SHORT ANSWER
Advances and Answers in Pediatric Health
Neuromuscular Training
ORTHOPEDICS
Young athletes who have sustained a concussion are more likely to experience time-loss injuries in the year after they return to sports . Many of these athletes also exhibit lingering neuromuscular motor control deficits , such as trouble with balance or reaction time , which may predispose them to further injuries . A recent Children ’ s Hospital Colorado Sports Medicine Center study has identified a viable treatment that could help reduce this risk . David Howell , PhD , Patrick Carry , PhD , and Julie Wilson , MD , have found encouraging results from using neuromuscular training ( NMT ) as a treatment for concussed athletes to reduce their risk of subsequent injuries ( 1 ).
The team enrolled 27 post-concussion youth athletes in the study , randomly assigned them to NMT intervention or standard care , and monitored injuries for one year after return-to-play clearance . The intervention group participated in guided strength exercises with landing stabilization focus twice a week for eight weeks and all athletes maintained a monthly log , documenting any sports-related injuries and their participation in any organized sports competitions .
After adjusting for age and sex , the researchers found the risk of subsequent injury in the control group to be 3.56 times that of the NMT intervention group , suggesting that NMT intervention can significantly reduce sports-related time-loss injuries . The results of this study could drastically change the way athletes return to play after sustaining a concussion — shifting toward a more standardized , evidence-based approach .
Most recently , at the ninth annual Pediatric Research in Sports Medicine Meeting , Dr . Wilson ’ s presentation of the study received the 2022 Hank Chambers Award for Best Scientific Presentation — Injury Prevention and Motion Analysis . •
1 . Howell DR , Seehusen CN , Carry PM , Walker GA , Reinking SE , Wilson JC . An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk : A Randomized Clinical Trial . Am J Sports Med . 2022 Mar ; 50 ( 4 ): 1120-1129 . doi : 10.1177 / 03635465211069372 . Epub 2022 Jan 21 . PMID : 35060759 .
Tiny Hearts , Huge Tech
FETAL IMAGING
The ability to see a fetal heart using echocardiography , in and of itself , is powerful and has improved postnatal congenital heart disease ( CHD ) surgical outcomes . Similar to postnatal care , MRI has the potential to add significant value to echocardiography by allowing physicians to visualize the entire fetal system . However , fetal cardiac MRI is exceptionally challenging to perform due to the small size of the fetal heart , fetal motion and lack of a reliable cardiac gating signal ( i . e ., trigger ) to capture the fetal heart rate .
Thanks to a cross-departmental collaboration between radiology , cardiology and maternal fetal medicine , two of the country ’ s top cardiac MRI scientists , Mehdi H . Moghari , PhD , and Alex Barker , PhD , have worked with cardiac MRI experts Lorna P . Browne , MD , Rick M . Friesen , MD , and many other partners to overcome these challenges . Children ’ s Hospital Colorado is now one of the few hospitals globally capable of performing fetal cardiac MRI in clinical practice with different two-dimensional ( 2D ), 3D and 4D imaging techniques .
To address the challenges that fetal cardiac MRI brings , the team developed two approaches . The first is self-gating , whereby the fetal heart rate is extracted from any motion in the acquired image and then the image is reconstructed inline on MRI scanners with the knowledge of this heart rate . The team at Children ’ s Colorado has imaged 38 fetuses successfully with this technique ( manuscript in review ). In the second technique , an MRI-compatible doppler ultrasound device is placed on the maternal abdomen to identify the fetal heart rate and send the information directly to the scanner . This technique is very successful in late third-trimester fetal hearts and has facilitated a 4D flow approach for visualizing the cardiovascular circulation . The team has imaged 17 fetuses with this device , which is now FDA-approved , and they are piloting an exciting research study to identify fetal biomarkers of aortic coarctation in third trimester fetuses .
Fetal cardiac evaluation with MRI is more than just beautiful images . This modality offers exceptional functional and anatomical information because it can image the entire complex fetal cardiovascular system , facilitating analysis of chamber size , complex blood flow patterns and fetal blood oxygen saturation and oxygen delivery to tissues . The team is optimistic that the unique abilities of fetal cardiac MRI may help answer some of the current unknowns that exist in prenatal CHD evaluations .
Many people from cardiology , radiology and maternal fetal medicine have significantly contributed to the development of these new technologies , including Bettina Cuneo , MD ( Fetal Cardiology ); Mariana Meyers , MD ( Fetal Radiology ); Erin Englund , PhD ; and Michael Zaretzky , MD ( Maternal Fetal Medicine ). The success of this project is due to this great cross-departmental partnership . •
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