Scott E. Ross

Bio: Scott E. Ross is an academic researcher from University of North Carolina at Greensboro. The author has contributed to research in topics: Ankle & Anterior cruciate ligament. The author has an hindex of 23, co-authored 61 publications receiving 3158 citations. Previous affiliations of Scott E. Ross include Uniformed Services University of the Health Sciences & University of North Carolina at Chapel Hill.

Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes.

Abstract: OBJECTIVE: Postural stability and neuropsychological testing are gradually becoming integral parts of postconcussion assessment in athletes. Clinicians, however, sometimes question the viability of instituting preseason baseline testing and the value of these results in making return-to-play decisions. Our purpose was to examine the course of recovery on various postural stability and neuropsychological measures after sport-related concussion. A secondary goal was to determine if loss of consciousness and amnesia, both of which are heavily weighted in most of the concussion classification systems, affect the rate of recovery. DESIGN AND SETTING: All subjects underwent a battery of baseline postural stability and neuropsychological tests before the start of their respective seasons. Any athletes subsequently injured were followed up at postinjury days 1, 3, and 5. Matched control subjects were assessed using the same test battery at the same time intervals. SUBJECTS: We studied 36 Division I collegiate athletes who sustained a concussion and 36 matched control subjects. MEASUREMENTS: We assessed postural stability using the Sensory Organization Test on the NeuroCom Smart Balance Master System and the Balance Error Scoring System. Neurocognitive functioning was measured with several neuropsychological tests: Trail-Making Test, Wechsler Digit Span Test, Stroop Color Word Test, and Hopkins Verbal Learning Test. RESULTS: Injured subjects demonstrated postural stability deficits, as measured on both the Sensory Organization Test and Balance Error Scoring System. These deficits were significantly worse than both preseason scores and matched control subjects' scores on postinjury day 1. Only the results on the Trail-Making Test B and Wechsler Digit Span Test Backward resulted in a logical recovery curve that could explain lowered neuropsychological performance due to concussive injury. Significant differences were revealed between the control and injured groups at day 1 postinjury, but a significant decline between baseline and postinjury scores was not demonstrated. Loss of consciousness and amnesia were not associated with increased deficits or slowed recovery on measures of postural stability or neurocognitive functioning. CONCLUSIONS: Athletes with cerebral concussion demonstrated acute balance deficits, which are likely the result of not using information from the vestibular and visual systems effectively. Neurocognitive deficits are more difficult to identify in the acute stages of concussion, although concentration, working memory, immediate memory recall, and rapid visual processing appear to be mildly affected. More research is necessary to determine the best neuropsychological test battery for assessing sport-related concussion.

Examination of static and dynamic postural stability in individuals with functionally stable and unstable ankles.

Abstract: OBJECTIVE To determine static and dynamic postural stability differences between functional ankle instability and stable ankle groups. DESIGN Subjects were required to balance on a single leg and remain motionless for 20 seconds. After completing 3 trials, they performed a jump-landing test, which required them to jump 50% to 55% of their maximum vertical jump height. They landed on a single leg, stabilized quickly, and remained motionless for 20 seconds. SETTING Sports Medicine Research Laboratory. PARTICIPANTS Subjects with functional ankle instability (n = 14) who reported at least 2 sprains and "giving way" sensations at their ankle joint within the year prior to testing. Fourteen subjects with no history of ankle sprain injury were matched to subjects with functional ankle instability. MAIN OUTCOME MEASURES Anterior/posterior and medial/lateral mean sway quantified static postural stability during single-leg stance. Dynamic postural stability was quantified with anterior/posterior and medial/lateral time to stabilization during single-leg jump landing. RESULTS Mean sway was not significantly different between groups in the anterior/posterior (P = 0.28) and medial/lateral (P = 0.65) directions. The functional ankle instability group took significantly longer to stabilize in the anterior/posterior (3.27 +/- 0.72 seconds vs. 2.33 +/- 0.33 seconds; P < 0.001) and medial/lateral (2.48 +/- 0.50 seconds vs. 2.00 +/- 0.65 seconds; P = 0.04) directions. CONCLUSIONS Individuals with functional ankle instability took significantly longer to stabilize than individuals with stable ankles after a single-leg jump landing. Differences between groups were not detected with mean sway measured during single-leg stance.

Ankle instability is associated with balance impairments: a meta-analysis.

