald c2=7.43; Pb=-1.02±0.37; OR=0.36; 95% CI:0.17-0.75), but was not correlated with anterior knee laxity. Within injured athletes, however, laxity in the unaffected knee was significantly related to time since menarche (r2=0.79, Pr2=0.72, P

Shoulder impairment and pain of individuals with newly acquired spinal cord injury compared to uninjured peers.

Cohort study. Shoulder pain prevalence is high in those with spinal cord injury (SCI) and is associated with decreased function, participation restrictions and decreased quality of life. Limited evidence exists regarding physical impairments of newly acquired SCI. The current study compared musculoskeletal factors at rehabilitation initiation in individuals with newly acquired SCI to uninjured individuals. We hypothesized no impairment differences of shoulder pain, strength, mobility, muscle extensibility, or rotator cuff integrity would exist between groups. Multi-site laboratory setting. Thirty-five individuals with newly acquired SCI and age and gender-matched controls without SCI (n = 34) participated. Musculoskeletal Pain Survey, shoulder range of motion (ROM), strength, pectoralis minor muscle extensibility (PM) and tissue integrity [Ultrasound Pathology Rating Scale (USPRS)] were obtained. Higher pain was reported by individuals experiencing new SCI along with lower strength across all bilateral measures, reduced elevation, external rotation, and horizontal adduction ROM, with large effect sizes. PM bilateral extensibility was reduced compared to controls, with moderate between group effect size; however, no USPRS score difference existed. This study provided the first comprehensive clinical description for individuals with newly acquired SCI. In comparison to matched uninjured controls, participants with new SCI reported greater shoulder pain with impairments in mobility, strength, and extensibility. The identified early clinical impairments aligned with progressive impairment including further pain development and persistence. Awareness and modification of these early clinical impairments may lead to improved long-term outcomes, improving the overall health and well-being of individuals with newly acquired SCI. Spinal Cord Injury Research Program Investigator-Initiated Research Award under Award No. W81XWH-17-1-0476.

Youth With Concussion Have Less Adaptable Gait Patterns Than Their Uninjured Peers: Implications for Concussion Management.

To compare cross-recurrence quantification analysis measurements obtained during gait between adolescents who sustained a diagnosed concussion within 14 days of assessment and healthy adolescents. Cross-sectional study. Youth athletes with concussion (n = 43; mean ± SD age, 14.4 ± 2.3 years; 56% female; tested median, 7 days post concussion) and healthy controls (n = 38; age, 14.9 ± 2.0 years; 55% female) completed a single-task and dual-task gait protocol while wearing a set of inertial sensors. We used cross-recurrence quantification analysis techniques to quantify the similarity between accelerations obtained from the sensor on the dorsum of each foot. Four outcome variables were compared between groups: percent determinism, average diagonal-line length, laminarity, and trapping time. Athletes with concussion had significantly higher percent determinism, laminarity, and trapping time than the control group in single-task and dual-task conditions (P<.05). Gait patterns, when simultaneously completing a secondary cognitive task (dual task), were no different from gait patterns under a single-task condition. Higher percent determinism, laminarity, and trapping time among athletes with concussion suggest that concussion may be associated with a more stuck and predictable gait pattern. These altered movement patterns may be one reason for underlying slower gait speeds that have been observed following concussion. J Orthop Sports Phys Ther 2020;50(8):438-446. Epub 22 May 2020. doi:10.2519/jospt.2020.9133.

How health outcomes differ between youth who suffer a traumatic, sport-related knee injury and matched controls - implications for rehabilitation and understanding post-traumatic osteoarthritis risk

How health outcomes differ between youth who suffer a traumatic, sport-related knee injury and matched controls - implications for rehabilitation and understanding post-traumatic osteoarthritis risk

Racing performance after surgical repair of medial condylar fracture of the third metacarpal/metatarsal bone in thoroughbred racehorses.

To report the performance of thoroughbred racehorses after surgical repair of a medial condylar fracture of the third metacarpal/metatarsal bone. Retrospective cohort study. Forty-three horses surgically treated for medial condylar fractures, 30 with previous racing experience, 13 without previous racing experience (nonexperienced). Medical records (2009-2017) were reviewed for signalment, radiographic fracture characteristics, repair technique, and postoperative morbidity and mortality. Each experienced horse was matched with two horses randomly selected from its most recent race to serve as healthy controls. Racing performance parameters (race rating, competitive level, speed rating, performance index) and career racing statistics were compared with multiple regression models between injured experienced horses and controls. The career racing statistics for nonexperienced horses were evaluated. Reasons for nonreturn to racing were obtained. The median duration of follow-up was 6 years (minimum 2, maximum 10). Twenty-one of 43 (49%) horses raced again as well as 18 of 30 (60%) experienced horses and three of 13 (23%) nonexperienced horses. Experienced horses were five times more likely than nonexperienced horses to return to racing (95% confidence interval = 0.07-0.58, P = .003). Higher preoperative racing performance parameters were associated with return to racing. Racing performance parameters were lower after the date of fracture in injured horses compared with controls. Experienced horses were more likely to return to racing after medial condylar fracture repair, although their performance was generally lower than that of comparably uninjured horses. Owners should be aware that horses with medial condylar fractures likely will race at a lower level than their uninjured peers.

