Student Number : 9801839H - MA research report - School of Human and Community Development - Faculty of Humanities / The Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) epidemic has spread throughout the world and its prevalence in sport has received increasing attention. The aim of this exploratory study was to examine the knowledge, attitudes and relationship behaviour with respect to HIV and AIDS among athletes participating in contact sport. In addition, this study included a preliminary investigation into whether sport participation facilitates the development of life skills which would act as a buffer against the risky behaviours that increases vulnerability to infection. A self-report questionnaire was specifically constructed to address the aims of the study. The sample comprised of 38 male athletes between the ages of 18 and 30, from the following codes of contact sport: boxing, rugby, and taekwondo in Gauteng. Content analysis and descriptive statistics were used to analyse the participants’ responses. The findings indicated that the athletes had a good level of knowledge, but some misconceptions still remain. Attitudes of the athletes appeared to be in favour of mandatory testing and disclosure of one’s status. Positions on the participation of HIV-positive athletes in sport alternated between exclusion on the basis of safety and inclusion so as not to facilitate the proliferation of stigma. Few athletes reported continued involvement in high-risk behaviour, but it was encouraging that the largest part of participants declared exhibiting preventative behaviour. Sport participation was found to have some biopsychosocial impact on participants, which may extend to enhance health-seeking behaviour. Research findings may be fundamental in directing future AIDS prevention efforts within and beyond the sports arena.

Background: Subconcussion, a mild traumatic brain injury, is best defined and identified by a lack of observable symptoms after axonal injury from minor head impacts. Subconcussive impacts are believed to accumulate with increased exposure over time, and are likely prodromal in the manifestation of a full-blown concussion. As evidenced by changes to changes in cerebral neurochemistry and structure, it is apparent that although individuals who have accumulated subconcussion may present as asymptomatic for motor and/or cognitive impairment using current clinical assessment tools, there is indication of long-term neurological damage which is presently going unrecognized. Objective: For the reasons stated above, a more sensitive and objective assessment tool is required to assess and recognize prodromal concussion manifestation in at risk populations with the intention of preventing further chronic sequelae. Design: Multiple baseline, time-series with repeated measures. Methods: Balance and bilateral reflex variability was assessed at pre-season and at post-season. Results: The current study identified significant changes to static balance postures (taken from the Balance Error Scoring System) through an objective postural assessment of centre of pressure (COP) and Area of Ellipse (AoE) calculations using a low-cost balance board and basic software interface after a season of accumulated subconcussion in female varsity rugby athletes. Specifically, double stance on the floor worsened by 31% in COPAP (p=.025) and by 26% in COPT (p=.038) and tandem stance on an unstable foam surface worsened by 180% in COPML (p=.014), 175% in COPAP (p=.025) and 141% in COPT (p=.005) between pre-and post-season. Our results indicate that these outcome measures are sensitive and can discriminate underlying balance deficits associated with accumulated subconcussive impacts. An objective measurement of spinal cord excitability through bilateral fluctuations of the Hoffman (H-) reflex in the tibial nerve found significantly elevated pre-season Cross Covariance (CCV) values which were 3x higher than those of a neurologically intact control population, suggesting prior neurological damage in study participants. Conclusion: The current study provides a platform for future research investigating bilateral fluctuation in spinal cord excitability after accumulated subconcussion and confirms balance decrements related to subconcussion can be identified through sensitive and specific measurement tools. / Graduate

Thesis (M.A.(Clinical Psychology)) -- University of Limpopo, 2015. / The effect of Cumulative Mild Head Injury (CMHI) in contact sports, such as rugby, is seen increasingly at school level where more and more injuries are reported. Research on CMHI in contact sport is needed specifically amongst previously disadvantaged groups where little or no research has taken place. The research is thus intended to seek a better understanding of CMHI in the contact sport of rugby specifically amongst amateur players. A quantitative research approach was utilised with a quasi-experimental research design. A sample of 18 student rugby players and 18 volleyball (non-contact sport) controls was used. In terms of mean performances the tests did not reveal a consistent pattern of deficits which is typically associated with the effects of Cumulative Mild Head Injuries. There were significant results however, in terms of variability that suggests potential deficits in attention among the rugby group. The results are therefore indicative of a poorer overall cognitive profile for the rugby playing group. It is concluded that the increased variability may be displayed in individuals who suffer CMHI at an earlier age.

