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Pangrazio O, Forriol F, Aguirre AS, Beletanga MD, Torres AR. Enhancing Protocols for Concussion Management in Professional Soccer Events. Cureus 2024; 16:e64064. [PMID: 39114186 PMCID: PMC11304360 DOI: 10.7759/cureus.64064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 08/10/2024] Open
Abstract
AIM Every year, there are an estimated 1.7 to 3.8 million sports-related traumatic brain injuries. A sports concussion results from an external force or a blow to the head or body, causing cranial encephalic trauma that can affect motor skills and brain function, producing varying symptoms related to an alteration in neurological functioning. Soccer poses a risk of concussions due to heading, where the player's head directly hits the ball to redirect or accelerate it. However, most concussions are caused by contact between players, such as head-to-head or head-to-elbow contact. This study analyzed the incidence of concussions or mild traumatic brain injuries in professional soccer during the "Copa America 2019" to understand the feasibility of soccer concussion protocols and propose evidence-based enhancements. METHODS The data were previously collected by our first two authors, O. Pangrazio and F. Forriol, during the 46th edition of the "Copa America 2019," where the South American Football Confederation implemented the Concussion Fast Recognition Protocol to detect traumatic brain injuries. The descriptive basic data will help to raise awareness and motivate further research in this field. We have analyzed and correlated it with global data to provide a comprehensive review and tangible evidence of the population size where soccer protocols are typically applied, thus calculating incidence rates to measure it mathematically. RESULTS Our study reveals that the incidence rate of concussions during the "Copa America 2019" was 5.3 per 1,000 athlete exposures, with a total of three concussions occurring among 567 players. Despite the effectiveness of current protocols in detecting concussions rapidly and accurately, the relatively low incidence rate at this level of professional competition poses a challenge to validating these protocols. These results indicate that while the protocols in place are efficient, the testing and validation of new tools and approaches would be more beneficial at different levels of play where the incidence rates of concussions are higher. In environments with a greater frequency of concussions, the robustness and reliability of these protocols can be more thoroughly evaluated, ensuring they provide optimal protection and care for athletes. CONCLUSION The incidence of concussions is low in professional soccer tournaments. Protocols are necessary to protect players and educate sports professionals. However, their validation is difficult given the low incidence of concussions at this level of competition. Our proposed protocol helps unify a basic approach in the field and an advanced approach in any emergency department, providing better detection of concussions and improved outcomes for players. This protocol should be validated in populations with higher incidence rates to demonstrate its effectiveness.
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Affiliation(s)
- Osvaldo Pangrazio
- Orthopedics, South American Football Confederation (CONMEBOL), Luque, PRY
| | - Francisco Forriol
- Family Medicine, South American Football Confederation (CONMEBOL), Luque, PRY
| | - Alex S Aguirre
- Pediatrics, Boston University Chobania and Avedisian School of Medicine, Boston Medical Center, Boston, USA
| | - Maria D Beletanga
- General Practice, Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center, Boston, USA
| | - Alcy R Torres
- Pediatrics, Boston University School of Medicine, Boston, USA
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Shafik A, Bennett P, Rosenbloom C, Okholm Kryger K, Carmody S, Power J. Sport-related concussion attitudes and knowledge in elite English female footballers. SCI MED FOOTBALL 2024; 8:119-125. [PMID: 36541545 DOI: 10.1080/24733938.2022.2161613] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sport-related concussions (SRC) are more common and more severe in women's football than men's yet the knowledge and attitudes of SRC in the women's game are not well understood. The objective of this study was to assess the SRC knowledge and attitude in elite female footballers. METHODS An online questionnaire was sent to all registered players in the English Football Association Women's Super League (WSL) and Championship. Respondents completed an amended version of the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS). Concussion Knowledge Index (CKI) and Concussion Attitudes Index (CAI) scores were derived for all respondents. RESULTS One hundred and twenty-three players completed the survey with 111 fitting the inclusion criteria. The mean CKI score was 20.5 ± 2.3 and the mean CAI score was 63.3 ± 6.3. A weak positive correlation was shown between the CKI and CAI (r = 0.20; p = 0.03). Previous concussion education had a significant impact on increased knowledge (U = 1198; p = 0.04). There was no significant difference in concussion attitudes and knowledge between the WSL and Championship or in those with a previous concussion history and no previous concussion (p > 0.05). CONCLUSION Previous SRC education demonstrated an increased knowledge around concussion but a limited impact towards concussion attitudes. It is suggested that concussion education should be mandated across the professional game to enhance player welfare.
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Affiliation(s)
- Andrew Shafik
- Sport and Exercise Medicine, University of Leeds, Leeds, UK
- Millwall Football Club Medical Department, London, UK
| | - Pippa Bennett
- The Football Association, Technical Directorate, Burton-Upon-Trent, UK
| | - Craig Rosenbloom
- The Football Association, Technical Directorate, Burton-Upon-Trent, UK
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
- Tottenham Hotspur Football Club Medical Department, London, UK
| | - Katrine Okholm Kryger
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
- Health and Applied Science, St Mary's University Twickenham, London, UK
| | - Sean Carmody
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC,University of Amsterdam, Amsterdam, The Netherlands
| | - Jonathan Power
- Sport and Exercise Medicine, University of Leeds, Leeds, UK
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McNamee M, Anderson LC, Borry P, Camporesi S, Derman W, Holm S, Knox TR, Leuridan B, Loland S, Lopez Frias FJ, Lorusso L, Malcolm D, McArdle D, Partridge B, Schramme T, Weed M. Sport-related concussion research agenda beyond medical science: culture, ethics, science, policy. JOURNAL OF MEDICAL ETHICS 2024:jme-2022-108812. [PMID: 36868564 DOI: 10.1136/jme-2022-108812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes.
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Affiliation(s)
- Mike McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | | | - Pascal Borry
- Department of Public Health and Primary Care, Leuven, Leuven, Belgium
| | - Silvia Camporesi
- Global Health & Social Medicine, King's College London, London, UK
- Department of Political Sciences, University of Vienna, Wien, Austria
| | - Wayne Derman
- Institute of Sport & Exercise Medicine, Dept of Exercise, Sport & Lifestyle Medicine, Facuty of Medicine & Health Science, Stellenbosch University, Stellenbosch, South Africa
- IOC Research Center, Stellenbosch, South Africa
| | - Soren Holm
- Centre for Social Ethics and Policy, University of Manchester, Manchester, UK
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | | | - Bert Leuridan
- Centre for Philosophical Psychology, University of Antwerp, Antwerpen, Belgium
| | - Sigmund Loland
- Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
| | | | - Ludovica Lorusso
- Departament de Psicologia Social, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Dominic Malcolm
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Brad Partridge
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Thomas Schramme
- Department of Philosophy, University of Liverpool Faculty of Humanities and Social Sciences, Liverpool, UK
| | - Mike Weed
- Centre for Sport, Physical Education & Activity Research (spear), Canterbury Christ Church University, Canterbury, UK
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Musko PA, Demetriades AK. Are Sex Differences in Collegiate and High School Sports-Related Concussion Reflected in the Guidelines? A Scoping Review. Brain Sci 2023; 13:1310. [PMID: 37759911 PMCID: PMC10526868 DOI: 10.3390/brainsci13091310] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Sport-related concussion (SRC) is a common sport injury. Females are participating in sports at increasing rates, and there is growing awareness that female athletes may be more vulnerable to SRC. Objectives: We aimed to identify sex differences in epidemiology, clinical manifestation and assessment of SRC and examine how these relate to the 6th International Conference on Concussion in Sport (ICCS). Methods: We conducted a scoping review of the Medline database and identified 58 studies examining the effects of sex on SRC in collegiate and high school athletes that were written in English and published in a peer-reviewed journal between March 2012 and March 2022. Results: We found that female athletes suffer higher rates of concussion in sex-comparable sports, in particular soccer. Female athletes experience more somatic symptoms-headache/migraine/sleep disturbance-and may take longer to recover from concussion. Sex differences were also identified regarding some aspects of sideline concussion assessment with the Sport Concussion Assessment Tool. Conclusions: Females are at greater risk and experience SRC differently than males; this is mostly likely due to a combination of biomechanical factors, differences in neck musculature and hormonal and social factors. Sex differences are not widely addressed by the 6th ICSS, which informs many sports' concussion protocols.