Abstract: ARNOLD, B. L., S. DE LA MOTTE, S. LINENS and S. E. ROSS. Ankle Instability Is Associated with Balance Impairments: A Meta-Analysis. Med. Sci. Sports Exere., Vol: 41, No. 5, pp. 1048-1062, 2009. Purpose: Our primary purpose was to determine whether balance impairments were associated with functional ankle instability (FAI). Methods: Our literature search consisted of four parts: 1) an electronic search of PubMed, CINAHL, pre-CINAHL, and SPORTDiscus; 2) a forward search of articles selected from the electronic search using the Science Citation Index; 3) a hand search of the previously selected articles; and 4) a direct contact with corresponding authors of the previously selected articles. We initially identified 145 articles and narrowed these to 23 for inclusion in the metaanalysis. Identified outcomes were categorized by measurement units and balance task type (i.e., dynamic or static). Each study was coded based on whether inclusion or exclusion criteria were identified. Our statistical analysis included fixed, random, or mixed effect analyses based on the presence of within study heterogeneity and whether categories were being compared. Results: FAI was associated with poorer balance (standard difference of the mean [SDM] = 0.455, 95% confidence interval = 0.334-0.577, Z = 7.34, P < 0.001), but no difference existed between dynamic and static measure categories (Q = 3.44, P = 0.063). However, there was a significant difference between the dynamic measures (Q = 6.22, P = 0.0 13) with both time to stabilization and the Star Excursion Balance Test producing significant SDM and between static measures (Q = 13.00, P = 0.012). with the linear, time, velocity, and other measurement categories (but not area) producing significant SDM. Examination of individual outcomes revealed that time in balance and foot lifts produced very large SDM (3.3 and 4.8, respectively). Conclusion: FAI is associated with impaired balance. Due to the relatively large effect sizes

Single-leg jump-landing stabilization times in subjects with functionally unstable ankles.

Abstract: Scott E. Ross, PhD, ATC, and Kevin M. Guskiewicz, PhD, ATC, contributed to conception and design; acquisition and analysisand interpretation of the data; and drafting, critical revision, and final approval of the article. Bing Yu, PhD, contributed toconception and design; analysis and interpretation of the data; and drafting, critical revision, and final approval of the article.Address correspondence to Scott E. Ross, PhD, ATC, Virginia Commonwealth University, PO Box 842020, 1015 West MainStreet, Richmond, VA 23284. Address e-mail to seross@vcu.edu.Context: Factors contributing to functional ankle instabilitymay cause individuals with the condition to land from a jumpdifferently than those with stable ankles.Objective:To determine stabilization time differences duringsingle-leg jump landings between stable and unstable anklegroups and to report the reliability and precision of time-to-sta-bilization measures.Design:A mixed design with 1 between factor (ankle group)and 1 within factor (direction) was used to analyze the com-parison between our 10 subjects with functional ankle instabilityand 10 subjects with stable ankles. Time to stabilization (sec-onds) was the dependent measure. Reliability for time-to-sta-bilization measures of our 12 additional subjects with stable an-kles were assessed using intraclass correlation coefficients(ICC 2,7). Standard errors of measurements were also calcu-lated for time-to-stabilization measures.Setting:Sports medicine research laboratory.Patients or Other Participant(s): Ten subjects with func-tional ankle instability who reported at least 2 sprains and ‘‘giv-ing way’’ sensations at their ankles constituted the functionalankle instability group. Ten subjects without a history of anklesprain injury served as healthy subjects. Twelve additionalhealthy subjects participated in the reliability study.Intervention(s): Subjects performed a jump-landing test,which required them to jump 50% to 55% of their maximumvertical jump height and then land on a single leg on a forceplate. After landing, they stabilized quickly and remained as mo-tionless as possible in a single-leg stance for 20 s.Main Outcome Measure(s): Anterior-posterior and medial/lateral vibration magnitude curve fit time-to-stabilization.Results:Time to stabilization was longer for the functional ankleinstability group (1.98 6 0.81 s) than for the stable ankle group(1.45 6 0.30 s) (P, .05). Reliability (standard error of the mea-surement) values for anterior/posterior and medial/lateral time-to-stabilization were 0.79 (0.15 s) and 0.65 (0.26 s), respectively.Conclusions: Time to stabilization was longer for subjectswith functional ankle instability than subjects with stable ankles.The ankle instability may have impaired the subjects’ ability tostabilize after a single-leg jump landing. Reliabilities and stan-dard errors of the measurements of time-to-stabilization mea-sures were moderate and low, respectively.Key Words:chronic ankle instability, dynamic balance, pos-tural control

