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Research

Research Equipment and Facilities : Athletic Training Research Agenda : Faculty Research Interests : Current Student and Faculty Research Projects : Recent Publications
Recent Abstract Presentations : Research Grants and Awards : Research Links

Concussion Research

What is a concussion?

A concussion is an injury to the brain that affects the brain’s ability to function properly.  Concussions can be caused from several different mechanisms including a direct blow to the head, colliding with another person or object, and being struck on the body resulting in a whiplash type motion.  Common slang terms such as “dings” or “getting your bell rung” are often thought to not be serious head injuries, but in reality are concussions. 

Approximately 1.6 million to 3.8 million sport-related concussions are sustained annually among athletic individuals.(1) Concussions can result from a number of different mechanisms in sports such as contact with equipment (e.g. batted ball, goalpost), collision with a teammate or opponent, or being tackled and the head being whipped (e.g. whiplash).  While most people associate concussion with football, it is also very common in other sports such as soccer, basketball, lacrosse, and ice hockey and happens in both boys’ and girls’ sports.

How do I know if my child has a concussion?

Athletes sustaining a concussion may not always exhibit obvious signs and symptoms.  Each athlete may suffer unique behavioral, neurological, emotional, and physical abnormalities.  Unlike an ankle sprain, which presents with signs one can see, such as swelling and bruising, the signs and symptoms of concussion may be less apparent. Concussion can result in headache, confusion, memory loss, dizziness, and a number of other symptoms. It was once thought that loss of consciousness (“blacking out”) was required for an individual to be diagnosed with a concussion. We today, however, know that loss of consciousness is actually a rare occurrence with sports concussions, happening in less than 10% of the time.(3)

Signs Observed by Coaches
Confusion Loss of Consciousness Dizziness Easily Distracted Vomiting Drowsiness	Poor concentration Personality Change Memory Problems Irritability Nervousness Poor balance or coordination

Symptoms Reported by  Athletes
Headache Amnesia Neck Pain Nausea Dizziness Vision problems Sensitivity to Noise Sensitivity to light Ringing in Ears	Feel “in a fog” Drowsiness “Seeing Stars” Feeling “dinged” Poor concentration Memory Problems Nervousness Poor balance or coordination Vomiting
Signs Observed by Parents
Severity of headache Level of Consciousness Amnesia Nausea Dizziness Easily Distracted Vision problems Sensitivity to Noise Sensitivity to light	Drowsiness Poor concentration Personality Change Memory Problems Trouble Sleeping Irritability Nervousness Poor balance or coordination Vomiting

How are concussions detected?

Concussions are primarily detected through the observation of appropriate signs and symptoms displayed by the injured participant.  Clinical tests have been developed to aid in detecting the presence of a concussion and include objective measures to assess brain function and balance/coordination impairment.   Concussions are most often detected through the presentation of the signs and symptoms mentioned above. More recently there has been a trend to add more objective tests that assess cognition and coordination. Simple tests of cognitive function including asking the athlete specific questions about the event, asking them to remember a list of 5 unrelated words, asking them to repeat the months of the year or days of the week in reverse order or by repeating a short string of numbers in reverse order. Impairments in coordination or balance can be detected by having the athlete touch their finger to their nose, balance on one foot with eyes open, followed by with eyes closed, or walking a line like a tightrope (heel to toe).

Neuroimaging techniques such as CT scan or MRI are not able to detect the functional abnormalities caused by concussion. These techniques are important for ruling out more severe brain injury, but have no role in diagnosing a concussion, determining the severity of the injury, or for recommendations about when an athlete can return to activity. (5)

The ATSU Concussion Program utilizes a combination of brief mental status and balance tests (Sport Concussion Assessment Tool 2, Balance Error Scoring System) and more in depth neurocognitive tests (ImPACT and Pediatric ImPACT).

What do I do if my child has a concussion?

If you think your child has sustained a concussion, they should be immediately taken out of participating in the game or practice. They should be referred to the emergency room immediately if they are displaying any of the signs and symptoms that warrant immediate medical referral such as vomiting, decreasing mental status, unequal pupils, or seizures.  Adolescents and children should never be allowed to return to activity on the same day as their suspected injury (5). Athletes removed from participation due to a suspected concussion should be evaluated by a medical professional, preferably with experience in managing sport-related concussion (6). Some medical professionals may administer additional concussion assessments, including the Standardized Assessment of Concussion, Sport Concussion Assessment Tool, Acute Concussion Evaluation, or a computerized neurocognitive program, such as ImPACT.

When can my child return to sports and school?

            The general rule at all levels of play is that no athlete may return to activity if they are still having symptoms. One all symptoms subside and the scores on any additional tests improve, the athlete may begin a return-to-play progression. This progression takes place over a period of 4-6 days and allows the athlete to gradually return to sport While most athletes can return to play in about 7-10 days, so may take longer for their symptoms to subside and may have a more prolonged absence from sports.

            Athletes sustaining a concussion who are reporting numerous symptoms such as headache, dizziness, fatigue, and inability to concentrate should be encouraged to limit scholastic activities and other cognitive stressors, such as text-messaging and video games, to allow a period of cognitive rest. 5 This cognitive rest can vary from not attending school while symptomatic to attending school with academic accommodations (e.g. longer time to complete tests or assignments, rest periods).

