Neurological soft signs are associated with reduced medial-lateral postural control in adolescent athletes

Elena M Bonke; Amanda Clauwaert; Stefan M Hillmann; Uta Tacke; Caroline Seer; Eukyung Yhang; Yorghos Tripodis; Stian B Sandmo; Tim L T Wiegand; David Kaufmann; Elisabeth Kaufmann; Sutton B Richmond; Malo Gaubert; Johanna Seitz-Holland; Alexander Leemans; Stephan P Swinnen; Roald Bahr; Ofer Pasternak; Florian Heinen; Inga K Koerte; Michaela V Bonfert; Jolien Gooijers

doi:10.1016/j.jns.2022.120516

Neurological soft signs are associated with reduced medial-lateral postural control in adolescent athletes

J Neurol Sci. 2023 Feb 15:445:120516. doi: 10.1016/j.jns.2022.120516. Epub 2022 Dec 5.

Authors

Elena M Bonke¹, Amanda Clauwaert², Stefan M Hillmann³, Uta Tacke⁴, Caroline Seer⁵, Eukyung Yhang⁶, Yorghos Tripodis⁷, Stian B Sandmo⁸, Tim L T Wiegand⁹, David Kaufmann¹⁰, Elisabeth Kaufmann¹¹, Sutton B Richmond¹², Malo Gaubert¹³, Johanna Seitz-Holland¹⁴, Alexander Leemans¹⁵, Stephan P Swinnen¹⁶, Roald Bahr¹⁷, Ofer Pasternak¹⁸, Florian Heinen¹⁹, Inga K Koerte²⁰, Michaela V Bonfert²¹, Jolien Gooijers²²

Affiliations

¹ cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany; Graduate School of Systemic Neurosciences, LMU, Munich, Germany; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
² Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium. Electronic address: [email protected].
³ Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany. Electronic address: [email protected].
⁴ University Children's Hospital (UKBB), Basel, Switzerland. Electronic address: [email protected].
⁵ Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium; KU Leuven, Leuven Brain Institute, Department of Movement Sciences, Movement Control and Neuroplasticity Research Group, Belgium. Electronic address: [email protected].
⁶ Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA. Electronic address: [email protected].
⁷ Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Alzheimer's Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA. Electronic address: [email protected].
⁸ Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. Electronic address: [email protected].
⁹ cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
¹⁰ cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany; Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany. Electronic address: [email protected].
¹¹ cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany; Department of Neurology, LMU, Munich, Germany. Electronic address: [email protected].
¹² Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA. Electronic address: [email protected].
¹³ cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany; Radiology Department, CHU Rennes, Rennes, France; Inria, CNRS, Inserm, IRISA UMR 6074, Empenn ERL, University of Rennes, Rennes, France. Electronic address: [email protected].
¹⁴ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
¹⁵ Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: [email protected].
¹⁶ Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium. Electronic address: [email protected].
¹⁷ Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway. Electronic address: [email protected].
¹⁸ Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
¹⁹ Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany. Electronic address: [email protected].
²⁰ cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU, Munich, Germany; Graduate School of Systemic Neurosciences, LMU, Munich, Germany; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
²¹ Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany. Electronic address: [email protected].
²² Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium; KU Leuven, Leuven Brain Institute, Department of Movement Sciences, Movement Control and Neuroplasticity Research Group, Belgium. Electronic address: [email protected].

PMID: 36702068
DOI: 10.1016/j.jns.2022.120516

Abstract

Introduction: Neurological soft signs (NSS) are minor deviations from the norm in motor performance that are commonly assessed using neurological examinations. NSS may be of clinical relevance for evaluating the developmental status of adolescents. Here we investigate whether quantitative force plate measures may add relevant information to observer-based neurological examinations.

Methods: Male adolescent athletes (n = 141) aged 13-16 years from three European sites underwent a neurological examination including 28 tests grouped into six functional clusters. The performance of tests and functional clusters was rated as optimal/non-optimal resulting in NSS+/NSS- groups and a continuous total NSS score. Participants performed a postural control task on a Balance Tracking System measured as path length, root mean square and sway area. ANCOVAs were applied to test for group differences in postural control between the NSS+ and NSS- group, and between optimal/non-optimal performance on a cluster- and test-level. Moreover, we tested for correlations between the total NSS score and postural control variables.

Results: There was no significant overall difference between the NSS+ and NSS- group in postural control. However, non-optimal performing participants in the diadochokinesis test swayed significantly more in the medial-lateral direction than optimal performing participants. Moreover, a lower total NSS score was associated with reduced postural control in the medial-lateral direction.

Conclusion: Our findings demonstrate that NSS are related to postural control in adolescent athletes. Thus, force plate measures may add a quantitative, objective measurement of postural control to observer-based qualitative assessments, and thus, may complement clinical testing.

Keywords: Adolescent athletes; Diadochokinesis; Maturation; Minor neurological dysfunction; Neurological soft signs; Postural control.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Athletes*
Humans
Male
Neurologic Examination
Postural Balance*

Abstract

Publication types

MeSH terms

Grants and funding