La douleur est une sensation universelle pour qui les termes descriptifs élicitent une reconnaissance immédiate. Les sensations de brûlure, de démangeaisons ou de tranchements aigus servent de signal d’alarme ayant pour but d’éviter des dommages corporels. Chez les athlètes, cette alerte est souvent ignorée afin d’atteindre l’excellence en performance. Dépendant du sport, le type de douleur ressenti peut varier. Dans le cas des athlètes d’endurance, la douleur survient naturellement dans le muscle due aux contractions répétées sur une longue période. Alternativement, les athlètes pratiquant un sport de contact doivent aussi anticiper de la douleur « mécanique » produite par des coups infligés par les adversaires. La différence dans la demande et la spécificité de chaque sport sont cependant rarement prises en considération dans les études sur la douleur chez les athlètes. Dans le cadre de ce mémoire de maitrise, une revue de portée a été réalisée pour mieux comprendre comment la perception de la douleur chez les athlètes de sports de contact est étudiée. Trois composantes ont été analysées : Les types de sports de contacts étudiés, les groupes auxquels ils sont comparés, et les méthodes utilisées pour induire expérimentalement la douleur. Onze études ont été retenues. Deux sous-catégories de sports de contact ont été identifiées. Les sports de combat ont plus souvent été inclus dans ces études que les sports d’équipe. Ces athlètes étaient comparés à des groupes composés de non-athlètes et d’athlètes de sports « non-contact ». Quatre méthodes d’induction expérimentale de la douleur ont été utilisés, soit, la pression mécanique, le froid, la chaleur et l’ischémie musculaire. Une justification des choix de méthode d’induction de la douleur ou types d’athlètes inclus dans le cas d’un groupe contrôle de sport non-contact est rarement fourni. Un vide existe dans la littérature quant à la comparaison de la perception de la douleur d’athlètes de sport de contact avec un groupe d’athlètes non-contact et une méthode d’induction expérimentale de la douleur choisi délibérément pour mieux refléter la réalité de la pratique sportive. Un protocole expérimental est proposé pour combler ce besoin. / Pain is a universal sensation whose descriptive terms elicit immediate recognition. The burning, itching, or sharp feelings serve as an alarm system meant to avoid bodily harm. In athletes, this warning is often ignored in the pursuit of performance. Depending on the sport, the type of pain encountered can vary. In the case of endurance athletes, pain occurs naturally within the muscle due to repeated contraction over a long period. Alternatively, athletes in contact sports must also anticipate mechanical pain caused by opponents. The difference in demand and the specificity of each sport are however very rarely taken into consideration when studying pain in athletes. A scoping review was used to better understand how pain perception in contact sport athletes is being studied. Three components were analysed: the types of contact sports being studied, the groups they are being compared to, and the methods used to experimentally induce and study pain. A total of 11 articles were included. Two subcategories of contact sport were identified. Combat sports were more often included in studies than team contact sport. These athletes were compared to both non-athletes and non-contact athletes. Four methods of experimental pain induction were used, namely, the pain pressure test, the cold pressor test, an ischemic pain protocol, and heat pain protocol. Justification was not always provided for either pain protocol selection or non-contact athletes selected as control group. A gap exists in the literature in comparing contact sport athletes’ pain perception with a deliberately chosen athlete control group using a pain induction protocol meant to emulate a facet of pain experienced during exercise. A protocol proposal is included in the discussion to meet this demand.

Lors du dernier consensus international sur les commotions cérébrales (CC) dans le sport tenu à Berlin en 2016, les lignes directrices proposées insistent sur le besoin de biomarqueurs de diagnostic et de suivi des CC, donnant à la prise en charge clinique un caractère plus objectif que celui de l’évaluation traditionnelle des symptômes. L’objectif principal de cette thèse est de dresser un inventaire de paramètres d’évaluation clinique pouvant servir de référence et d’outil au clinicien lors la prise en charge des CC, particulièrement chez les athlètes de sports de contact. Pour l’élaboration de ces outils, en plus de tenir compte des spécificités anthropométriques et démographiques des athlètes, une attention particulière a été portée à ceux présentant un trouble déficitaire de l’attention avec hyperactivité (TDAH) et ceux ayant des antécédents de CC. Le premier objectif de la thèse était de produire des scores normatifs de référence pour l’échelle des symptômes postcommotionnels (PCSS), en plus d’examiner si et comment les antécédents de CC affectent ces scores (étude 1). Le deuxième objectif était de produire des valeurs normatives de la variabilité de la fréquence cardiaque (VFC) à court terme, chez des athlètes de sports de contact, tout en tenant compte des principaux déterminants qui pouvaient l’influencer (étude 2). Le troisième objectif était d’évaluer les scores de base du PCSS et la VFC à court terme, chez des athlètes de sports de contact avec TDAH et de les comparer à ceux d’athlètes sains appariés (étude 3). Les résultats de l’étude 1 ont montré que les scores normatifs des symptômes très élevés et susceptibles de signaler une CC variaient de 1 à 4 et plus, sur une échelle de 6, selon les symptômes concernés (n = 22). La comparaison des proportions des symptômes entre les groupes d’athlètes sans CC et ceux ayant des antécédents de CC a confirmé la présence de symptômes anormalement élevés chez les athlètes à CC répétées. Les résultats de l’étude 2 ont montré que la fréquence cardiaque (FC) était le principal déterminant des paramètres de la VFC standard. Par conséquent, les paramètres de la VFC ont été standardisés et leurs limites normatives développées en fonction de la FC moyenne. L’étude 3 a montré que les athlètes avec TDAH ont produit des scores de symptômes significativement plus élevés comparativement à ceux des athlètes sains appariés. L'évaluation de la VFC a révélé une réduction de plusieurs paramètres chez le groupe avec TDAH. En conclusion, les normes de référence proposées dans cette thèse pourraient être utilisées lors de l’évaluation et du suivi des CC chez les athlètes de sports de contact de sexe masculin. Les outils d’évaluation qui accompagnent nos travaux font directement voir si un score donné se situe dans les limites normales. L’accès facile à ces outils et leur simplicité d’utilisation et d’interprétation sont particulièrement intéressants lorsque l’intervention clinique est combinée à d’autres interventions dans un contexte multidisciplinaire. Il reste que, avec les athlètes souffrant d’un TDAH ou ayant des antécédents de CC, l’interprétation des scores devrait être faite avec prudence. / At the last international consensus on concussion in sports held in Berlin in 2016, the guidelines that were proposed emphasized the need for diagnostic and monitoring biomarkers for concussion, giving clinical management a more objective basis than that of traditional symptom assessment. The main objective of this thesis was to develop an inventory of clinical assessment parameters that may serve as reference and toolbox for the clinician in the management of concussion, particularly in contact sport athletes. For the development of these tools, in addition to taking into account the anthropometric and demographic specificities of the athletes, special attention has been paid to those with ADHD and those with a history of concussions. The first objective of the thesis was to produce a normative baseline scores post concussion symptom scale (PCSS), in addition to examining whether and how concussion history affects these scores (Study 1). The second objective was to produce normative values of short-term heart rate variability (HRV) in contact sport athletes, while accounting for the major determinants that could influence it (Study 2). The third objective was to evaluate baseline PCSS scores and short-term HRV in contact sports athletes with ADHD and to compare them with healthy matched athletes (Study 3). Study 1 showed that the higher normative scores of symptoms likely to signal concussion ranged from 1 to 4 and above on a scale of 6, according to the symptoms (n = 22). A comparison of symptom proportions between groups of athletes without concussions and those with a history of concussions confirmed the prevalence of abnormally high symptoms in athletes with a history of concussions. The results of study 2 showed that heart rate (HR) was the primary determinant of standard HRV parameters. Therefore, the HRV parameters were standardized and their normative limits developed in relation to the mean HR. Study 3 showed that athletes with ADHD produced significantly higher symptom scores compared to matched healthy athletes. Assessment of HRV revealed a lowering in several parameters in the ADHD group. In conclusion, the reference standards proposed in this thesis may be used in the assessment and monitoring of concussion in male contact sports athletes. The assessment tools available in our work directly indicate whether a given score is within the normal range. The easy access to these tools and the simplicity of their use and interpretation are of particular relevance when a clinical intervention is combined with other interventions in a multidisciplinary context. However, for athletes with ADHD or a history of concussions, interpretation of scores should be made with caution.