Balance Measures for Discriminating between Functionally Unstable and Stable Ankles

Abstract: ROSS, S. E., K. M. GUSKIEWICZ, M. T. GROSS, and B. YU. Balance Measures for Discriminating between Functionally Unstable and Stable Ankles. Med. Sci. Sports Exerc., Vol. 41, No. 2, pp. 399-407, 2009. Purpose: To identify force plate measures that discriminate between ankles with functional instability and stable ankles and to determine the most accurate force plate measure for enabling this distinction. Methods: Twenty-two subjects (177 + 10 cm, 77 ± 16 kg, 21 ± 2 yr) without a history of ankle injury and 22 subjects (177 + 10 cm, 77 + 16 kg, 20 ± 2 yr) with functional ankle instability (FAI) performed a single-leg static balance test and a single-leg jump-landing dynamic balance test. Static force plate measures analyzed in both anterior/posterior (A/P) and medial/lateral (M/L) directions included the following: ground reaction force (GRF) SD; center-of-pressure (COP) SD; mean, maximum, and total COP excursion; and mean and maximum COP velocity. COP area was also analyzed for static balance. A/P and M/L time to stabilization quantified dynamic balance. Greater values of force plate measures indicated impaired balance. A stepwise discriminant function analysis examined group differences, group classification, and accuracy of force plate measures for discriminating between ankle groups. Results: The FAI group had greater values than the stable ankle group for A/P GRF SD (P 0.027), M/L GRF SD (P = 0.006), M/L COP SD (P = 0.046), A/P mean COP velocity (P = 0.015), M/L mean COP velocity (P 0.016), A/P maximum COP velocity (P = 0.037), M/L mean COP excursion (P = 0.014), M/L total COP excursion (P = 0.016), A/P time to stabilization (P = 0.011), and M/L time to stabilization (P = 0.040). M/L GRF SD and A/P time to stabilization had the greatest accuracy scores of 0.73 and 0.72, respectively. Conclusion: Although 10 measures identified group differences, M/L GRF SD and A/P time to stabilization were the most accurate in discriminating between ankle groups. These results provide evidence for choosing these GRF

Consensus statement on concussion in sport

Abstract: The new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document under the Background section. This document is developed primarily for use by physicians and healthcare professionals who are involved in the care of injured athletes, whether at the recreational, elite or professional level.

Acute Effects and Recovery Time Following Concussion in Collegiate Football Players: The NCAA Concussion Study

Abstract: ContextLack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury.ObjectiveTo prospectively measure immediate effects and natural recovery course relating to symptoms, cognitive functioning, and postural stability following sport-related concussion.Design, Setting, and ParticipantsProspective cohort study of 1631 football players from 15 US colleges. All players underwent preseason baseline testing on concussion assessment measures in 1999, 2000, and 2001. Ninety-four players with concussion (based on American Academy of Neurology criteria) and 56 noninjured controls underwent assessment of symptoms, cognitive functioning, and postural stability immediately, 3 hours, and 1, 2, 3, 5, 7, and 90 days after injury.Main Outcome MeasuresScores on the Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and a neuropsychological test battery.ResultsNo player with concussion was excluded from participation; 79 players with concussion (84%) completed the protocol through day 90. Players with concussion exhibited more severe symptoms (mean GSC score 20.93 [95% confidence interval {CI}, 15.65-26.21] points higher than that of controls), cognitive impairment (mean SAC score 2.94 [95% CI, 1.50-4.38] points lower than that of controls), and balance problems (mean BESS score 5.81 [95% CI, –0.67 to 12.30] points higher than that of controls) immediately after concussion. On average, symptoms gradually resolved by day 7 (GSC mean difference, 0.33; 95% CI, −1.41 to 2.06), cognitive functioning improved to baseline levels within 5 to 7 days (day 7 SAC mean difference, −0.03; 95% CI, −1.33 to 1.26), and balance deficits dissipated within 3 to 5 days after injury (day 5 BESS mean difference, −0.31; 95% CI, −3.02 to 2.40). Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7. There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion.ConclusionsCollegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion.