Context:Up to 90% of pediatric athletes return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R); however, <50% RTS at the same level and second ACL injury rates are up to 32%.Objectives:(1) Determine which physical and patient-reported outcome measures guide clinical decision-making on RTS in pediatric athletes after ACL-R and (2) present a framework with insights from cognitive and neurophysiological domains to enhance rehabilitation outcomes.Data Sources:PubMed, CINAHL, Embrase, and Cochrane library databases and gray literature.Study Selection:Data on pediatric (<18 years) ACL-R patients, RTS, tests, and decision-making were reported in 1214 studies. Two authors independently reviewed titles and abstract, excluding 962 studies. Gray literature and cross-reference checking resulted in 7 extra studies for full-text screening of 259 studies. Final data extraction was from 63 eligible studies.Study Design:Scoping review.Level of Evidence:Level 4.Data Extraction:Details on study population, aims, methodology, intervention, outcome measures, and important results were collected in a data chart.Results:Studies included 4456 patients (mean age, 14 years). Quadriceps and hamstring strength (n = 25), knee ligament arthrometer (n = 24), and hop tests (n = 22) were the most-reported physical outcome measures guiding RTS in <30% of studies with cutoff scores of limb symmetry index (LSI) ≥85% or arthrometer difference <3 mm. There were 19 different patient-reported outcome measures, most often reporting the International Knee Documentation Committee (IKDC) (n = 24), Lysholm (n = 23), and Tegner (n = 15) scales. Only for the IKDC was a cutoff value of 85% reported.Conclusion:RTS clearance in pediatric ACL-R patients is not based on clear criteria. If RTS tests were performed, outcomes did not influence time of RTS. Postoperative LSI thresholds likely overestimate knee function since biomechanics are impaired despite achieving RTS criteria. RTS should be considered a continuum, and biomechanical parameters and contextual rehab should be pursued with attention to the individual, task, and environment. There is a need for psychological monitoring of the ACL-R pediatric population.
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BACKGROUND: A limited number of patients return to sport (RTS) after an anterior cruciate ligament reconstruction (ACLR) and patients who RTS have a relatively high risk for second ACL injury. The purpose of the current study was to compare the results of a test battery between patients who returned to the pre-injury level of sport (RTS group) and patients who did not (NO-RTS group). It was hypothesized that the RTS group showed better test results.METHODS: Sixty-four patients (age 27.8 ± 8.8 years) were included. The results of a multicomponent test battery (jump-landing task assessed with the Landing Error Scoring System (LESS), three hop tests, isokinetic strength test for quadriceps and hamstring) were compared between groups with a 2 × 2 ANOVA.RESULTS: The RTS group showed a significantly lower LESS score (p = 0.010), significantly higher absolute scores on hop tests with both legs (injured leg: single leg hop test p = 0.013, triple leg hop test p = 0.024, side hop test p = 0.021; non-injured leg: single leg hop test p = 0.011, triple leg hop test p = 0.023, side hop test p = 0.032) and significantly greater hamstring strength in the injured leg (p = 0.009 at 60°/s, p = 0.012 at 180°/s and p = 0.013 at 300°/s). No differences in test results were identified between patients who sustained a second ACL injury and patients who did not.CONCLUSION: Patients after ACLR with better jump-landing patterns, hop performance and greater hamstring strength have greater likelihood for RTS. However, our findings show that RTS criteria fail to identify patients who are at risk for a second ACL injury.
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Wat is de kracht van sport?’ Dat was de uitdagende, prikkelende vraag die wij aan 25 studenten hebben voorgelegd. Het beantwoorden van deze vraag bleek een complexe en soms frustrerende exercitie. Tijdens de zoektocht naar het antwoord moest steeds de balans tussen breedte en diepte van de vraag in de gaten gehouden worden. Daarnaast bleken de studenten soms onzeker over wat zij, als ‘slechts’ studenten, konden bijdragen aan het beantwoorden van deze moeilijke vraag waar vele wetenschappers zich op stuk hebben gebeten. Naar onze mening is de bijdrage van deze studenten heel groot. Zij hebben een compleet en actueel beeld gegeven van hun perceptie over de kracht van sport.
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The Sport Empowers Disabled Youth 2 (SEDY2) project encourages inclusion and equal opportunities in sport for youth with a disability by raising their sports and exercise participation in inclusive settings. The SEDY2 Inclusion Handbook is aimed at anybody involved in running or working in a sport club, such as a volunteer, a coach, or a club member. The goal of the handbook is to facilitate disability inclusion among mainstream sport providers by sharing SEDY2 project partners’ best practices and inclusive ideas.
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Sports are activities enjoyed by many across the globe, regardless of age. The existence and promotion of youth sports has often been based on various assumptions about its value and role in society. Sports participation is assumed to be fun and good and is assumed to contribute to the development of young people. As a result, sports are often seen as an essential part of life for youth. Participation in sports and physical activity is assumed to help young people to develop in a context in which they are able to learn important positive societal values (Fraser-Thomas et al., 2005; Holt, 2008). Although there is a widespread belief in the positive dimensions of sports participation for young people, there is a need for research and theory that identifies and critically looks at the processes through which sports participation by youth is experienced and shapes their lives (Coakley, 2011). I return to this critical perspective after I elaborate on the ways sports are viewed as important effective activities for positive youth development.