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Affiliation(s)
- Patryk A. Musko
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK;
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Iring-Sanchez S, Tosto J, Favre M, Kim S, Falvo M, Serrador JM. The consideration of post-exercise impact on SCAT3 scores in athletes immediately following a head injury. Brain Inj 2023; 37:643-654. [PMID: 36961103 PMCID: PMC11025343 DOI: 10.1080/02699052.2023.2184868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 03/25/2023]
Abstract
METHODS Symptoms were assessed immediately following completion of a rugby match (median 60 minutes). Players removed from the match for assessment due to a head hit were classified as head injured. Controls completed match without head hit. RESULTS 209 players (67 female; 33 ± 13 years) participated with 80 experiencing a head injury. Symptom severity was significantly greater in head injured (26.2 ± 17.6) compared with controls (8.9 ± 11.5, P < 0.001). 21% of control players reporting >16 symptom severity, misclassifying them as suspected concussion. There were no significant sex differences. Factor analysis produced four symptom clusters of which Headache was most discriminatory between the head injured (median = 1.7) and controls (median = 0.0). CONCLUSION These findings demonstrate that exercise and contact during a game affect symptom assessment, increasing the likelihood of misclassifying players with suspected concussion. Factor characterization of symptoms associated with head injury using an exercised comparison group provides more useful discrimination. These results highlight the necessity for objective measures to diagnose concussions outside of symptom self-report.
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Affiliation(s)
- Stephanie Iring-Sanchez
- Pharmacology, Physiology & Neuroscience, Rutgers Biomedical Health Sciences, Newark, NJ, USA
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ USA
| | - Jenna Tosto
- RUSK Rehabilitation, New York University Grossman School of Medicine, New York, NY USA
| | - Michelle Favre
- Pharmacology, Physiology & Neuroscience, Rutgers Biomedical Health Sciences, Newark, NJ, USA
| | - Sinae Kim
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ USA
| | - Michael Falvo
- Pharmacology, Physiology & Neuroscience, Rutgers Biomedical Health Sciences, Newark, NJ, USA
- War Related Illness and Injury Study Center, Department of Veterans Affairs, NJ Healthcare System, East Orange, NJ, USA
| | - Jorge M. Serrador
- Pharmacology, Physiology & Neuroscience, Rutgers Biomedical Health Sciences, Newark, NJ, USA
- MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, Australia
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Hicks SD, Onks C, Kim RY, Zhen KJ, Loeffert J, Loeffert AC, Olympia RP, Fedorchak G, DeVita S, Gagnon Z, McLoughlin C, Madeira MM, Zuckerman SL, Lee T, Heller M, Monteith C, Campbell TR, Neville C, Fengler E, Dretsch MN. Refinement of saliva microRNA biomarkers for sports-related concussion. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:369-378. [PMID: 34461327 DOI: 10.1016/j.jshs.2021.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/29/2021] [Accepted: 07/13/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Recognizing sport-related concussion (SRC) is challenging and relies heavily on subjective symptom reports. An objective, biological marker could improve recognition and understanding of SRC. There is emerging evidence that salivary micro-ribonucleic acids (miRNAs) may serve as biomarkers of concussion; however, it remains unclear whether concussion-related miRNAs are impacted by exercise. We sought to determine whether 40 miRNAs previously implicated in concussion pathophysiology were affected by participation in a variety of contact and non-contact sports. Our goal was to refine a miRNA-based tool capable of identifying athletes with SRC without the confounding effects of exercise. METHODS This case-control study harmonized data from concussed and non-concussed athletes recruited across 10 sites. Levels of salivary miRNAs within 455 samples from 314 individuals were measured with RNA sequencing. Within-subjects testing was used to identify and exclude miRNAs that changed with either (a) a single episode of exercise (166 samples from 83 individuals) or (b) season-long participation in contact sports (212 samples from 106 individuals). The miRNAs that were not impacted by exercise were interrogated for SRC diagnostic utility using logistic regression (172 samples from 75 concussed and 97 non-concussed individuals). RESULTS Two miRNAs (miR-532-5p and miR-182-5p) decreased (adjusted p < 0.05) after a single episode of exercise, and 1 miRNA (miR-4510) increased only after contact sports participation. Twenty-three miRNAs changed at the end of a contact sports season. Two of these miRNAs (miR-26b-3p and miR-29c-3p) were associated (R > 0.50; adjusted p < 0.05) with the number of head impacts sustained in a single football practice. Among the 15 miRNAs not confounded by exercise or season-long contact sports participation, 11 demonstrated a significant difference (adjusted p < 0.05) between concussed and non-concussed participants, and 6 displayed moderate ability (area under curve > 0.70) to identify concussion. A single ratio (miR-27a-5p/miR-30a-3p) displayed the highest accuracy (AUC = 0.810, sensitivity = 82.4%, specificity = 73.3%) for differentiating concussed and non-concussed participants. Accuracy did not differ between participants with SRC and non-SRC (z = 0.5, p = 0.60). CONCLUSION Salivary miRNA levels may accurately identify SRC when not confounded by exercise. Refinement of this approach in a large cohort of athletes could eventually lead to a non-invasive, sideline adjunct for SRC assessment.
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Affiliation(s)
- Steven D Hicks
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA.
| | - Cayce Onks
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; Department of Family Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Raymond Y Kim
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Kevin J Zhen
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Jayson Loeffert
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; Department of Family Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Andrea C Loeffert
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Robert P Olympia
- Department of Emergency Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Gregory Fedorchak
- Department of Research and Development, Quadrant Biosciences Inc., Syracuse, NY 13210, USA
| | - Samantha DeVita
- Department of Research and Development, Quadrant Biosciences Inc., Syracuse, NY 13210, USA
| | - Zofia Gagnon
- Department of Biology, Marist College, Poughkeepsie, NY 12601, USA
| | | | - Miguel M Madeira
- Department of Biology, Marist College, Poughkeepsie, NY 12601, USA
| | - Scott L Zuckerman
- Sports Concussion Center, College of Medicine, Vanderbilt University, Nashville, TN 37212, USA
| | - Timothy Lee
- Sports Concussion Center, College of Medicine, Vanderbilt University, Nashville, TN 37212, USA
| | - Matthew Heller
- Department of Family Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA
| | - Chuck Monteith
- Department of Athletic Training, Colgate University, Hamilton, NY 13346, USA
| | - Thomas R Campbell
- Department of Rehabilitation Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Christopher Neville
- Department of Physical Therapy Education, Orthopedics, and Neuroscience, College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Elise Fengler
- Department of Exercise Science, Syracuse University, Syracuse, NY 13210, USA
| | - Michael N Dretsch
- Department of Medical Research-West, Walter Reed Army Institute of Research, US Army Joint Base Lewis-McChord, Hillhurst, WA 98433, USA
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Iacobucci G. Any sportsperson with suspected concussion should stop playing, says new UK guidance. BMJ 2023; 381:915. [PMID: 37116908 DOI: 10.1136/bmj.p915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Planchet J, Lynch CR, Mozzer PL, Seichepine D. Reliability of the Balance Error Scoring System test is maintained during remote administration. Concussion 2023. [DOI: 10.2217/cnc-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Aim: This study investigates if scores on the Balance Error Scoring System (BESS) are affected when administered remotely. Materials & methods: Participants included 26 undergraduate students, aged 19-32 (mean: 21.85 ± 2.95). Each participant received the BESS test remotely and in person, and scores on each were compared. To minimize potential practice effects, participants were randomly assigned to two equal sized groups to take the BESS remotely first or in person first. Results: The mean difference between scores for the remote and in-person assessments was 0.711 (95% CI: 0.708–2.131). There was no significant difference between scores (p = 0.312) indicating the BESS maintains reliability when administered remotely. Conclusion: Administration of the BESS remotely was possible without any significant challenges.
