OBJECTIVE: To evaluate whether integrating longitudinal clinical data improves machine learning (ML)-based prediction of time to medical clearance following sport-related concussion (SRC) and to identify clinical features most strongly associated with classification of either 'prolonged' recovery (≥ 30 days) or 'normal' recovery (< 30 days).

METHODS: A retrospective cohort of 217 athletes (mean age 26.94 years) from the USF Concussion Center (2021-2025) was analyzed. Six ML classifiers were trained on Visit 1 features (n = 48) and combined Visit 1 + Visit 2 features (n = 95). Internal validation was performed using Leave-One-Out Cross-Validation (LOOCV).

RESULTS: Prolonged recovery occurred in 81.1% of the cohort. Adding Visit 2 features improved accuracy in 66% of models, with XGBoost achieving the highest accuracy (0.84, +5% gain over Visit 1). Specificity remained low (0.00-0.34) due to class imbalance. VOR Vertical Headache and its change score were the most frequent predictors of prolonged recovery, present in 81% and 100% of models, respectively. Treatment presence between visits emerged as the strongest predictor of normal recovery.

CONCLUSIONS: Longitudinal clinical data modestly improves ML-based SRC recovery predictions. Vestibulo-oculomotor symptoms - particularly headache provoked during vertical VOR testing - are robust prognostic indicators. These findings support the utility of granular VOMS subscores for early risk stratification and targeted rehabilitation. External validation is required before clinical deployment. Code: https://github.com/MeganTran6023/Sport-Related-Concussions_Machine-Lear…. IRB: USF STUDY003514.

BACKGROUND: Traumatic brain injury (TBI), particularly mild forms resulting from blast exposure, remains a diagnostic challenge among veterans due to delayed symptom onset and overlapping psychological conditions such as posttraumatic stress disorder. Current diagnostic methods rely heavily on subjective assessments, contributing to underdiagnosis and inconsistent care. Electroencephalography (EEG) offers a non-invasive, real-time measure of cortical activity with high temporal resolution, making it a promising tool for objective TBI assessment. This sub-study, nested within a randomized controlled trial evaluating hyperbaric oxygen therapy (HBOT) for veterans with TBI, investigates EEG as both a diagnostic modality and a therapeutic monitor.

METHODS: This sub-study adopts the same triple-blinded, randomized, parallel-group design as the parent trial. Participants are veterans with mild to moderate TBI, randomized to receive either HBOT or a sham treatment. EEG data are collected at three time points: baseline (pre-treatment), midpoint (18-21 dives), and post-treatment (2 weeks after completion). EEG recordings are performed during standardized cognitive and motor tasks using a 32-channel wireless headset. Primary outcomes include event-related potential amplitudes and alpha-band spectral power, analyzed for longitudinal changes and group differences. Secondary outcomes include latency measures, spectral power across additional frequency bands, and functional connectivity metrics. Data are modeled using repeated measures analysis to assess treatment effects and individual trajectories.

DISCUSSION: This sub-study aims to validate EEG as a scalable and objective tool for diagnosing and monitoring TBI in clinical settings. By identifying electrophysiological signatures associated with injury severity and treatment response, EEG may enhance diagnostic precision and support personalized care strategies. The integration of EEG within a larger therapeutic trial framework allows for comprehensive evaluation of its clinical utility. Findings may inform future protocols for TBI assessment and contribute to the development of neurophysiological biomarkers that complement existing symptom-based approaches.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06581003. Registered on 30 August 2024.

BACKGROUND: Anterolateral ligament and medial collateral ligament injuries could happen concomitantly with anterior cruciate ligament ruptures. The anterolateral ligament is injured more often than the medial collateral ligament during concomitant anterior cruciate ligament ruptures although it offers less restraint to knee movement. Comparing the material properties of the medial collateral ligament and anterolateral ligament helps improve our understanding of their structure-function relationship and injury risk before the onset of injury.

METHODS: Eight cadaveric lower extremity specimens were prepared and mechanically tested to failure in a laboratory setting using a hydraulic platform. Measurements of surface strains of superficial surface of each medial collateral ligament and anterolateral ligament specimen were found using three-dimensional digital image correlation. Ligament stiffness was found using ultrasound shear-wave elastography. t-tests were used to assess for significant differences in strain, stress, Young's modulus, and stiffness in the two ligaments.

FINDINGS: The medial collateral ligament exhibited greater ultimate failure strain along its longitudinal axis (p = 0.03) and Young's modulus (p < 0.0018) than the anterolateral ligament. Conversely, the anterolateral ligament exhibited greater ultimate failure stress than the medial collateral ligament (p < 0.0001). Medial collateral ligament failure occurred mostly in the proximal aspect of the ligament, while most anterolateral ligament failure occurred in the distal or midsubstance aspect (P = 0.04).

