Neurocognitive and Reactive Return to Play Testing Protocol in Overhead Athletes Following Upper Extremity Injury

Abstract

The incidence of upper extremity (UE) injuries in sport, particularly with the shoulder and elbow in baseball/softball players, appears to be increasing yearly, especially in younger age athletes. Improving the objective criteria and testing methods used to determine return to play (RTP) readiness following non-operative or post-operative management of UE injuries is one aspect of the rehabilitation process that may significantly help in reducing reinjury rates. Currently, the majority of clinicians are still using post operative time frame and/or strength/range of motion as their main criteria for clearance to RTP following UE injury. This demonstrates an inadequate reflection of the actual unpredictable, dynamic environment athletes are returning to participate in. In our clinical experiences, objective testing to allow for clearance to sport participation should incorporate neurocognitive and reactive testing to promote improvements in the athlete's ability to dual task and focus/concentrate on the multi-dimensional tasks at hand. We know that neuroplastic changes occur following UE injury resulting in decreased proprioception and increased motor activation with simple UE tasks. Currently the research on UE return to play testing is limited. The purpose of this clinical commentary was to describe the utilization and provide reference values for a series of reactive neurocognitive UE tests, to assist with RTP, in high school and collegiate overhead athletes (baseball and softball) utilizing the Blaze Pod light system. The use of a more dynamic reactive testing battery may decrease the reinjury rates when an athlete is cleared for participation by measuring readiness in chaotic circumstances that are more reflective of the sporting environment the athlete is working to return to resulting in a greater sense of confidence, performance and prevention of reinjuries.

Keywords: UCL injury; neurocognitive training; recurrent shoulder instability; return to performance.

Figure 1.. Reactive CKCUEST+ test with light targets (Blazepods). Blazepods are positioned 36 inches apart in length with the two on the same side being 12 inches apart. This test is completed twice bilaterally. Number of taps and reaction time are recorded.

Figure 2.. Reactive Triangle CKCUEST+ test with the target lights (Blazepods). Pods are positioned 36 inches apart in length with the two on the same side being 12 inches apart. This test is completed twice bilaterally. Number of taps, reaction time, and number of errors are recorded.

Figure 3.. Reactive Right vs. Left CKCUEST+ test with light targets (Blazepods). Pods are positioned 36 inches apart with the two on the same side positioned 12 inches from each other. This test is completed twice. Number of taps, reaction time, and number of errors are recorded

Figure 4.. Reactive 90/90 Wall Throws test with light targets (Blazepods). Middle pod is positioned 5 feet from the ground with the remaining two pods 12 inches from the center. This test is completed twice bilaterally. Number of taps, reaction time, and number of errors are recorded

Figure 5.. Reactive CKCUEST+ and Reactive Triangle CKCUEST+ tests with light targets (Blazepods) in a modified testing position.

Figure 6.. Right vs. Left CKCUEST+ test with light targets (Blazepods) in a modified testing position.