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Affiliation(s)
- Joey Planchet
- Life Sciences Department, Neuropsychology Laboratory, University of New Hampshire, 88 Commercial Street, Manchester, NH 03101, USA
| | - Camden R Lynch
- Life Sciences Department, Neuropsychology Laboratory, University of New Hampshire, 88 Commercial Street, Manchester, NH 03101, USA
| | - Pamella L Mozzer
- Life Sciences Department, Neuropsychology Laboratory, University of New Hampshire, 88 Commercial Street, Manchester, NH 03101, USA
| | - Daniel Seichepine
- Life Sciences Department, Neuropsychology Laboratory, University of New Hampshire, 88 Commercial Street, Manchester, NH 03101, USA
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Consequences of Sport-Related Concussion on Health-Related Quality of Life in Adolescents: A Critically Appraised Topic. J Sport Rehabil 2023; 32:107-114. [PMID: 36220144 DOI: 10.1123/jsr.2022-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
Abstract
CLINICAL SCENARIO Sport-related concussions (SRCs) are a prevalent and problematic injury occurring among adolescents participating in sports. Health-related quality of life (HRQoL) has been shown to be affected in a portion of adolescents recovering from SRCs, though the exact nature of the relationship has yet to be firmly established for this age group through the duration and completion of recovery. HRQoL can be a nebulous construct but is often described as multifaceted and demonstrates effects of an illness, injury, or condition on one's overall well-being, encompassing satisfaction and comfortability of physical, psychosocial, sleep, and cognitive attributes. CLINICAL QUESTION How do adolescents diagnosed with sport-related concussion perceive changes in health-related quality of life domain measures throughout recovery? SUMMARY OF KEY FINDINGS Four studies met the inclusion criteria, including 1 longitudinal prospective case series and 3 longitudinal prospective cohort studies. The literature indicated that adolescents who sustained an SRC reported an initial immediate decrease in overall HRQoL as well as domains including cognitive, physical, school, and sleep. This initial decrease was particularly notable in those with delayed recovery or those diagnosed with post-concussion syndrome. Despite the initial decrease, all participants of varying SRC recovery duration reportedly returned to healthy, normative levels of HRQoL upon recovery. CLINICAL BOTTOM LINE Adolescents reportedly experience initial decreases in various HRQoL domains immediately after SRC but appear to rebound to a healthy status upon recovery regardless of recovery duration. STRENGTH OF RECOMMENDATION Results of the review of 4 longitudinal studies established level B evidence.
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Davidson B, Anglim M, Williams RM. Assessment of Concussion Knowledge, Attitudes, and Behaviors Among Adolescent Female Club Soccer Athletes. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2023. [DOI: 10.1123/ijatt.2022-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Concussion education for athletes is essential for informed decision making to aid recovery. Education about concussion symptoms, treatment, and protocols can improve symptom recognition, reporting behaviors, protocol compliance, and overall health outcomes. This pilot study aimed to understand current concussion knowledge, attitudes, and beliefs among female club soccer players aged 12–18 years. Findings identified gaps in concussion education and knowledge among these athletes. Continued concussion education efforts are needed to increase concussion knowledge and players’ confidence, focusing on creative education practices.
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Gomez D, Glang A, Haarbauer-Krupa J, Bull R, Tucker P, Ratcliffe J, Hall A, Gioia GA, Jain S, Sathian U, Simon HK, Wright D. Stakeholder perspectives on navigating the pediatric concussion experience: Exploring the needs for improved communication across the care continuum. NeuroRehabilitation 2023; 52:605-612. [PMID: 37125574 PMCID: PMC10481243 DOI: 10.3233/nre-220220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND For children, the post-concussion return to school process is a critical step towards achieving positive health outcomes. The process requires integration between healthcare professionals, parents, and school personnel. OBJECTIVE This research team conducted focus groups with stakeholders including parents, education personnel, school nurses, external healthcare providers (nurses) and athletic trainers to identify communication patterns between healthcare providers outside of the school setting and school personnel. METHODS Data from focus groups were analyzed using a Thematic Analysis approach. Researchers used an inductive (bottom-up) coding process to describe semantic themes and utilized a critical realist epistemology. RESULTS We identified four key themes within focus group data: (1) lack of effective communication between hospital and outpatient healthcare providers to school personnel; (2) parents who were strong advocates had improved communication with healthcare professionals and garnered more accommodations for their children; (3) non-school professionals and families were often confused about who the point of contact was at a given school; and (4) differing experiences for athletes vs. non-athletes. CONCLUSION This study suggests gaps in communication between healthcare and school professionals when children return to school following a concussion. Improving communication between healthcare providers and school staff will require a multi-faceted approach.
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Affiliation(s)
- Douglas Gomez
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Ann Glang
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC) Atlanta, GA, USA
| | - Rachel Bull
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Paula Tucker
- Department of Emergency Medicine, Nell Hodgson Woodruff School of Nursing, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan Ratcliffe
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Alex Hall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gerard A. Gioia
- Division of Pediatric Neuropsychology, Children’s National Hospital, George Washington University School of Medicine Washington, DC, USA
| | - Shabnam Jain
- Pediatric Emergency Medicine, Children’s Healthcare of Atlanta, Emory University Atlanta, GA, USA
| | - Usha Sathian
- Pediatric Urgent Care, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Harold K. Simon
- Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - David Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Prevalence of Acute Neck Pain Following Sports-Related Concussion in High School Athletes. Clin J Sport Med 2022; 32:e556-e561. [PMID: 36315823 DOI: 10.1097/jsm.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore the prevalence of acute neck pain in high school athletes following sports-related concussion (SRC) and to examine the role of acute neck pain in modifying or amplifying concurrent concussive symptoms. DESIGN Retrospective observational. SETTING High school sporting events. PARTICIPANTS High school athletes who suffered a sports-related concussion between the 2011 and 2019 academic years academic years from the National Athletic Treatment, Injury and Outcomes Network (NATION) Study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Prevalence of neck pain (yes/no) along with 33 other commonly reported concussion symptoms, number of symptoms reported, mechanism of injury (contact with person/surface or object), sport type (contact/noncontact), and injury history (first time/repeated injury). RESULTS One hundred thirty-eight of 401 athletes (33.9%) indicated acute neck pain following SRC. Those with neck pain reported significantly more symptoms overall (M = 13.53, SD = 6.89) relative to their non-neck pain counterparts (M = 8.46, SD = 5.68; t [191.35] = 7.11, P < 0.001). Athletes with SRC due to contact with a surface were significantly less likely to report neck pain than those reported contact with a person. Neck pain, repeated injury, and female sex were significantly associated with a greater number of concussion symptoms in the acute phase. CONCLUSIONS Our data suggest that acute neck pain is a frequent acute symptom following SRC and signals the necessity for additional screening to seek and identify comorbid cervical pathology. Prospective studies should seek to access the benefit of cervical therapy in the early stages in SRC patients with neck pain to reduce the risk of persistent postconcussion symptoms.