INTERPRETATION: Despite both being ligamentous structures, the medial collateral ligament and anterolateral ligament exhibited separate material properties during ultimate failure testing. The weaker material properties of the anterolateral ligament likely contribute to higher rates of concomitant injury with anterior cruciate ligament ruptures.

Interoception, sometimes referred to as the 'hidden sense,' communicates the state of internal conditions for autonomic energy regulation and is important for human motor control as well as self-awareness. The insula, the cortex of interoception, integrates internal senses such as hunger, thirst and emotions. With input from the cerebellum and proprioceptive inputs, it creates a vast sensorimotor network essential for static posture and dynamic movement. With humans being bipedal to allow for improved mobility and energy utilization, greater neuromotor control is required to effectively stabilize and control the four postural zones of mass (i.e., head, torso, pelvis, and lower extremities) over the base of support. In a dynamic state, this neuromotor control that maintains verticality is critical, challenging energy management for somatic motor control as well as visceral and autonomic functions. In this perspective article, the authors promote a simple series of posture photographs to allow one to integrate more accurate alignment of their postural zones of mass with respect to the gravity line by correlating cortical interoception with cognitive feedback. Doing this focuses one on their body perception in space compared to the objective images. Strengthening interoceptive postural awareness can shift the net result of each zone of postural mass during day-to-day movement towards stronger posture biomechanics and can serve as an individualized strategy to optimize function, longevity, and rehabilitation.

INTRODUCTION: It is well documented that marked weakness of the quadriceps is present after knee joint injury. This joint trauma induces a presynaptic reflex inhibition of musculature surrounding the joint, termed arthrogenic muscle inhibition (AMI). The extent to which anterior cruciate ligament (ACL) injury affects thigh musculature motor unit activity, which may affect restoration of thigh muscle strength after injury, is undetermined.

METHODS: A randomized protocol of knee flexion and extension isometric contractions (10%-50% maximal voluntary isometric contraction) were performed for each leg on 54 subjects with electromyography array electrodes placed on the vastus medialis, vastus lateralis, semitendinosus, and biceps femoris. Longitudinal assessments for motor unit recruitment and average firing rate were acquired at 6-month intervals for 1 year post ACL injury.

RESULTS: The ACL-injured population demonstrated smaller quadriceps and hamstrings motor unit size (assessed via motor unit action potential peak-to-peak amplitude) and altered firing rate activity in both injured and uninjured limbs compared to healthy controls. Motor unit activity remained altered compared to healthy controls at 12 months post ACL reconstruction (ACLR).

DISCUSSION: Motor unit activity was altered after ACLR up to 12 months post-surgery. Further research is warranted to optimize rehabilitation interventions that adequately address altered motor unit activity and improve safety and success with return to sport after ACLR. In the interim, evidence based clinical reasoning with a focus on development of muscular strength and power capacity should be the impetus behind rehabilitation programming to address motor control deficits.

BACKGROUND: Low back pain is an extremely prevalent issue with an extensive impact, ranging from decreased quality of life to lost years of productivity. Many interventions have been developed to alleviate chronic lower back pain, yet it remains a widespread problem. The objective of this study was to examine the role of artificial intelligence guided resistance training relative to clinical variables in subjects experiencing lower back pain.

METHODS: 69 out of 108 enrolled and 92 accrued subjects completed the 8-week intervention. Subjects were randomized into four groups (Control, Training, Clinical, or Combined). The Training cohort received supervised artificial-intelligence-guided core-focused resistance training while the Clinical group received clinical care. The Combined group received both clinical care and artificial-intelligence-guided training and the Control group received no treatment. Participants were evaluated using functional testing and patient-reported outcomes at baseline, 4 weeks, and 8 weeks.

FINDINGS: In the clinical tests, the Clinical and Combined cohorts showed increased total time for isometric extensor endurance and the Clinical cohort increased total distance traveled in the 6-min walk test at 8 weeks. The Training, Clinical, and Combined groups showed improvements in Patient-reported outcomes after 8 weeks. Most of the significant improvements were only seen at the 8-week evaluation for both the clinical evaluations and Patient-reported outcomes. The Control group did not show significant improvements in any outcome measures.

INTERPRETATION: The present data indicate that core-focused interventions, including artificial-intelligence-guided moderate-resistance exercise, can increase objective functional outcomes and patient satisfaction using Patient-reported outcomes in individuals with lower back pain.