Return to Activity Progression (7)
No activity Light aerobic exercise Sport-specific exercise Non-contact training drills Full contact practice Return to play	Complete physical and cognitive rest Walking, swimming, stationary cycle Running, skating *No head impact More complex training drills (passing) Participate in normal training activities (following medical clearance) Normal game play

The ATSU Concussion Program

Dr. Tamara Valovich McLeod, a leading pediatric concussion researcher has studied numerous aspects of sport-related concussion. She was a contributing author for the NATA Position Statement on the Management of Sport-Related Concussion and a consultant and contributing author on the Appropriate Medical Coverage for Secondary School-Aged Athletes. She is currently chairing the writing group for the NATA’s pediatric overuse injury position statement. Dr. McLeod serves on the Editorial Board for The Journal of Athletic Training, The Journal of Sport Rehabilitation, Athletic Training and Sports Health Care and as a reviewer for Perceptual and Motor Skills, Athletic Therapy Today, and the Board of Certification.

The ATSU Concussion Program works with local high schools and club sports organizations to provide pre-injury baseline testing and post-injury follow up testing for numerous research studies. Current studies are aimed at assessing quality of life following concussion, post-injury impact of concussion on neurocognitive and balance impairments, validation of the Sport Concussion Assessment Tool 2 in pediatric athletes, and validation of the Pediatric ImPACT computerized neurocognitive test. All athletes participating in ATSU Concussion research receive free baseline and post-injury concussion assessments and parent and athlete concussion education materials.

For more information on the ATSU Concussion Program

Dr. Tamara Valovich McLeod can be contacted at 480-219-6000 or tmcleod@atsu.edu

Links of interest

Additional information on sport-related concussion can be found at the following websites or by contacting the ATSU Concussion Program.

• Center for Disease Control and Prevention Concussion Toolkits
• National Athletic Trainers’ Association Position Statement
• The Brain Injury Association of Florida
• The Brain Injury Association of New Jersey
• ImPACT

Concussion References

1.  Langlois JA, Rutland-Brown, W., Wald, M.M. The Epidemiology and Impact of Traumatic Brain Injury: A Brief Overview. J Head Trauma Rehabil. 2006;21:375-378.
2.  Aubry M, Cantu RC, Dvorak J, Graf-Baumann T, Johnston KM, Lovell MR, McCrory PR, Meeuwisse W, Schamasch P. Summary and agreement statement of the first International Conference on Concussion in Sport, Vienna, 2001. Br J Sports Med. 2002;36:6-10.
3.  McCrea M, Guskiewicz KM, Marshall SW, Barr WB, Randolph C, Cantu RC, Onate JA, Yang J, Kelly JP. Acute effects and recovery time following concussion in collegiate football players: The NCAA Concussion Study. JAMA. 2003;290:2556-2563.
4.  Perriello VA. Suggested guidelines for management of head trauma in sports. National Federation of State High School Associations. www.nfhs.org
5.  McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R. Consensus statement on Concussion in Sport-The 3rd International Conference on Concussion in Sport held in Zurich, November 2008. J Sci Med Sport. 2009;
6.  Guskiewicz KM, Bruce SL, Cantu RC, Ferrara MS, Kelly JP, McCrea M, Putukian M, Valovich McLeod TC. National Athletic Trainers' Association Pronouncement Committee: Position Statement on Sport-Related Concussion. J Athl Train. 2004;39:280-297.

Research Equipment and Facilities

The Athletic Training Program seeks to foster the value of scholarly activity and to develop students' leadership skills in the research aspects of Athletic Training. The multidisciplinary setting at Arizona School of Health Sciences, which includes physical therapy, occupational therapy, physician assistant studies, medical informatics, and audiology, promotes cross-disciplinary scholarship and provides students with exposure to a variety of different research programs. Several research spaces are available to students seeking to pursue laboratory and clinical research on and off campus. 

The Arizona School of Health Sciences houses a 1,600 square foot Interdisciplinary Research Lab (IRL) with an expanded offering of research equipment and opportunities. Currently, equipment available for student research projects includes a Kistler 9286 AA Slimline Force Plate and Walkway System (Figures 1), a portable multi-component force plate for measuring ground reaction forces and moments acting in any direction and two surface EMG units, the Noraxon Myosystem 1200 4-channel and Myosystem 1400 8-channel surface EMG, for assessment of neuromuscular performance characteristics (Figure 2). A LigMaster computerized stress device is available for assessment of ankle, knee, elbow, and glenohumeral joint force-displacement characteristics was purchased. The lab is also equipped with a Cybex 330 Isokinetic Dynamometer with the HUMAC/Windows/CYBEX 300 upgrade (Figure 3), DataPac 2K2 data acquisition software, a Teton tremor box and foam blocks for balance assessment (Figures 4), an two treadmills, a total gym, electrogoniometers, a lower extremity perturbation device (Figure 5), Lite-Gait unweighted treadmill, Parvo metabolic cart and several desktop and laptop computers.

Studies measuring glenohumeral joint (Figure 7) or elbow (Figure 8) laxity and stiffness can utilize the LigMaster computerized stress device. Three-dimensional scapular kinematics can also be assessed using custom software developed by Advanced Motion Measurement (www.advancedmotionmeasurement.com) integrated with a Polhemus 3 Space Fastrak electromagnetic spatial tracking system.  A clinical tool for measureiment of scapular kinematics involves a modified Saunders Baseline™ Digital Inclinometer for assessing scapular upward rotation (Figure 9).