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Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, Aries M, Bashford T, Bell MJ, Bodien YG, Brett BL, Büki A, Chesnut RM, Citerio G, Clark D, Clasby B, Cooper DJ, Czeiter E, Czosnyka M, Dams-O’Connor K, De Keyser V, Diaz-Arrastia R, Ercole A, van Essen TA, Falvey É, Ferguson AR, Figaji A, Fitzgerald M, Foreman B, Gantner D, Gao G, Giacino J, Gravesteijn B, Guiza F, Gupta D, Gurnell M, Haagsma JA, Hammond FM, Hawryluk G, Hutchinson P, van der Jagt M, Jain S, Jain S, Jiang JY, Kent H, Kolias A, Kompanje EJO, Lecky F, Lingsma HF, Maegele M, Majdan M, Markowitz A, McCrea M, Meyfroidt G, Mikolić A, Mondello S, Mukherjee P, Nelson D, Nelson LD, Newcombe V, Okonkwo D, Orešič M, Peul W, Pisică D, Polinder S, Ponsford J, Puybasset L, Raj R, Robba C, Røe C, Rosand J, Schueler P, Sharp DJ, Smielewski P, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Temkin N, Tenovuo O, Theadom A, Thomas I, Espin AT, Turgeon AF, Unterberg A, Van Praag D, van Veen E, Verheyden J, Vyvere TV, Wang KKW, Wiegers EJA, Williams WH, Wilson L, Wisniewski SR, Younsi A, Yue JK, Yuh EL, Zeiler FA, Zeldovich M, Zemek R. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol 2022; 21:1004-1060. [PMID: 36183712 PMCID: PMC10427240 DOI: 10.1016/s1474-4422(22)00309-x] [Citation(s) in RCA: 255] [Impact Index Per Article: 127.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023]
Abstract
Traumatic brain injury (TBI) has the highest incidence of all common neurological disorders, and poses a substantial public health burden. TBI is increasingly documented not only as an acute condition but also as a chronic disease with long-term consequences, including an increased risk of late-onset neurodegeneration. The first Lancet Neurology Commission on TBI, published in 2017, called for a concerted effort to tackle the global health problem posed by TBI. Since then, funding agencies have supported research both in high-income countries (HICs) and in low-income and middle-income countries (LMICs). In November 2020, the World Health Assembly, the decision-making body of WHO, passed resolution WHA73.10 for global actions on epilepsy and other neurological disorders, and WHO launched the Decade for Action on Road Safety plan in 2021. New knowledge has been generated by large observational studies, including those conducted under the umbrella of the International Traumatic Brain Injury Research (InTBIR) initiative, established as a collaboration of funding agencies in 2011. InTBIR has also provided a huge stimulus to collaborative research in TBI and has facilitated participation of global partners. The return on investment has been high, but many needs of patients with TBI remain unaddressed. This update to the 2017 Commission presents advances and discusses persisting and new challenges in prevention, clinical care, and research. In LMICs, the occurrence of TBI is driven by road traffic incidents, often involving vulnerable road users such as motorcyclists and pedestrians. In HICs, most TBI is caused by falls, particularly in older people (aged ≥65 years), who often have comorbidities. Risk factors such as frailty and alcohol misuse provide opportunities for targeted prevention actions. Little evidence exists to inform treatment of older patients, who have been commonly excluded from past clinical trials—consequently, appropriate evidence is urgently required. Although increasing age is associated with worse outcomes from TBI, age should not dictate limitations in therapy. However, patients injured by low-energy falls (who are mostly older people) are about 50% less likely to receive critical care or emergency interventions, compared with those injured by high-energy mechanisms, such as road traffic incidents. Mild TBI, defined as a Glasgow Coma sum score of 13–15, comprises most of the TBI cases (over 90%) presenting to hospital. Around 50% of adult patients with mild TBI presenting to hospital do not recover to pre-TBI levels of health by 6 months after their injury. Fewer than 10% of patients discharged after presenting to an emergency department for TBI in Europe currently receive follow-up. Structured follow-up after mild TBI should be considered good practice, and urgent research is needed to identify which patients with mild TBI are at risk for incomplete recovery. The selection of patients for CT is an important triage decision in mild TBI since it allows early identification of lesions that can trigger hospital admission or life-saving surgery. Current decision making for deciding on CT is inefficient, with 90–95% of scanned patients showing no intracranial injury but being subjected to radiation risks. InTBIR studies have shown that measurement of blood-based biomarkers adds value to previously proposed clinical decision rules, holding the potential to improve efficiency while reducing radiation exposure. Increased concentrations of biomarkers in the blood of patients with a normal presentation CT scan suggest structural brain damage, which is seen on MR scanning in up to 30% of patients with mild TBI. Advanced MRI, including diffusion tensor imaging and volumetric analyses, can identify additional injuries not detectable by visual inspection of standard clinical MR images. Thus, the absence of CT abnormalities does not exclude structural damage—an observation relevant to litigation procedures, to management of mild TBI, and when CT scans are insufficient to explain the severity of the clinical condition. Although blood-based protein biomarkers have been shown to have important roles in the evaluation of TBI, most available assays are for research use only. To date, there is only one vendor of such assays with regulatory clearance in Europe and the USA with an indication to rule out the need for CT imaging for patients with suspected TBI. Regulatory clearance is provided for a combination of biomarkers, although evidence is accumulating that a single biomarker can perform as well as a combination. Additional biomarkers and more clinical-use platforms are on the horizon, but cross-platform harmonisation of results is needed. Health-care efficiency would benefit from diversity in providers. In the intensive care setting, automated analysis of blood pressure and intracranial pressure with calculation of derived parameters can help individualise management of TBI. Interest in the identification of subgroups of patients who might benefit more from some specific therapeutic approaches than others represents a welcome shift towards precision medicine. Comparative-effectiveness research to identify best practice has delivered on expectations for providing evidence in support of best practices, both in adult and paediatric patients with TBI. Progress has also been made in improving outcome assessment after TBI. Key instruments have been translated into up to 20 languages and linguistically validated, and are now internationally available for clinical and research use. TBI affects multiple domains of functioning, and outcomes are affected by personal characteristics and life-course events, consistent with a multifactorial bio-psycho-socio-ecological model of TBI, as presented in the US National Academies of Sciences, Engineering, and Medicine (NASEM) 2022 report. Multidimensional assessment is desirable and might be best based on measurement of global functional impairment. More work is required to develop and implement recommendations for multidimensional assessment. Prediction of outcome is relevant to patients and their families, and can facilitate the benchmarking of quality of care. InTBIR studies have identified new building blocks (eg, blood biomarkers and quantitative CT analysis) to refine existing prognostic models. Further improvement in prognostication could come from MRI, genetics, and the integration of dynamic changes in patient status after presentation. Neurotrauma researchers traditionally seek translation of their research findings through publications, clinical guidelines, and industry collaborations. However, to effectively impact clinical care and outcome, interactions are also needed with research funders, regulators, and policy makers, and partnership with patient organisations. Such interactions are increasingly taking place, with exemplars including interactions with the All Party Parliamentary Group on Acquired Brain Injury in the UK, the production of the NASEM report in the USA, and interactions with the US Food and Drug Administration. More interactions should be encouraged, and future discussions with regulators should include debates around consent from patients with acute mental incapacity and data sharing. Data sharing is strongly advocated by funding agencies. From January 2023, the US National Institutes of Health will require upload of research data into public repositories, but the EU requires data controllers to safeguard data security and privacy regulation. The tension between open data-sharing and adherence to privacy regulation could be resolved by cross-dataset analyses on federated platforms, with the data remaining at their original safe location. Tools already exist for conventional statistical analyses on federated platforms, however federated machine learning requires further development. Support for further development of federated platforms, and neuroinformatics more generally, should be a priority. This update to the 2017 Commission presents new insights and challenges across a range of topics around TBI: epidemiology and prevention (section 1 ); system of care (section 2 ); clinical management (section 3 ); characterisation of TBI (section 4 ); outcome assessment (section 5 ); prognosis (Section 6 ); and new directions for acquiring and implementing evidence (section 7 ). Table 1 summarises key messages from this Commission and proposes recommendations for the way forward to advance research and clinical management of TBI.
