performance training for concussion...

Performance Training for Concussion

Robert E. Mangine M.Ed, PT, ATC

National Director Clinical Sports Residency

NovaCare Rehabilitation

Associate Athletic Director Sports Medicine

University of Cincinnati

Department of Athletics’

Adjunct Clinical Instructor

University of Cincinnati

Department of Orthopedics’

Disclosure• The Institution or individuals do not have any financial or

ownership in any company associated with our research

• Journal of Optometry and Visual Performance (accepted)

An Exploratory Study of the Potential Effects of Vision

Training on Concussion Incidence in Football

Joseph F. Clark1, Pat Graman2, James K. Ellis3, Robert E.

Mangine3,4,5, Joseph T. Rauch3,4,5, Ben Bixenmann6, Kimberly A.

Hasselfeld5, Jon G. Divine,5 Angelo J. Colosimo5, Gregory D.

Myer7,8,9,

Conservative estimates indicate that 5 to 8 million

adults and children are injured each year in sport,

exercise, and recreational settings.

Conservative estimates indicate that 5 to 8 million

adults and children are injured each year in sport,

exercise, and recreational settings.

Physical factors such as muscle imbalances,

high-speed collisions, overtraining and physical

fatigue are the primary causes of exercise and

sport injuries.

Physical factors such as muscle imbalances,

high-speed collisions, overtraining and physical

fatigue are the primary causes of exercise and

sport injuries.

However, psychological factors may also play a

role.

However, psychological factors may also play a

role.

Personality factors, stress levels, and certain

predisposing attitudes have all been identified

as psychological antecedents to athletic injury.

Personality factors, stress levels, and certain

predisposing attitudes have all been identified

as psychological antecedents to athletic injury.

Concussion in Sports

�Estimated 3.6 million traumatic brain injuries occur per year in the US1

�The NCAA reported an increased incidence of concussion of 7% annually over a 15 year period from 1988-20042

� Likewise the concussion rate doubled from 0.17 to 0.34 per 1000 athlete exposures over the same time period

�Females may be at higher risk for concussion and a prolonged period of post concussive symptoms3

1) www.cdc.gov

2) Daneshvar, DH, et al. The Epidemiology of Sports-Related Concussion. Clin Sports Med 2011;30(1):1-17

3) Dick RW. Is there a gender difference in concussion incidence and outcome? Br J Sports Med 2009;43(suppl 1):i46-i50

Program Development

• In 2009 we changed our Concussion

Program to reflect NFL evolution of TBI

management

• Independent clinical evaluation

• Education emphasis

• Looking at RTC’s for pre-participation

evaluation

• Progressive Front end research

Performance Training

Technical Skill

– Normal ADL patterns first

– Sports specific movements second

Tactical Sense (under trained )

- Proprioception

- Kinesthetic awareness

Physical Fitness

– Strength

– Power

– Speed and endurance

Visual Field enhancement

Tactical Sense

Why Has Vision Changed

Image found on the web: http://thumbsup.in.th/tag/teen/

Vision in sports

• High-performance vision training has

previously been used in the University of

Cincinnati athletic department for

performance enhancement

Vision in Sports

• Vision is also an integral

part of an athlete’s ability

to avoid injury during

competition

• Often protective

equipment worn by an

athlete may obstruct the

acquisition of visual

information

Vision in Sports

• In 2011, the National Federation of State

High School Associations required all field

hockey players to wear protective eyewear

High-performance vision training

• Our hypothesis:

– Similar high-performance vision training used

previously for performance enhancement may

improve an athlete’s reaction time to

information acquired throughout their visual

field and help them to avoid injury

High-Performance Vision Training

• High-performance vision

training was initiated as a part

of performance enhancement

for the University of

Cincinnati football team

– Dynavision D2 light board

training

– Strobe glasses

– Vision tracking drills


• Functional peripheral vision

– Information from the peripheral visual fields

that is able to be recognized with a fast enough

reaction time to allow the athlete to utilize this

information during competition


• Functional peripheral vision

training

– Objective assessment of reaction

time to information from the

peripheral visual field compared to

the central visual field

– Reaction time of outer two rings

divided by inner two rings

Dynavision – A* High-performance vision training

• Improved peripheral vision

reaction time among athletes

following high-performance

vision training

– Functional peripheral vision ratio:

• Untrained athlete: 1.50+0.23

• Vision trained athlete: 1.42+0.15

– P<0.01

– n=105 athletes

High Performance VT and Stereopsis

12

3

Pre-Training

Post-Training0

10

20

30

40

50

Stereopsis

(mm)

Years (2011-2013)

Stereopsis with

Vision TrainingPre-Training

Post-Training

Results are from Baseball Players following 6 weeks of vision training

on 3 consecutive seasons.


• High-performance vision training initiated

for all members of the University of

Cincinnati football team prior to the 2010

season

• Each athlete had ~4 hours of vision training

during pre-season camp and then continued

as time allowed throughout the season

High-performance vision trainingYear Number of

concussions

Coach trends

2006 9 Contact practices

2007 8 No in season contact



2010* 1 Contact daily

2011 3 Contact daily

2012 1 Contact daily

2013 1 Minimal contact


• Results:

– 2006-2009: 8.75 (+1.7) concussions per year

– August 1st 2010 vision training initiated

– 2010-2013: 1.5 (+1.0) concussions per year

– Statistically significant P<0.001


�Conclusions:

� Improved functional peripheral vision

following high-performance vision training

among the UC football team allowed the

athletes to react faster to their changing

environment and avoid concussions

Concussion Duration Prediction

-10

0

10

20

30

40

50

60

0 5 10 15 20 25 30

Weeks Predicted

We

ek

s A

ctu

al

Figure 1

Dynavision ™

• Light Board

– 5 ft by 5 ft board

• Lights

• Screen

• Stand

– The board can go up

and down to

accommodate variable

heights up to 7 feet. In this Figure is an image and explanation

of the Dynavision ™ and its major

components. Computer interface not

shown.

(Tachistoscope )

De-or Re-Training our Visual

Fields

Out with Friends

Dinner with the Family

Cheering your Bearcats

Enjoying the SightsOut on a Date

A day at the Beach

Injury Rate per Season

Baseline D1 - Trial D2 - Trial

For this exercise, watch the screen to see the

picture flashed on the screen. Find and write

down the number seen in the picture. You

will have a few seconds to write this. Then

the picture will show again for a few

seconds – mark down and keep track of

your score. Next the screen will say ready,

watch carefully for the flashed picture and

repeat until told to stop or finished. Press

space once to start. Hit space at any time to

advance to the next slide.

READY

1234

1234

READY

kq1hHPyd

B

kq1hHPyd

B

Conclusion

� A traumatic brain injury is an injury to the

brain.

� We can diagnose it and provide an

environment to promote healing and recovery.

� More work, research and understanding, is

needed to keep people safe and get them better

faster.

Questions??? Thank You

• [email protected]

Dynavision – Reaction Test Dynavision – Strike Zone

Dynavision Training Results

•Vision training initiated prior to 2011 season•Batting average improved by 0.034 points

•Clinically significant compared with the rest of the Big East

performance training for concussion...

Documents