ATSU's Mesa Campus Learning Resource Center (LRC) supports the teaching and eventual practice of students and the teaching and research of its faculty. The LRC takes advantage of electronically based information resources that have developed since the emergence of the Internet a decade ago to facilitate and support access and use evidence in support of all instruction, research, and services at the University. The LRC’s collections are a blending of print and electronic resources to bring information access into the curriculum and clinical rotations of the students.

Access to and use of the LRC’s electronic resources is facilitated through its website (on the ATSU Intranet) and its online portal (http://atsu.azhin.org). The we site provides access to the LRC’s print holding, information on services provided and copies of LRC service request forms. The portal provides access to, and facilitates use of, more than 1,000 clinically oriented electronic, full text journals, more than120 full text medical textbooks, and an array of web-based, health information-based vendors. Via the LRC’s membership in the National Network of Medical Libraries’ Docline interlibrary loan system and OCLC’s interlibrary loan system, it can rapidly borrow books and articles from more than 20,000 libraries worldwide. More than 75 percent of the articles obtained from other libraries are received digitally within three days.

Figure 1: Force Platform Walkway System.
Figure 2: Measurement of neuromuscular responses during landing.
Figure 3: Cybex Isokinetic Dynamometer	Figure 4: Balance assessment on the Teton Tremor Box.
Figure 5: Lower Extremity Perturbation Device	Figure 7: LigMaster computerized stress device for assessment of glenohumeral joint laxity and stiffness.
Figure 8: LigMaster computerized stress device for assessment of valgus elbow laxity and stiffness.	Figure 9: Use of a modified digital inclinometer to objectively assess scapular upward rotation.

 

ASHS Athletic Training Research Agenda

The Athletic Training Program has adopted a research agenda focused on outcomes research to enable evidence-based athletic training practice. As a framework for conducting patient-oriented outcomes research, the Athletic Training Program has adopted the National Center for Medical Rehabilitation Research (NCMRR) disablement model. The NCMRR has proposed the use of a disablement model as an organizing framework for supporting its research efforts. The core disablement concepts of “impairments, functional limitations, and disabilities” have become generally accepted. The NCMRR Model includes the elements of “pathophysiology, impairment, functional limitation, disability, and social limitation.”  This framework is also intended to encourage and promote interdisciplinary research efforts.

Usage of this model as a philosophical guide for research also opens the door to alternate funding sources, especially at the federal level. Multiple agencies, including the National Center for Medical Rehabilitation Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Aging, Department of Rehabilitation Medicine, National Institute on Disability and Rehabilitation Research, and the National Council on Disability support this line of investigation.  

Additionally, because this model looks at all aspects of "disablement," which could range from simple disease to long-term disability, it therefore also considers the interaction of the individual and their environment when placed within a disabled state. Thus, it is very much in keeping with ATSU's theme of "Defining Whole Person Healthcare." In fact, this model very much reflects the results of any pathophysiological condition upon the "whole person" as well as their interactions with society. From this point of view, it is a very public health oriented model as well. Figure 10 represents where current faculty research interests fit into the NCMRR disablement model.

NCMRR Disablement Model
Patho- physiology	Impairment	Functional Limitation	Disability	Societal Limitation
Interruption of or interference with normal physiological and develop- mental processes or structures.	Loss and/or abnormality of cognitive, emotional, physiological, or anatomical structure or function, including all losses or abnorm- alities, not just those attributable to the initial patho-physiology.	Restriction or lack of ability to perform an action in the manner or within a range consistent with the purpose of an organ or organ system.	Inability or limitation in performing tasks, activities, and roles to levels expected within physical and social contexts.	Restriction, attributable to social policy of barriers (structural or attitudinal), which limits fulfillment of roles or denies access to services and opportunities that are associated with full participation in society.
ATSU Athletic Training Program Research
Patho- physiology	Impairment	Functional Limitation	Disability	Societal Limitation
Shoulder injury Mild head injury	Mild head injury Shoulder injury Neuro- muscular control	Mild head injury Shoulder injury Neuro- muscular control	Health-related quality of life Mild head injury Shoulder injury Pediatric sports medicine	Health-related quality of life Mild head injury Pediatric sports medicine
Figure 10. Athletic training faculty research interests fit the NCMRR disablement model.

Faculty Research Interests

Dr. Sauers' primary research interests are related to examination and rehabilitation of the athletic shoulder with specific interests in shoulder outcomes assessment, the effectiveness of interventions for treating shoulder impairment, and shoulder mobility assessment. Dr. Sauers is also interested in the study of shoulder kinematics with research aimed at quantifying normal and pathologic laxity and stiffness of the glenohumeral joint and evaluating the relationship between micro-instability, scapular dyskinesis, and posterior capsular tightness in the overhead-throwing athlete. Dr. Sauers' doctoral work revolved around the development and utilization of instrumented shoulder arthrometry for the quantification of glenohumeral joint laxity and stiffness. Currently, Dr. Sauers directs a variety of projects aimed at increasing our understanding of normal and pathologic measures at the shoulder in overhead athletes and patients with shoulder instability. Dr. Sauers is also interested in studying issues related to athletic training education in the context of health professions education and issues related to post-professional education, including specialty certification and residency education in healthcare.

Parsons' research interests include the impact of information and computer technology on medical and allied healthcare practice. His research also explores narratives and communication and activity networks within organizations and their relationship to organizational processes and dynamics

Dr. Valovich McLeod’s ongoing line of research revolves around sports medicine concerns of the pediatric and female athlete, with special emphasis on sports-related mild traumatic brain injury. Dr. McLeod completed her dissertation on the use of clinical assessment tools for concussion in youth sports athletes. She has also looked at factors affecting the use of clinical concussion assessments such as practice effects and exertion and is sitting on the NATA Pronouncements Committee on the Management of Sports Related Concussions. She hopes to continue her work in this area by investigating the short- and long-term effects of pediatric sports concussion as well as recovery following concussion. Dr. McLeod also has research interests regarding gender differences in lower extremity function, specifically neuromuscular control, and postural stability. Her approach to studying the gender bias in ACL injury rates focuses on the pediatric athlete and at what point in development do these differences occur. She also has interest in an injury prevention approach with younger athletes through neuromuscular and balance training. Dr. McLeod is also involved in the development of a youth sports coaching curriculum focusing on safety, injury prevention, and positive coaching behaviors for the Dwight Patterson Sports Academy in Mesa.

Dr. Snyder’s research has primarily focused on muscle physiology, with particular emphasis on muscle injury and the associated soreness. Her interest in injured muscle led her to conduct an investigation on the short- and long- term effects of electrical muscle stimulation on markers of muscle injury. Dr. Snyder is interested in the effect of other therapeutic modalities or rehabilitation interventions on injured muscle. She has examined the biomechanics and muscle activity of the static and ballistic stretching techniques. In addition, she has investigated the effects of static, ballistic, and progressive velocity stretching techniques on performance and is interested in researching the effects of different types of warm-up programs on sport-specific performance. Recently, Dr. Snyder has transitioned from an emphasis on muscle physiology to an emphasis on  clinical outcomes research. She is particularly interested in measuring the outcomes of various athletic training interventions as well as assessing the quality of life of high school and college athletes who suffer a musculoskeletal injury.

Mr. Anderson's primary research interests are clinically oriented and include manual therapy techniques, post-surgical rehabilitation, and functional testing following ACL reconstruction. In addition, he also has clinical and research interests in the Functional Movement Screen and its use in predicting potential injury and as a return to play criteria following lower extremity injury.

Dr. Huxel’s research interests include neuromuscular control, specifically as it relates to dynamic restraint of the shoulder.  Dr. Huxel completed her dissertation on stiffness regulation and muscle activation strategies of the shoulder.  Within this area, she has looked at factors such as gender, age, joint position, and rehabilitation exercises.  Dr. Huxel is also involved in studies examining shoulder adaptations and injuries as a result of overhead activities.    A secondary research area of Dr. Huxel’s is exercise associated muscle cramps.  She works collaboratively with faculty from Indiana State University to examine a neuromuscular-based theory to explain exercise associated muscle cramps using an electrically induced muscle cramp model.  They are also interested in validating the model and testing responses treatment methods.

Dr. Bay teaches courses in research methodology, statistical analysis and evidence-based medicine. His current areas of research interest concern the relationship between patients’ perception of their illness and their subjective and objective responses to therapeutic interventions, as well as the application of structural equation modeling to medical research.

Current Student and Faculty Research Projects

Neuromuscular Control

• Neuromuscular responses during anticipated and unanticipated landings in males and females
• Gender differences during static and dynamic clinical balance assessments
• Laxity and stiffness of the knee following a closed kinetic chain exercise bout
• Neuromuscular properties of lower extremity muscles in prepubescent boys and girls during landing activities and following a single-leg weight-bearing perturbation
• The effect of a core stability training program on core strength and balance in college basketball players
• Balance gains in female high school basketball players following a neuromuscular training program
• Comparison of muscle activation patterns of the gluteal muscles during various rehabilitation exercises
• Ground reaction forces and rate of loading in high school female basketball players prior to and following an 8-week neuromuscular training program

Shoulder Injury

• Quantification of glenohumeral joint laxity and stiffness in patients with documented shoulder instability
• Acute and chronic adaptations in the throwing shoulder of professional baseball pitchers
• Chronic adaptations in the throwing shoulder of professional baseball players
• Clinical Measures of Shoulder Motion in Professional Baseball Players: A Comparison of the Dominant and Non-Dominant Shoulders in Pitchers and Position Players
• The effects of a seven-month season on selected clinical measures of shoulder mobility in the professional baseball player
• Reliability of a Classification Protocol for the Assessment of Scapular Motion in Patients with Shoulder Pathology
• The value of selected clinical measures of shoulder mobility for predicting shoulder pathology in the professional baseball player: A prospective study
• Range of motion effects of a three week PNF hold-relax facilitory protocol on glenohumeral internal rotation
• A comparison of glenohumeral joint laxity and stiffness in the throwing and non-throwing shoulders of high school baseball pitchers
• A comparison of ulnar collateral ligament laxity and stiffness in the throwing and non-throwing shoulders of high school baseball pitchers
• Qualitative assessment and comparison of scapular kinematics between aquatic athletes with moderate and severe shoulder impingement
• A comparison of three-dimensional scapular kinematics in the throwing and non-throwing shoulders of professional baseball pitchers
• Impairment, functional loss, and disability in professional baseball players with shoulder and elbow pathology
• The relationship between pitch count and pitch frequency and shoulder and elbow injuries in female youth softball players
• Conservative vs. operative intervention for atraumatic glenohumeral instability in the overhead athlete: A systematic review
• The effects of an eight-week scapular stabilization and postural exercise program on scapular kinematics in collegiate swimmers
• The diagnostic value of special tests for the detection of SLAP lesions in the shoulder: a systematic review.