Comprehension of social-legal exchanges in adults with and without traumatic brain injury.

To characterize comprehension of conditional social-legal rules and broader social reasoning in adults with and without traumatic brain injury (TBI). Participants were 20 adults with moderate-to-severe TBI (11 women) and 21 adults without TBI (13 women), ages 24 to 64 years. Participants completed the Wason task, a test of logical reasoning of conditional rules comprising precautionary rules, social-exchange rules, and legal social-exchange rules. Dependent variables were response accuracy and response time. Across rule categories, TBI group participants were significantly less accurate, F(1, 39) = 9.03, p < .01, semipartial R2 = 0.18, and slower, F(1, 39) = 7.32, p < .01, semipartial R2 = 0.16, than comparison peers. Rule category had no effect on accuracy, but for both groups legal social-exchange rules were associated with longer response times, F(1, 78) = 9.82, p < .01, semipartial R2 = 0.11. Processing speed test scores correlated with accuracy, F(1, 37) = 4.62, p < .05, semipartial R2 = 0.11, and response times, F(1, 78) = 4.45, p < .05, semipartial R2 = 0.14, in both groups. Adults with TBI underperformed their uninjured peers in both accuracy and speed of comprehending on precautionary rules, social-exchange rules, and legal social-exchange rules. These differences were attributable in part to differences in processing speed both within and between groups. Results highlight the potential costs of TBI-related cognitive problems in social-legal contexts, suggest the need to better accommodate individuals with TBI who are already involved in legal systems, and identify cognitive mechanisms for future study of social-legal rule comprehension in TBI and other populations with cognitive impairments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Characterizing computer-mediated communication, friendship, and social participation in adults with traumatic brain injury

ABSTRACTBackground: Adults with traumatic brain injury (TBI) report loss of friendship and reduced social participation after injury, but there is limited information regarding quantity of friends and methods of communication. Our objective was to characterize friendship networks, social participation, and methods of communication, including computer-mediated communication (CMC), used by adults with TBI compared to uninjured adults. Methods: Participants were 25 adults with TBI and 26 uninjured healthy comparisons (HC) adults, who completed the Participation Assessment with Recombined Tools-Objective (PART-O) and the Social Network Questionnaire (SNQ). Results: Adults with TBI had significantly fewer total friends and significantly lower levels of productivity and overall social participation. Face-to-face interaction was the preferred method of contact for both groups. Adults with TBI were significantly less likely to use texting as a primary method of communication than their uninjured peers, but used other methods of communication at similar rates. Conclusion: Our study supports prior findings of reduced friendships and reduced social participation after TBI and adds new information about similarities and differences in communication methods between adults with and without TBI.

Comprehension of Legal Language by Adults With and Without Traumatic Brain Injury.

To characterize comprehension of written legal language in adults with and without traumatic brain injury (TBI). Nineteen adults with moderate-to-severe TBI (11 females) and 21 adults without TBI (13 females), aged 24 to 64 years. Participants completed a multiple-choice assessment of legal-language comprehension, with written stimuli either presented in their original legal form or manipulated to simplify syntax or use more frequently occurring words. Across stimulus types, TBI group participants were significantly less accurate and slower than comparison peers, with no effect of linguistic manipulation. Working memory and reading fluency test scores correlated with task accuracy and speed in both groups. Adults with TBI underperformed their uninjured peers in both accuracy and speed on a task of legal-language comprehension, and these differences were attributable in part to differences in working memory and reading fluency. Results highlight the potential costs of TBI-related communication problems in criminal proceedings and the need to formally evaluate language comprehension in individuals with TBI who are in the criminal justice system.

Facial emotion recognition of older adults with traumatic brain injury

ABSTRACTObjectives: The objective of this study was to examine the effects of traumatic brain injury (TBI) and age on facial emotion recognition abilities in adults. Age and TBI were expected to have negative effects on emotion recognition and a TBI by age interaction was hypothesized such that older adults with TBI would have the lowest emotion recognition scores. Methods: A prospective cohort study was conducted. Participants were 26 adults with moderate-severe TBI (13 older and 13 younger) and 26 uninjured peers matched for age, sex, and education. Emotion recognition was measured using the Emotion Recognition Task, which is comprised of dynamically morphed facial expressions of the six basic emotions, presented at different intensity levels. Results : TBI and older age were associated with poorer recognition of both subtle and intense expressions, but only for expressions of anger and sadness. There was no interaction of age and TBI. Conclusions: Results add to the growing evidence of emotion recognition impairments after TBI, particularly for select negative emotions, and extend this finding to adults over the age of 60. Further research is needed to better understand social cognitive effects of TBI across the adult lifespan.

Use of Multiple Assessments Improves Discrimination Between Adolescents with Concussion From Uninjured Peers

Use of Multiple Assessments Improves Discrimination Between Adolescents with Concussion From Uninjured Peers