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Affiliation(s)
- Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Mathew Abrams
- International Neuroinformatics Coordinating Facility, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Åkerlund
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Nada Andelic
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marcel Aries
- Department of Intensive Care, Maastricht UMC, Maastricht, Netherlands
| | - Tom Bashford
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Michael J Bell
- Critical Care Medicine, Neurological Surgery and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yelena G Bodien
- Department of Neurology and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - András Büki
- Department of Neurosurgery, Faculty of Medicine and Health Örebro University, Örebro, Sweden
- Department of Neurosurgery, Medical School; ELKH-PTE Clinical Neuroscience MR Research Group; and Neurotrauma Research Group, Janos Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| | - Randall M Chesnut
- Department of Neurological Surgery and Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, Universita Milano Bicocca, Milan, Italy
- NeuroIntensive Care, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, Italy
| | - David Clark
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Betony Clasby
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Endre Czeiter
- Department of Neurosurgery, Medical School; ELKH-PTE Clinical Neuroscience MR Research Group; and Neurotrauma Research Group, Janos Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| | - Marek Czosnyka
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance and Department of Neurology, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Véronique De Keyser
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Ramon Diaz-Arrastia
- Department of Neurology and Center for Brain Injury and Repair, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Thomas A van Essen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurosurgery, Medical Center Haaglanden, The Hague, Netherlands
| | - Éanna Falvey
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco and San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Anthony Figaji
- Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA, Australia
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, OH, USA
| | - Dashiell Gantner
- School of Public Health and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Guoyi Gao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine
| | - Joseph Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Benjamin Gravesteijn
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fabian Guiza
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Deepak Gupta
- Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Mark Gurnell
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - Gregory Hawryluk
- Section of Neurosurgery, GB1, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Hutchinson
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Swati Jain
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Ji-yao Jiang
- Department of Neurosurgery, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hope Kent
- Department of Psychology, University of Exeter, Exeter, UK
| | - Angelos Kolias
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Erwin J O Kompanje
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marc Maegele
- Cologne-Merheim Medical Center, Department of Trauma and Orthopedic Surgery, Witten/Herdecke University, Cologne, Germany
| | - Marek Majdan
- Institute for Global Health and Epidemiology, Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Amy Markowitz
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Michael McCrea
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Ana Mikolić
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - David Nelson
- Section for Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lindsay D Nelson
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Virginia Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - David Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matej Orešič
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Wilco Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - Dana Pisică
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Louis Puybasset
- Department of Anesthesiology and Intensive Care, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino IRCCS for Oncology and Neuroscience, Genova, Italy, and Dipartimento di Scienze Chirurgiche e Diagnostiche, University of Genoa, Italy
| | - Cecilie Røe
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - David J Sharp
- Department of Brain Sciences, Imperial College London, London, UK
| | - Peter Smielewski
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, UCSD School of Medicine, La Jolla, CA, USA
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth University Hospital and University of Glasgow, Glasgow, UK
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences Leiden University Medical Center, Leiden, Netherlands
| | - Nino Stocchetti
- Department of Pathophysiology and Transplantation, Milan University, and Neuroscience ICU, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nancy Temkin
- Departments of Neurological Surgery, and Biostatistics, University of Washington, Seattle, WA, USA
| | - Olli Tenovuo
- Department of Rehabilitation and Brain Trauma, Turku University Hospital, and Department of Neurology, University of Turku, Turku, Finland
| | - Alice Theadom
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Ilias Thomas
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Abel Torres Espin
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dominique Van Praag
- Departments of Clinical Psychology and Neurosurgery, Antwerp University Hospital, and University of Antwerp, Edegem, Belgium
| | - Ernest van Veen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Thijs Vande Vyvere
- Department of Radiology, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences (MOVANT), Antwerp University Hospital, and University of Antwerp, Edegem, Belgium
| | - Kevin K W Wang
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Eveline J A Wiegers
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - W Huw Williams
- Centre for Clinical Neuropsychology Research, Department of Psychology, University of Exeter, Exeter, UK
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Stephen R Wisniewski
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Frederick A Zeiler
- Departments of Surgery, Human Anatomy and Cell Science, and Biomedical Engineering, Rady Faculty of Health Sciences and Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario, ON, Canada
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Al-Husseini A, Fazel Bakhsheshi M, Gard A, Tegner Y, Marklund N. Shorter recovery time in concussed elite ice hockey players by early head-and-neck cooling - a clinical trial. J Neurotrauma 2022. [PMID: 36222612 DOI: 10.1089/neu.2022.0248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A sports-related concussion (SRC) is most commonly sustained in contact sports, and is defined as a mild traumatic brain injury. An exercise-induced elevation of core body temperature is associated with increased brain temperature that may accelerate secondary injury processes following SRC, and exacerbate the brain injury. In a recent pilot study, acute head-neck cooling of 29 concussed ice hockey players resulted in shorter time to return-to-play. Here, we extended the clinical trial to include players of 19 male elite Swedish ice hockey teams over 5 seasons (2016-2021). In the intervention teams, acute head-neck cooling was implemented using a head cap for ≥45 minutes in addition to the standard SRC management used in controls. The primary endpoint was time from SRC until return-to-play (RTP). Sixty-one SRCs were included in the intervention group and 71 SRCs in the control group. The number of previous SRCs was 2 (median and interquartile range (IQR): 1.0 - 2.0) and 1 (IQR 1.0 - 2.0) in the intervention and control groups, respectively; p= 0.293. Median time to initiate head-neck cooling was 10 min (IQR 7-15; range 5-30 min) and median duration of cooling was 45 min (IQR 45-50; range 45-70 min). The median time to RTP was 9 days in the intervention group (IQR 7-13.5 days) and 13 days in the control group (IQR 9-30; p<0.001). The proportion of players out from play for more than the expected recovery time of 14 days was 24.7% in the intervention group, and 43.7% in controls (p<0.05). Study limitations include that a) allocation to cooling or control management was at the discretion of the medical staff of each teams, decided prior to each season, and not by strict randomization, b) no sham cap was used and evaluations could not be performed by blinded assessors and c) it could not be established with certainty that injury severity was similar between groups. While the results should thus be interpreted with caution, early head-neck cooling, with the aim of attenuating cerebral hyperthermia, may reduce post-SRC symptoms and lead to earlier return-to-play in elite ice hockey players.