Mild Head Injury

• A prospective investigation of concussion management practices of high school and junior college certified athletic trainers
• Establishing normative on the Automated Neuropsychological Assessment Metrics (ANAM) in pediatric athletes
• The effects of two-a-day practices on cognitive function and symptom reports in collegiate football players
• A survey of mild head injury assessment and management practices of Arizona high school certified athletic trainers
• Development of a handheld computer assessment protocol for sports-related concussions
• Physician knowledge and management practices for sports-related concussion
• Reliability of the Head-Injury Symptom Scale in pediatric athletes

Pediatric Sports Medicine

• A survey of youth athletes on sports participation characteristics
• A survey of the knowledge base of youth sports coaches concerning injury prevention and management
• Neuromuscular properties of lower extremity muscles in prepubescent boys and girls during landing activities and following a single-leg weight-bearing perturbation

Other Areas

• Assessmesnt of valgus laxity and stiffness at the elbow using computerized stress arthrometry in collegiate athletes
• A survey of the current educational environments of athletic training education programs:  Academic vs. health professions models

Recent Publications

Almquist JL, Valovich McLeod TC, Cavanna A, Jenkinson D, Lincoln AE, Loud K, Peterson BC, Portwood C, Reynolds J, Woods T. Summary Statement: Appropriate Medical Coverage for Secondary School-Aged Athletes. Journal of Athletic Training. 2008;43(4):417-428.

Snyder AR, Parsons JT, Valovich McLeod TC, Bay RC, Michener LA, Sauers EL. Utilizing disablement models and clinical outcomes assessment to enable evidence-based athletic training practice: Part I – Disablement Models. Journal of Athletic Training. 2008;43(4):429-437.

Valovich McLeod TC, Snyder AR, Parsons JT, Bay RC, Michener LA, Sauers EL. Utilizing disablement models and clinical outcomes assessment to enable evidence-based athletic training practice: Part II – Clinical Outcomes Assessment. Journal of Athletic Training. 2008;43(4):438-446

Parsons JT, Valovich McLeod TC, Snyder AR, Sauers EL. Change is Hard: Adopting A Disablement Model for Athletic Training? [Commentary] Journal of Athletic Training. 2008;43(4):447-449.

Valovich McLeod TC. The Effectiveness of Balance Training Programs on the Incidence of Ankle Sprains in Adolescent Athletes. [Critically Appraised Topic]. Journal of Sport Rehabilitation. 2008;17:317-324.

Valovich McLeod TC, McGaugh JW, Boquiren ML, Bay RC. Youth sports coaches do not have adequate knowledge regarding first-aid and injury prevention. Applied Research in Coaching and Athletics Annual. 2008;23:130-146.

Valovich McLeod TC, Bay RC, Heil J, McVeigh SD. Identification of Sport and Recreational Activity Concussion History Through the Pre-Participation Screening and a Symptom Survey in Young Athletes. Clinical Journal of Sport Medicine. 2008;18(3):235-240.

Borsa PA, Laudner K, Sauers EL. Mobility and stability adaptations in the shoulder of theoverhead athlete: a theoretical and evidence-based perspective. Sports Medicine.
2008;38(1):17-36.

Mailer BJ, Valovich McLeod TC, Bay RC. Healthy Youth are Reliable in Reporting Symptoms on a Graded Symptom Scale. Journal of Sport Rehabilitation. 2008;17:11-20.

Snyder AR, Valovich McLeod TC. Selecting patient-based outcome measures. Athletic Therapy Today. 2007;12(6):12-15.

Tweed EM, Sauers EL, Valovich McLeod TC. Evidence based practice in athletic training. (Section of: Review of Evidence Based Practice in Nursing and Allied Health Professions, Ed: Kronenfeld M, Stephenson P, Nail-Chiwetalu B.) Journal of the Medical Librarians Association. 2007;95(4) :394-407.

Snyder AR, Valovich McLeod TC, Sauers EL. Defining, Valuing, and Teaching Clinical Outcomes Assessment in Professional and Post-Professional Athletic Training Education Programs. Athletic Training Education Journal. 2007;2(Apr-Jun):1-11.

Martineau C, Kingma JJ, Bank L, Valovich McLeod TC. Sport-Related Concussion Management for the Physician Assistant. Journal of the American Academy of Physician Assistants. 2007;20(5):22-27.
*American Academy of Physician Assistants PAragon Publishing Awards Nominee

Medina JM, Valovich McLeod TC, Kingma JJ, Howell SK. Neuromuscular preactivity of the quadriceps and hamstrings prior to landing in high school male athletes, female athletes, and female non-athletes. Journal of Electromyography and Kinesiology. Available online 15 February 2007.

Valovich McLeod TC, Schwartz CD, Bay RC. Sport-related concussion misunderstandings among youth coaches. Clinical Journal of Sport Medicine. 2007;17(2):140-142.
Sauers EL, August AA, Snyder AR. The acute effects of Fauls' modified passive stretcing routine on shoulder range of motion in collegiate baseball players. Journal of Sport Rehabilitation. 2007; 16:1-13.

Snyder AR, Hartman A, Valovich McLeod TC. The Impact of Stretching on Sports Injury Risk and Performance. Athletic Therapy Today. 2006;11(6):66-69.
Sauers EL. Clinical evaluation of scapular dysfunction. Athletic Therapy Today. 2006;11(5):10-14.

Docherty Steele CM, Valovich McLeod TC, Shultz SJ. Postural control deficits in participants with functional ankle instability as measured by the Balance Error Scoring System. Clinical Journal of Sport Medicine. 2006;16(3):203-208.

Crawford SD, Sauers EL. Glenohumeral joint laxity and stiffness in the functional throwing position of high school baseball pitchers. Journal of Athletic Training. 2006;41(1):36-43.
Witwer AB, Sauers EL. Clinical measures of shoulder mobility in the collegiate water polo player. Journal of Sport Rehabilitation. 2006;15:45-57.

Guskiewicz KM, Bruce SL, Cantu RC, Ferrara MS, Kelly JP, McCrea M, Putukian M, Valovich McLeod TC. Research based recommendations on management of sport related concussion: summary of the National Athletic Trainers' Association position statement. British Journal of Sports Medicine. 2006 Jan;40(1):6-10.

Valovich McLeod TC, Barr WB, McCrea M, Guskiewicz KM. Psychometric and measurement properties of concussion assessments in youth sports. Journal of Athletic Training. 2006; 41(4): 399-408.

Tommasone BA, Valovich McLeod TC. Concussion incidence in contact sports. Evidence based practice article. Journal of Athletic Training. 2006; 41(4): 470-472.

Valovich McLeod TC. Proper fit and maintenance of ice hockey helmets. Athletic Therapy Today. 2005;10(6):54-57.

Valovich McLeod TC. The prediction of intracranial injury following minor head trauma in the pediatric population. Journal of Athletic Training. 2005;40(2):123-125.
1st runner up for the 2006 Journal of Athletic Training non-research manuscript award.

Shultz SJ, Windley TC, Kulas AS, Schmitz RJ, Valovich McLeod TC, Perrin DH. Low levels of anterior tibial loading enhance knee extensor reflex response characteristics. Journal of Electromyography and Kinesiology.2005;15(2): 61-71.

Downar JM, Sauers EL. Clinical measures of shoulder mobility in the professional baseball player. Journal of Athletic Training. 2005;40(1):23-29.

Guskiewicz KM, Bruce SL, Cantu RC, Ferrara MS, Kelly JP, McCrea M, Putukian M, Valovich McLeod TC. Recommendations on Management of Sport-related Concussion: Summary of the National Athletic Trainers' Association Position Statement. Neurosurgery. 2004;55(4):891-896.

Recent Abstract Presentations

Valovich McLeod TC, Bay RC, Snyder AR. Adolescent Athletes With A Self-Report History of Sport-Related Concussion Demonstrate Lower Health-Related Quality of Life. Submitted to the 3rd International Conference on Concussion in Sport. October 2008, Zurich, Switzerland.

Parsons JT, Valovich McLeod TC. Graduated Approach to Teaching Critical Appraisal of Athletic Training Evidence. Submitted to the 2009 Athletic Training Educator’s Conference.

Sauers EL, Moran CL, Bay RC. Most Professional Athletic Training Education Programs
are NOT Housed With Peer Healthcare Professions. Journal of Athletic Training.2008;43(2Suppl): S102

Ellery TE, Sauers EL, Snyder AR, Bay RC. The Design and Development of the Functional Arm Scale for Throwers© (FAST©). Journal of Athletic Training. 2008;43(2 Suppl): S51.

Dykstra DL, Bay RC, Snyder AR, Sauers EL. The Relationship Between Pitching, Injury
and Pain History and Health-Related Quality of Life in High School and College Female
Softball Pitchers Journal of Athletic Training. 2008;43(2 Suppl): S22.
*Oral Presentation Finalist, 2008 NATA Research & Education Foundation StudentResearch Awards Competition

Piebes SK, Bay RC, Snyder AR, Valovich McLeod TC. The reliability of the Head Impact Test and Pediatric Migraine Disability Assessment for measuring the impact of headache on health-related quality of life in adolescents. Journal of Athletic Training. 2008;43(2 Suppl): S92.

Strasser KM, Erickson SE, Valovich McLeod TC. The effects of two-a-day practices on cognitive function and symptom reports in collegiate football players. Journal of Athletic Training. 2008;43(2 Suppl): S31.

Teeters JC, Valovich McLeod TC, Bay RC, Martinez J, Parson JT, Sauers EL, Snyder AR. Cross-Sectional Study of the Health-Related Quality of Life (HRQOL) Using the Pediatric Data Collection Instrument (PODCI) in an Adolescent Population. Journal of Athletic Training. 2008;43(2 Suppl): S93.

