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Citation

Powell D, Stuart S, Fearn D, Bowen S, Steel H, Jones T & Godfrey A (2020) Wearables as objective tools in sport-related concussion: a protocol for more informed player management. Physiotherapy, 107 (Supplement 1), pp. e142-e143. https://doi.org/10.1016/j.physio.2020.03.207

Abstract
Purpose: Concussion is common in rugby and can lead to motor, cognitive and sensory dysfunction. Returning to participation before complete recovery increases risk of secondary injury. Yet, pitch-side medical staff make return-to-play decisions based on brief post-injury subjective observations, which may miss subtle deficits that objective assessments can capture. Similarly, concussion symptoms can last ≥14days but there are no current objective tools to continuously monitor players during that time. The primary purpose of this project is to use wearable technology to monitor free-living/habitual gait as a possible clinical marker of concussion. Specifically, the project will continuously monitor university-level rugby players for repeated 1-week intervals. Acute phase free-living assessment may inform improved player management by detecting abnormal motor function outside of the acute timeframe. Methods: University-level rugby players (n = 100, 50 M:50F) will be recruited and assessed over three seasons (October to April, 2019-2022). All players will undergo pre-season testing including detailed medical history as well as a battery of clinical, cognitive, physiological (e.g. neck strength), motor (e.g. balance) and sensory tests. Subsequently during each season, players suspected of concussion (training or matches) will be clinically examined by a physiotherapist trained in assessing head injuries and referred to the study. Examinations conducted at baseline will be repeated immediately post-concussion (pitch-side and 24-hours), within acute phase (7-14 days) and post-season for longitudinal assessment. All gait and balance assessment will use a single wearable, providing data to investigate possible use as a pitch-side and free-living assessment tool, with other features captured for covariate analysis. Pitch-side gait and balance will be assessed with a discrete wearable with validated algorithms during the following: (i) modified balance error scoring test; (ii) intermittent and tandem walks over 10m; (ii) 2-minute continuous walking under single and dual task (forward digit span); and (iii) dynamic gait index. Players will also wear the wearable continuously for 1-week at repeated time points to examine habitual gait. In addition, participants will undergo a battery of clinical, cognitive and sensory assessments, such as; (i) sport-related concussion assessment tool; (ii) computerised cognitive batteries for attention, executive function, working memory and visuo-spatial ability; (ii) basic visual acuity chart; (iii) vestibular, ocular motor screening; and (iv) eye-tracking for oculomotor function. Between group (concussed or non-concussed) differences will be analysed with covariance for pre and post-season, and linear mixed models to further examine concussed player time-points and recovery. Results: The protocol and data collection/analysis methods will be presented at the Physiotherapy UK 2019 conference. Conclusion(s): The prevalence of concussion in rugby is growing, but methods to facilitate improved player welfare are lacking. This project will determine the effectiveness of using wearable derived gait and balance data gathered during free-living as an objective means to better inform return-to-play protocols. Implications: Wearable free-living assessment offers objective outcomes to monitor players who suffer concussion, better informing return-to-play while improving player welfare and safety. This work will be used to inform return-to-play protocols in contact sports.

Keywords
Gait; Objective Assessment; Rugby

Journal
Physiotherapy: Volume 107, Issue Supplement 1