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Affiliation(s)
- Ali Al-Husseini
- Lund University, 5193, Department of Clinical Sciences, Neurosurgery, Lund, Sweden;
| | | | - Anna Gard
- Lund University, 5193, Department of Clinical Sciences Lund, Entregatan 7, Hisshall EA, plan 4, Lund, Lund, Skane, Sweden, 22242;
| | - Yelverton Tegner
- Luleå University of Technology, Division of Medical Sciences, Department of Health Sciences, Department of Health Sciences, Luleå, Sweden, SE 971 87;
| | - Niklas Marklund
- Lund University, 5193, Clinical Sciences, Neurosurgery, Klinikgatan 17B, Lund, Sweden, 221 85.,Skåne University Hospital Lund, 59564, Neurosurgery, Lund, Sweden, 221 85;
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Klein SK, Brown CB, Ostrowski-Delahanty S, Bruckman D, Victorio MC. Identifying Migraine Phenotype Post Traumatic Headache (MPTH) to Guide Overall Recovery From Traumatic Brain Injury. J Child Neurol 2022; 37:8830738221100327. [PMID: 35656769 DOI: 10.1177/08830738221100327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The primary aim of this study is to develop an easy way to identify migraine phenotype posttraumatic headache (MPTH) in children with traumatic brain injury, to treat headache in traumatic brain injury effectively, and to promote faster recovery from traumatic brain injury symptoms overall. Methods: We evaluated youth aged 7-20 years in a pediatric neurology traumatic brain injury (TBI) clinic, assigning a migraine phenotype for post-traumatic headache (MPTH) at the initial visit with the 3-item ID Migraine Screener. We stratified the sample by early (≤6 weeks) and late (>6 weeks) presenters, using days to recovery from concussion symptoms as the primary outcome variable. Results: 397 youth were assessed; 54% were female. Median age was 15.1 years (range 7.0-20.4 years), and 34% of the sample had sports-related injuries. Migraine phenotype for posttraumatic headache (MPTH) was assigned to 56.1% of those seen within 6 weeks of traumatic brain injury and 50.7% of those seen after the 6-week mark. Irrespective of whether they were early or late presenters to our clinic, patients with migraine phenotype (MPTH) took longer to recover from traumatic brain injury than those with posttraumatic headache (PTH) alone. Log rank test indicated that the survival (ie, recovery) distributions between those with migraine phenotype posttraumatic headache (MPTH) and those with posttraumatic headache (PTH) were statistically different, χ2(3) = 50.186 (P < .001). Conclusions: Early identification of migraine phenotype posttraumatic headache (MPTH) following concussion can help guide more effective treatment of headache in traumatic brain injury and provide a road map for the trajectory of recovery from traumatic brain injury symptoms. It will also help us understand better the mechanisms that underlie conversion to persistent posttraumatic headache and chronic migraine after traumatic brain injury.
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Affiliation(s)
- Susan K Klein
- Neurology, NDSC, 1079Akron Children's Hospital, Akron, OH, USA
| | - Cynthia B Brown
- Neurology, NDSC, 1079Akron Children's Hospital, Akron, OH, USA
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Norton AA, Wilson JJ. Use of the Independent Medical Spotter in Identifying Head Injuries in Division I Football Players. Clin J Sport Med 2022; 32:318-321. [PMID: 33852433 DOI: 10.1097/jsm.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sport-related concussion (SRC) is a known risk of contact sports and strategies to minimize risk have been used. We aimed to determine if an independent medical spotter (IMS) identified more SRCs than would otherwise be detected by trained sideline medical staff (SMS). DESIGN Prospective review of SRCs during competition in the 2019 season and retrospective review of SRCs in the 2015 to 2018 seasons, which also used an IMS. SETTING Division I football games (home and away) of a Big 10 Conference institution. PARTICIPANTS All football team members who participated in competition. INDEPENDENT VARIABLES Occurrence of SRC during competition and whether the IMS or SMS directly visualized the injury. MAIN OUTCOME MEASURES The total number of SRCs that occurred during competition in the 2015 to 2019 football seasons and whom observed the SRC-SMS or IMS-or if a student athlete reported symptoms after competition. RESULTS Over the 5-year study period, 24 SRCs occurred during competition. Of those, 19 (79.2%) were observed by SMS, 2 (8.3%) by the IMS, and 3 (12.5%) were reported to SMS after competition ended. CONCLUSIONS Most SRCs are accurately identified by SMS, but a small number were apparent only to the IMS who seemed to add sensitivity in detecting a SRC. Instances remain in which SRC recognition and diagnosis were delayed despite trained SMS and IMS. CLINICAL RELEVANCE An IMS allows for a small-added player protection benefit using different vantage points to identify potential SRCs during competition.
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Affiliation(s)
- Adam A Norton
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Beitchman JA, Burg BA, Sabb DM, Hosseini AH, Lifshitz J. The pentagram of concussion: an observational analysis that describes five overt indicators of head trauma. BMC Sports Sci Med Rehabil 2022; 14:39. [PMID: 35292090 PMCID: PMC8922760 DOI: 10.1186/s13102-022-00430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022]
Abstract
Background Multifarious clinical presentations of traumatic brain injury (TBI) makes detection difficult. Acceptance of the Fencing Response as an indicator of moderate TBI with localization to the brainstem expanded interest towards other possible indicators. Methods We hypothesized that an individual experiencing traumatic forces to the head resulting in concussion could display additional brainstem-mediated responses. Using YouTube™, videos were systematically evaluated for mechanical forces imposed on the head with a subsequent, observable behavior. Searches identified 9.9 million non-unique videos in which 0.01% were viewed and 79 met inclusion criteria. Videos of head injuries occurred during athletic activity (57%), assaults (38%), automobile accidents (4%) and impact by an inanimate object (1%). Results Individuals with acute head injury were identified as adults (70%; n = 55), teens (29%; n = 23), and children (1.2%; n = 1). Those identified as males made up majority of injured persons (n = 77♂, 2♀). Individuals in the videos were observed to demonstrate the Fencing Response (47%; n = 37), seizing (44%; n = 35), snoring (24%; n = 19), crying (7.6%; n = 6), and vomiting (3.8%; n = 3). Conclusion Each response, which together comprise the “Pentagram of Concussion”, indicates the presence of traumatic forces to the head that present with one or more pentagram signs that would localize dysfunction to the brainstem. Clinical consideration of these responses helps to immediately identify patients at high risk for a brain injury with brainstem involvement that may have otherwise been mistaken for a different diagnosis.
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Affiliation(s)
- Joshua A Beitchman
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.,Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Joe R. and Theresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,UT Southwestern Medical Center, Children's Medical Center Dallas, Dallas, TX, 75235, USA
| | - Brendan A Burg
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.,Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,University of Southern California, Los Angeles, CA, 90089, USA
| | - Dylan M Sabb
- Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Family and Community Medicine, Davis Hospital, University of California, CA, Sacramento, USA.,University of California Davis, Sacramento, CA, 95817, USA
| | | | - Jonathan Lifshitz
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA. .,Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. .,Phoenix VA Health Care System, Phoenix, AZ, USA. .,Neurotrauma & Social Impact research team, University of Arizona College of Medicine - Phoenix, 7th Floor BSPB
- 475 N. 5th St., Phoenix, AZ, 85004-2127, USA.