Martinez J, Valovich McLeod TC, Bay RC, Teeters JC, Parson JT, Sauers EL, Snyder AR. Cross-Sectional Study of the Health-Related Quality of Life (HRQOL) Using the Medical Outcomes Short Form (SF-36) in an Adolescent Population. Journal of Athletic Training. 2008;43(2 Suppl): S93.

Valovich McLeod TC, Bay RC, Teeters JC, Parsons JT, Sauers EL, Snyder AR. Health-Related Quality of Life is Affected by Recent Injury in Adolescents. Journal of Athletic Training. 2008;43(2 Suppl): S92.

Strasser KM, Erickson SE, Valovich McLeod TC. The effects of two-a-day practices on cognitive function and symptom reports in collegiate football players. Proceedings of the 2008 EATA Symposium. 2008.
Graduate Student Award Finalist.

Mailer BJ, Valovich McLeod TC. Base Rate Concussion-Related Symptoms Among Middle School Athletes. Journal of Athletic Training. 2007;42(2 Suppl): S128.

Snyder AR, Bohls C, Valovich McLeod TC, Falsone S. Hip Muscle Activation During Two Positions and Three Directions of Band Walks. Journal of Athletic Training. 2007;42(2 Suppl): S76.

Sauers EL, Johnson MP, Tafoya J, Boquiren M. The acute and chronic effects of throwing on shoulder mobility in collegiate baseball pitchers. Journal of Athletic Training. 2007;42(2):S-23.

Simmons E, Sauers EL, Kronenfeld M, Bay RC. A systematic review of the effectiveness of interventions for atraumatic shoulder instability in overhead athletes. Journal of Athletic Training. 2007;42(2):S-128.

Rogers BR, Freeman AM, Shultz SJ, Valovich McLeod TC. Neuromuscular activation of lower extremity muscles in prepubescent males and females during a single-leg, weight-bearing perturbation. Journal of Athletic Training. 2007;42(2 Suppl): S78.

Valovich McLeod TC, Armstrong TA, Miller M, Sauers JL. Balance Improvements in Female High School Basketball Players Following an 6-week Pre-season Neuromuscular Training Program. Journal of Athletic Training. 2007;42(2 Suppl): S35.

Valovich McLeod TC, Heil J, McVeigh SD, Bay RC. Identification of Sport and Recreational Activity Concussion History Through the Pre-Participation Screening and a Symptom Survey in Young Athletes. Journal of Athletic Training. 2006;41(2):S-91.

Malone C, Sauers EL, Valovich McLeod TC. Stiffness and laxity of the medial collateral ligament with and without knee bracing. Journal of Athletic Training. 2006;41(2):S-90.

Kingma JJ, Livingston J, Valovich McLeod TC. Inter and intratester reliability of the ImageJ software program for the analysis of hamstring range of motion. Journal of Athletic Training. 2006;41(2):S-18.

Valovich McLeod TC, Mailer BJ, Bay RC. Healthy Youth are Reliable in Reporting Symptoms on a Graded Symptom Scale. Proceedings of the 22nd Annual RMATA Meeting and Clinical Symposia, Salt Lake City, Utah, April 2006.

Research Grants and Awards

Snyder AR, Valovich McLeod TC: Principal Investigators
Parsons JT, Bay RC, Sauers EL, Kronenfeld M, Teeters J: Co-investigators
Title: The Clinical Outcomes Research Education for Athletic Trainers (CORE-AT) Program: Training Clinical Researchers for Evidenced-Based Practice.
Funding Agency: National Athletic Trainers’ Association Research and Education Foundation.
Budget Requested: $107,013. Status: Approved for full funding

Valovich McLeod TC: Co-investigator
Title: The Impact of Whole-body Vibration on Static and Dynamic Balance in Older Adults With and Without Vestibular Dysfunction.
Funding Agency: Bertec Corporation Equipment Loan Competition. Funding is for use of a BalanceCheck™ system for a one-year period.

Valovich McLeod TC: Principal Investigator
Title: “Heads Up! The Usage of Digital Diagnosis Tools for Sideline Concussion Assessment in the Youth Athlete.
Funding Agency: Catholic Healthcare West
Budget Requested: $14,330 Status: Approved for full funding

Snyder AR, Valovich McLeod TC: Principal Investigators
Parsons JT, Bay RC, Sauers EL: Co-investigators
Title: Health Related Quality of Life in Adolescents with Sport-Related Musculoskeletal Injury.
Funding Agency: A.T. Still University Strategic Research Initiative
Budget Requested: $62,794 Status: Approved for $24,214 + 2 year post-doctoral fellow @ $36,000 per year.