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BACKGROUND: The current literature on the value of clinical evaluation for predicting time to return to sport (RTS) after acute hamstring injuries has not been systematically summarised.OBJECTIVES: The aim of this study was to systematically review the literature on the prognostic value of clinical findings (patient history and physical examination) for time to RTS after acute hamstring injuries in athletes.DATA SOURCES: The databases PubMed, EMBASE, SPORTDiscus and Cochrane Library were searched between October 2014 and August 2015.STUDY ELIGIBILITY CRITERIA: Studies evaluating patient history and/or physical assessment findings as possible predictors for time to RTS (described in days or weeks) following acute hamstring injuries in athletes were eligible for inclusion.DATA ANALYSIS: Two authors independently screened the search results and assessed risk of bias using the modified Quality in Prognosis Studies (QUIPS) tool for quality appraisal of prognosis studies. We used a best-evidence synthesis to determine the level of evidence.RESULTS: Sixteen studies were included, of which one study had a low risk of bias and 15 had a high risk of bias. Moderate evidence for an association with time to RTS was found for three clinical findings (visual analogue scale; pain at time of injury, self-predicted time to RTS and clinician predicted time to RTS). There was limited evidence for an association with time to RTS for seven clinical findings (muscle pain during everyday activities, popping sound at injury, forced to stop within 5 min, visual bruising at the site of injury, width (cm) of tenderness to palpation, pain on trunk flexion and pain on active knee flexion initially after injury). The remaining clinical findings revealed either conflicting evidence or limited evidence for an association with time to RTS.CONCLUSION: There is at present no strong evidence that any clinical finding at baseline provides a valuable prognosis for time to RTS after an acute hamstring injury. There is moderate evidence that visual analogue scale pain at time of injury and predictions for time to RTS by the patient and the clinician are associated with time to RTS. The methodological quality of the current literature is characterised by a substantial risk of bias and reporting of RTS definitions and criteria for RTS were inconsistent. We provide recommendations that can guide the design of future studies.
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Context: Only 55% of the athletes return to competitive sports after an anterior cruciate ligament (ACL) injury. Athletes younger than 25 years who return to sports have a second injury rate of 23%. There may be a mismatch between rehabilitation contents and the demands an athlete faces after returning to sports. Current return-to-sports (RTS) tests utilize closed and predictable motor skills; however, demands on the field are different. Neurocognitive functions are essential to manage dynamic sport situations and may fluctuate after peripheral injuries. Most RTS and rehabilitation paradigms appear to lack this aspect, which might be linked to increased risk of second injury.Objective: This systematic and scoping review aims to map existing evidence about neurocognitive and neurophysiological functions in athletes, which could be linked to ACL injury in an integrated fashion and bring an extensive perspective to assessment and rehabilitation approaches.Data Sources: PubMed and Cochrane databases were searched to identify relevant studies published between 2005 and 2020 using the keywords ACL, brain, cortical, neuroplasticity, cognitive, cognition, neurocognition, and athletes.Study Selection: Studies investigating either neurocognitive or neurophysiological functions in athletes and linking these to ACL injury regardless of their design and technique were included.Study Design: Systematic review. Level of Evidence: Level 3.Data Extraction: The demographic, temporal, neurological, and behavioral data revealing possible injury-related aspects were extracted and summarized.Results: A total of 16 studies were included in this review. Deficits in different neurocognitive domains and changes in neurophysiological functions could be a predisposing risk factor for, or a consequence caused by, ACL injuries.Conclusion: Clinicians should view ACL injuries not only as a musculoskeletal but also as a neural lesion with neurocognitive and neurophysiological aspects. Rehabilitation and RTS paradigms should consider these changes for assessment and interventions after injury.
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Various discourses construct youth sport as a site for pleasure and participation, for positive development, for performance and for protection/safeguarding. Elite youth sport however continues to be a site for emotionally abusive coaching behaviour. Little attention has been paid to how the institutional context may enable or sustain this behaviour. Specifically, how do coaches and directors involved in high-performance women’s gymnastics position themselves in relationship to these discourses to legitimize the ways they organize and coach it? We drew on a Foucauldian framework to analyse the technologies and rationalities used by directors and coaches of elite women’s gymnastics clubs to legitimize and challenge current coaching behaviours. The results of the 10 semi-structured interviews showed how coaches and directors legitimized coaching behaviour using discourses of pleasure, protection, performance and of coaching expertise and assigning responsibility for current coaching behaviour to athletes, parents, (other) coaches and global and national policies.
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An important factor affecting sports development in India has been a longstanding issue with deploying policy initiatives introduced as early as 2001. Consequently, this paper explores policies implemented in India till today, highlighting two main issues; inadequate consideration of certain aspects of policy formulation and lack of effective implementation. Policy transfer is then explored as an option to overcome formulation issues of lack of feasibility, financial assistance and knowledge. The success of policy transfer (both external and internal) would, however, depend on how effectively India manages to implement the policies. India can formulate the best policies but, if they are not implemented effectively, the return might remain low. Consequently, we highlight the need for India to prioritise effective policy implementation whilst considering policy transfer as an option to overcome formulation issues.
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