Doctoral Degrees (Exercise, Sport and Lifestyle Medicine)
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Browsing Doctoral Degrees (Exercise, Sport and Lifestyle Medicine) by browse.metadata.advisor "Derman, Wayne"
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- ItemEye tracking as a diagnostic and monitoring tool for sports-related concussion(Stellenbosch : Stellenbosch University, 2020-03) Snegireva, Nadja; Welman, Karen; Derman, Wayne; Patricios, Jon; Stellenbosch University. Faculty of Medicine and Health Sciences. Sport Science.ENGLISH SUMMARY : Background: Eye movements have become an easy-to-quantify biomarker for a range of disorders; however, the potential for concussion assessment still needs to be validated. The aim of this prospective cohort study was to establish whether eye tracking technology (ETT) would be a clinically useful, reliable, and valid method to diagnose and monitor youth and adult athletes who have sustained a sports-related concussion (SRC). Methods: To investigate the clinical utility of ETT, an online survey amongst sports medicine clinicians (n = 171) was conducted. For determination of reliability and validity, a testing battery with selected eye tracking metrics (n = 47) was implemented three times (3.0 ± 1.4, 26.1 ± 47.2 and 45.8 ± 19.3 days post-injury) on concussed adult and youth athletes (n = 70) and twice on non-concussed age-and-sex matched athletes (n = 92) with 7.0 ± 3.9 days between sessions. Results: There was insufficient awareness among surveyed clinicians that concussion could lead to abnormal eye movements. Thus, with the exception of abnormal pupil light reflex (examined by 68%), eye movement deficits were inspected by less than half of the respondents (46.3 ± 12%). Only 11% clinicians had actually worked with ETT. Self-paced saccade (SPS) count in the adult group, and the blink duration in the memory-guided saccade (MGS) task, proportion of antisaccade errors, and gain of diagonal smooth pursuit (SP) in the youth group indicated good reliability (ICC > 0.75). Concussed youth athletes had a higher blink duration in the fast MGS task (p = 0.001, η2 = 0.17) and a tendency for higher blink duration in the sinusoidal SP task (p = 0.016, η2 = 0.06) compared to non-concussed youths, as well as to their own subsequent post-concussion values (blink duration decreased over time by 24%, p = 0.35, and 18%, p = 0.48, accordingly). Conclusion. Overall, this study was not able to confirm the findings of previous research on eye tracking metrics for SRC assessment, due to insufficient reliability of described protocols when applied to athletes participating in contact sports. Clinicians can make use of the SPS count as indicator of a concussion among adult athletes, while longer blink durations in MGS or sinusoidal SP tasks might indicate a concussion in youth athletes. Increasing educational opportunities and practical experience of clinicians regarding the use of ETT for SRC assessment to encourage its broader use is advocated, since most deficits in saccades or smooth pursuit are missed during un-instrumented examination. Finally, serial comparison within the same individuals over time is more likely to detect the effect of a SRC than comparison to healthy controls.
- ItemHead smart: the implementation of a law variation in community rugby union and its effect on head injury rates(Stellenbosch : Stellenbosch University, 2024-03) Van Tonder, Riaan; Derman, Wayne; Brown, James; Hendricks, Sharief; Stellenbosch University. Faculty of Medical and Health Sciences. Dept. of Exercise, Sport and Lifestyle Medication.ENGLISH ABSTRACT: Background Concussion is a significant concern in contact and collision sports. Emerging evidence indicates potential negative long-term neurological and mental health outcomes associated with exposure to repetitive head impacts and concussion. Concussion is one of the commonest injuries in rugby union (‘rugby’) and most commonly occurs in the tackle. Thus, injury prevention strategies directed at the tackle require investigation. Objectives. The objective of this project was to investigate the implementation of a law variation trial in male amateur community rugby union and its effect on head injury rates, particularly concussion. The primary aim was to evaluate the effectiveness of lowering the maximum legal height of the tackle from shoulder- to armpit-level in reducing concussion incidence. Secondary aims were: 1) To characterise the tackle event and identify factors associated with illegal high tackles. 2) To investigate referee and player behaviour change as measures of successful implementation of the law variation. 3) To qualitatively explore stakeholder perceptions of the tackle law Methods.The study was conducted in Stellenbosch University's ‘Koshuisrugby’ League using a cross-sectional analytical design. Standardised epidemiological injury surveillance and return-to-play data were collected in years one and two of the study, and video footage of all matches in year 2. Covid-19 led to the cancellation of a planned third year of the study and thus no further injury or video surveillance occurred. Data were analysed to compare injury rates and severity between year 1 (2018; control year) and year 2 (2019; intervention year). Video footage was coded and analysed to characterise the tackle, identify factors associated with illegal high tackles, and investigate player and referee behaviour changes across one season. Individual, semi-structured stakeholder interviews were conducted to gain deeper understanding, through qualitative methods, of stakeholder perceptions of the effectiveness of the law variation and factors that influenced the law variation implementation. Results The incidence rate of concussion did not differ significantly between the control and intervention years (rate ratio: 0.69; 95% CI: 0.4 to 1.2; p=0.20). Overall, 108 matches were filmed and >14 000 tackles were coded and characterised. Factors associated with illegal high tackles were lower leagues, on tackles, arm tackles, upright tacklers, and ball carriers in low body positions. Promising positive player and referee behaviour changes were observed. Significantly fewer tacklers were upright in tackles in the last phase of the season and the sanctioning rate of illegal high tackles was significantly higher in the midphase of the season. Despite stakeholders valuing the law variation, many challenges remain to reduce concussion incidence. Ongoing educational campaigns are critical to address knowledge gaps and raise awareness. The prevailing culture in rugby, particularly in this cohort, pits performance against player welfare, mostly prioritising performance. This culture requires change. A multi-factorial, systems-based approach is needed to reduce concussion in rugby.