Snyder AR: Principal Investigator
Title: Outcomes Research in Athletic Training
Funding Agency: NATA Research and Education Foundation Post-Doctoral Research Fellowship
Budget Requested: $71,457 Status: Approved for full funding

Strasser KM and Valovich McLeod TC: (Faculty Advisor)
Title: The Effect of Two a Day Practices on Cognitive Function in Collegiate Football Athletes.
Funding Agency: National Athletic Trainers’ Association Research and Education Master’s Grant Program
Budget Requested: $810 Status: Approved for full funding

Snyder AR: Principal Investigator
Title: Outcomes Research in Athletic Training
Funding Agency: NATA Research and Education Foundation Post-Doctoral Research Fellowship
Budget Requested: $73,285 Status: Not funded, resubmission requested

Simmons E, Principal Investigator; Sauers EL, Bay C, & Kronenfeld M. Co-Investigators
Title: Conservative vs. operative intervention for atraumatic Glenohumeral instability in the overhead athlete: A systematic review
Funding Agency: NATA - Research and Education Foundation Osternig Masters Grant
Budget Requested: $620 Status: Approved for full funding

Payne JR, Principal Investigator; Kingma JJ amd Bosch PR Co-Investigators
Title: Stable diurnal cortisol patterns in MJCAA division II collegiate
female basketball players throughout a competitive basketball season
Funding Agency: NATA - Research and Education Foundation Osternig Masters
Grant
Budget Requested: $1000 Status: Approved for full funding

Valovich McLeod TC: Principal Investigator
Title: A prospective investigation of concussion education, assessment, and outcomes in a pediatric athletic population.
Funding Agency: National Operating Committee for Standards on Athletic Equipment
Budget Requested: $59,950 Status: Not funded

Miller AA and Snyder AR: (Faculty Advisor)
Title: The Influence of Static Stretching and Massage on Hip Flexion Range of Motion
Funding Agency: NATA Research and Education Foundation Osternig Masters Grant
Budget Requested: $1,000 Status: Not funded

Valovich McLeod TC: Co-investigator
Title: A Case Study Series of the Effects of Constraint-Induced Movement Therapy in Children With Hemiplegia
Funding Agency: Warner / Fermaturo and KCOM Board of Trustees, July 2005-2007, Budget Requested: $3,966.95 Status: Approved for full funding

Sauers EL and Valovich McLeod TC: Co-Directors
Title: Implementation, Evaluation, and Refinement of the Dwight Patterson Sports Academy P.L.A.Y.S. Curriculum to Promote Health, Safety, and Wellness in America’s Youth Sports
Funding Agency: Mesa HoHoKam Foundation
Budget Requested: $20,000 Status: Approved for $15,000 funding

Valovich McLeod TC and Schwartz C.
Title: Arizona School of Health Sciences Youth Sports Coaches’ Concussion Survey and Educational Program.
Funding Agency: Phoenix Coyotes Charities
Budget Requested: $985 Status: Approved for full funding

Sauers EL and Valovich TC: Co-Directors
Title: Design and Development of the Dwight Patterson Sports Academy P.L.A.Y.S. Curriculum to Promote Health, Safety, and Wellness in America’s Youth Sports.
Funding Agency: Mesa HoHoKam Foundation
Budget Requested: $25,000 Status: Approved for $20,000 funding

Valovich TC: Principal Investigator
Title: Gender Differences in Neuromuscular Response Characteristics Between Prepubescent Boys and Girls Following a Perturbation at the Knee..
Funding Agency: Warner / Fermaturo and KCOM Board of Trustees Research Fund
Budget Requested: $3,985 Status: Approved for full funding

Kingma J and VanderBunt E: Co-Investigators
Title: The Prevalence of Secondary Amenorrhea Among NCAA Division I Intercollegiate Female Athletes
Funding Agency: Warner / Fermaturo and KCOM Board of Trustees Research Fund
Budget Requested: $3,200 Status: Approved for full funding

Sauers EL: Principle Investigator
Title: Acute and chronic adaptations in the throwing shoulder of professional baseball pitchers with implications concerning injury
Funding Agency: NATA – Research and Education Foundation
Budget Requested: $40,330 Status: Approved for full funding

Sauers EL and Johnson MP: Co-Investigators
Title: Kinematics of the shoulder complex in the professional baseball pitcher at rest and following five throwing intervals.
Funding Agency: University of the Sciences in Philadelphia College of Graduate Studies Scholarly Activity Fund
Budget Requested: $4,948 Status: Approved for full funding

Sauers EL: Principle Investigator
Title: Acute and chronic adaptations in the throwing shoulder of collegiate baseball pitchers with implications concerning injury
Funding Agency: Warner / Fermaturo and KCOM Board of Trustees Research Fund
Budget Requested: $3,932 Status: Approved for full funding

Research Links

American Academy of Orthopaedic Surgeons - http://www.aaos.org/
American College of Sports Medicine - http://www.acsm.org/
American Journal of Sports Medicine - http://ajs.sagepub.com/
American Orthoapaedic Society for Sports Medicine - http://www.sportsmed.org/
American Shoulder and Elbow Surgeons - http://www.ases-assn.org/
American Sports Medicine Institute - http://www.asmi.org/
Brain Injury Association - www.biausa.org/
Cincinnati Sportsmedicine Research and Education Foundation - http://www.cincinnatisportsmed.com/
Journal of Athletic Training - http://www.journalofathletictraining.org/
NATA-Research and Education Foundation - http://www.natafoundation.org/
National Institutes of Health - http://www.nih.gov/
National Library of Medicine - http://www.nlm.nih.gov/
National Science Foundation - http://www.nsf.gov/
Orthopaedic Research and Education Foundation - http://www.oref.org/
PUB-MED - http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed
The Aircast Foundation - http://www.aircastfoundation.org/
The Shoulder Source - http://www.orthop.washington.edu/uw/tabID__3351/Default.aspx