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18
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Salmon DM, Chua J, Sullivan SJ, Whatman C, Brown J, Register-Mihalik J, Murphy I, Walters S, Clacy A, Sole G, Kerr ZY, Rasmussen K, England M. Sport concussion assessment in New Zealand high school rugby players: a collaborative approach to the challenges faced in primary care. Brain Inj 2022; 36:258-270. [PMID: 35143350 DOI: 10.1080/02699052.2022.2033839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVE To describe the collaborative development of a New Zealand Rugby Concussion Assessment (NZRCA) for primary care and to provide normative baseline data from a representative group of high school rugby players. METHODS This study, conducted over the 2018 and 2019 community rugby season where players were baseline tested during the pre- or start of season period. RESULTS Data were collected from 1428 players (males n = 1121, females n = 307) with a mean age of 15.9 ± 1.4 years. The mean ± SD symptom severity score was 11.3 ± 8.6, the mean number of endorsed symptoms was 8.5 ± 5.3 and the percentage feeling "normal" was 80.2 ± 15.3%. Only 5.3% of players reported no symptoms at baseline. The most common reported were: 'distracted easily' (72.5%), 'forgetful' (68.5%), and 'often tired' (62.6%). None of the participants achieved a perfect score for the SAC50. The majority of participants (89.7%) passed the tandem gait test with a time of 12.2 ± 1.7 seconds. Age, gender, and ethnicity were associated with NZRCA performance; albeit weakly. CONCLUSION This study provides normative reference values for high-school rugby players. These data will aid healthcare providers in their identification of suspected concussion in the absence of individualized baselines.
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Affiliation(s)
| | - Jason Chua
- New Zealand Rugby, Wellington, New Zealand
| | | | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ian Murphy
- New Zealand Rugby, Wellington, New Zealand
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Amanda Clacy
- School of Law & Society, University of the Sunshine Coast, Maroochydore, Australia
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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19
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Thibeault CM, Dorn AY, Radhakrishnan S, Hamilton RB. Longitudinal assessment of hemodynamic alterations after mild traumatic brain injury in adolescents: Selected case study review. JOURNAL OF CONCUSSION 2022. [DOI: 10.1177/20597002211065855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Alterations in the neurovasculature after traumatic brain injury (TBI) represents a significant sequelae. However, despite theoretical and empirical evidence supporting the near-ubiquity of vascular injury, its pathophysiology remains elusive. Although this has been shown for all grades of TBI, the vascular changes after injuries with the broad mild traumatic brain injuries (mTBI) classification, remain particularly difficult to describe. Our group has previously demonstrated hemodynamic alterations in mTBI by utilizing transcranial Doppler ultrasound and cerebrovascular reactivity in a cross-sectional study. That work identified a phasic progression of deviations over varying days post-injury. These phases were then characterized by a set of inverse models that provided a hypothetical process of hemodynamic dysfunction after mTBI. This model set provides a framework with the potential for guiding clinical treatment over the course of recovery. However, it is still unclear if individual patients will progress through the phases of dysfunction similar to that found at the population level. The work presented here explores six individual patients with high-density data collected during their post-injury recovery. Breath-hold index (BHI) was found to be the most robust feature related to mTBI longitudinally. All six subjects exhibited BHI recovery curves that followed the population model's progression. The changes in pulsatile features lacked the universality of BHI, but were present in subjects with higher self-reported symptom scores and longer periods of recovery. This work suggests neurovascular dysfunction after an mTBI may be a robust phenomenon. Additionally, the capabilities of TCD in capturing these changes highlights its potential for aiding clinicians in monitoring patient's recovery post mTBI.
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20
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Key VH, Noland JB. Concussion in Head Trauma. Facial Plast Surg Clin North Am 2021; 30:11-14. [PMID: 34809881 DOI: 10.1016/j.fsc.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Concussion in the setting of facial trauma is an entity that can be overlooked. Having a high index of suspicion is critical in initial management and prompt treatment. Clinical signs can be common manifestations of a concussion. Serial examinations are important as these clinical manifestations can occur later in the hospitalization. Cognitive assessment tools can also give a baseline of a patient and can be used to assess recovery from a concussion. Assessment of the vestibular and oculomotor system can play a critical role in treatment. Prompt recognition and immediate treatment can help shorten the symptomatology and course of treatment.
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Affiliation(s)
- Vincent H Key
- Orthopaedic Surgery/Sports Medicine, University of Kansas Health System, 3901 Rainbow Boulevard. Kansas City, KS 66160, USA.
| | - Joseph B Noland
- Family Medicine, University of Kansas Health System, Kansas City, KS, USA
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21
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Kotler DH, Iaccarino MA, Rice S, Herman S. Return to Cycling Following Brain Injury: A Proposed Multidisciplinary Approach. Phys Med Rehabil Clin N Am 2021; 33:91-105. [PMID: 34799005 DOI: 10.1016/j.pmr.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cycling is an important form of exercise, recreation, and transportation. Following traumatic brain injury, the benefits of cycling for health, fitness, and community mobility must be considered alongside potential risk for recurrent injury. In addition to medical concerns and exercise tolerance, key domains include motor function, attention, and visuospatial and executive function, which have previously been explored with regard to driving. Cycling skill is a combination of cognitive and motor function, and can be trained with appropriate education and intervention. We discuss the relationship of brain injury rehabilitation to specific features of cycling, including case studies.
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Affiliation(s)
- Dana H Kotler
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA. https://twitter.com/@iaccarinomd
| | - Sarah Rice
- Athletico Physical Therapy, Chicago, IL, USA
| | - Seth Herman
- California Rehabilitation Institute, Los Angeles, CA, USA
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22
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Lumba-Brown A, Prager EM, Harmon N, McCrea MA, Bell MJ, Ghajar J, Pyne S, Cifu DX. A Review of Implementation Concepts and Strategies Surrounding Traumatic Brain Injury Clinical Care Guidelines. J Neurotrauma 2021; 38:3195-3203. [PMID: 34714147 DOI: 10.1089/neu.2021.0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Despite considerable efforts to advance the science surrounding traumatic brain injury (TBI), formal efforts supporting the current and future implementation of scientific findings within clinical practice and healthcare policy are limited. While many and varied guidelines inform the clinical management of TBI across the spectrum, clinicians and healthcare systems are not broadly adopting, implementing, and/or adhering to them. As part of the Brain Trauma Blueprint TBI State of the Science, an expert workgroup was assembled to guide this review article, which describes: (1) possible etiologies of inadequate adoption and implementation; (2) enablers to successful implementation strategies; and (3) strategies to mitigate the barriers to adoption and implementation of future research.
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Affiliation(s)
- Angela Lumba-Brown
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | | | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neurosurgery Research Laboratory, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Michael J Bell
- Pediatrics, Critical Care Medicine, Children's National Hospital, Washington DC, USA
| | - Jamshid Ghajar
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Scott Pyne
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - David X Cifu
- Virginia Commonwealth University School of Medicine, and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA
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23
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Glendon K, Blenkinsop G, Belli A, Pain M. Prospective study with specific Re-Assessment time points to determine time to recovery following a Sports-Related Concussion in university-aged student-athletes. Phys Ther Sport 2021; 52:287-296. [PMID: 34715487 DOI: 10.1016/j.ptsp.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Time to recovery for symptom burden and neurocognition following a Sports-Related Concussion (SRC) has previously been determined by consolidating varying re-assessment time points into a singular point, and has not been established for Vestibular-Ocular-Motor (VOM) function or academic ability. OBJECTIVES Establish when recovery of symptom burden, neurocognition, VOM function, and academic ability occurs in university-aged student-athletes. METHODS Student-athletes completed an assessment battery (Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Vestibular Ocular-Motor Screening (VOMS), Perceived Academic Impairment Tool (PAIT)) during pre-season (n = 140), within 48 hours, 4, 8 and 14 days post-SRC and prior to Return To Play (RTP) and were managed according to the Rugby Football Union' community pathway (n = 42). Student-athletes were deemed recovered or impaired according to Reliable Change Index' (RCI) or compared to their individual baseline. RESULTS Symptom burden recovers by four days post-SRC on RCI and to baseline by eight days. VOM function and academic ability recovers by 8 days. Some student-athletes demonstrated worse performance at RTP on all tests by RCI and to baseline, except for on VOMS score and near point convergence by RCI change. CONCLUSIONS Variation in individual university-aged student-athletes requires a multi-faceted approach to establish what dysfunctions post-SRC exist and when recovery occurs.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, University of Birmingham, UK
| | - M Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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24
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Salmon DM, Chua J, Sullivan SJ, Whatman C, Brown J, Register-Mihalik J, Murphy I, Walters S, Clacy A, Sole G, Kerr ZY, Rasmussen K, England M. Baseline concussion assessment performance of community-based senior rugby players: a cross-sectional study. Brain Inj 2021; 35:1433-1442. [PMID: 34658272 DOI: 10.1080/02699052.2021.1972452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report pre-season baseline concussion assessment performance among senior rugby players and explore associations between assessment performance and player demographics. DESIGN A cross-sectional study using the New Zealand Rugby Concussion Assessments (NZRCA), comprising symptom, cognitive and dynamic coordination assessments was conducted in the 2018-2019 season. METHODS Players' baseline assessments were characterised using descriptive statistics; effect sizes (ES) and t-tests were used to explore associations between player demographic characteristics and NZRCA performance. RESULTS A total of 733 players (11.4% female) aged between 16 and 52 years completed the NZRCA. The median (range) value for symptom severity, endorsed symptoms and "percentage normal" was respectively, 5 (0-40), 5 (0-21) and 90% (30-100%). A perfect standardised assessment of concussion score was achieved by one participant; seven achieved ≥27/30 for immediate recall, and 22 achieved a perfect delayed recall score. Most participants (n = 674, 92%) passed the tandem gait test. Associations between NZRCA performance and gender, concussion history, and Pasifika ethnicity were observed with effect sizes ranging from small (0.18) to large (0.70). Six hundred and twenty-three (85%) participants reported at least one symptom. CONCLUSIONS The results from this study could help support decision-making by clinicians, improving the management of concussions in the community setting.
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Affiliation(s)
- Danielle M Salmon
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Jason Chua
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - S John Sullivan
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Chris Whatman
- School of Sport and Recreation, Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center and Rehab University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina U.S.A
| | - Ian Murphy
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Simon Walters
- School of Sport and Recreation, Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Amanda Clacy
- Vitality Village, Wearebe, Kensington, Queensland, Australia
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center and Rehab University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina U.S.A
| | - Karen Rasmussen
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Mike England
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
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25
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Rosenbloom C, Chatterjee R, Chu W, Broman D, Okholm Kryger K. Sport-related concussion return-to-play practices of medical team staff in elite football in the United Kingdom. SCI MED FOOTBALL 2021; 6:317-324. [DOI: 10.1080/24733938.2021.1983921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Craig Rosenbloom
- The Football Association, Technical Directorate, Burton-upon-Trent, UK
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
| | - Robin Chatterjee
- Institute of Sport, Exercise and Health, London, UK
- British Association of Sport and Exercise Medicine, Doncaster, UK
| | - Wing Chu
- Vita Health Group, London, UK
- Freedom Clinics, London, UK
| | - Daniel Broman
- The Football Association, Technical Directorate, Burton-upon-Trent, UK
- Isokinetic Medical Group, London, UK
| | - Katrine Okholm Kryger
- Sport and Exercise Medicine, Queen Mary University of London, London, UK
- Health and Applied Science, St Mary’s University, London, UK
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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26
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Wallace J, Mulenga D, Bretzin A, Delfin D, Muyinda G, Sichizya KA, Mulenga J. Diversifying sport-related concussion measures with baseline balance and ocular-motor scores in professional Zambian football athletes. PHYSICIAN SPORTSMED 2021; 49:289-296. [PMID: 32876504 DOI: 10.1080/00913847.2020.1819149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Normative values of common sport-related concussion assessment tools may assist clinical diagnosis and management. However, current baseline normative values are not representative of athletic participants across international domains. This study develops healthy baseline norms on the Balance Error Scoring System (BESS), and King-Devick (K-D), providing baseline reference values for professional Zambian football athletes. METHODS Of the 125 male participants (aged 24.48 ± 5.41 years) screened for this study, 9 (7.2%) reported a previous history of concussion, 98 (78.4%) completed the Balance Error Scoring System and 88 (70.4%) completed the King-Devick. Descriptive statistics calculated for the BESS and the K-D test included mean, standard deviation, median, interquartile range (IQR), and percentiles ranks. MAIN FINDINGS Participants scored a mean ± standard deviation of 10.15 ± 5.6 and a median [IQR] of 9 [6-12.25] errors on the total BESS and completed the K-D test in a mean ± standard deviation 56.85 ± 10.55 seconds and a median [IQR] 55.28 [48.7-64.8] seconds. CONCLUSIONS Cross-cultural awareness and management of sport-related concussion are continuously improving the safety and well-being of athletic participants around the world. The diverse representation in these data may aid in interpretation of post-injury performance during sport-related concussion management in Zambia. This study develops baseline reference values currently lacking within African cultures and demonstrates the feasibility and global clinical utility of two sport-related concussion assessment resources.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA.,Department of Epidemiology, Harvard University TH Chan School of Public Health, Boston, USA
| | - Davie Mulenga
- Department of Physiotherapy, University Teaching Hospital, University of Zambia (UTH), Lusaka, Zambia
| | - Abigail Bretzin
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Danae Delfin
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Gabriel Muyinda
- Department of Physiotherapy, University Teaching Hospital, University of Zambia (UTH), Lusaka, Zambia
| | - Kachinga Agrippa Sichizya
- Department of Physiotherapy, University Teaching Hospital, University of Zambia (UTH), Lusaka, Zambia
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27
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Garnett D, Bholah A, Olivier B, Patricios J, D’Hotman Y, Sunassee K, Cobbing S. The epidemiology of injury and illness amongst athletes at the Indian Ocean Island Games, Mauritius, 2019. SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE 2021; 33:v33i1a11211. [PMID: 36816894 PMCID: PMC9924607 DOI: 10.17159/2078-516x/2021/v33i1a11211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The Indian Ocean Island Games is a multi-sport event that occurs every four years and includes athletes from seven islands of the Indian Ocean, namely, Comoros, Reunion, Mayotte, Madagascar, Maldives, Seychelles, and Mauritius. Objectives This study aims to describe the injury and illness epidemiology of the athletes participating during the 2019 Indian Ocean Islands Games. Methods This prospective cohort study recorded injury and illness cases from athletes who competed in these Games. All medical physicians received detailed instructions and training on data collection using an injury report form. All athletes (minors and adults) who provided consent, or consent given from the minors' guardians, were included in this study. Athletes who did not provide consent for this study were excluded. Results Athletes (n = 1 521; 531 women and 990 men) reported 160 injuries (injury incidence rate of 11%) and 85 illnesses (illness incidence rate of 6%). The percentage of distribution of injuries were highest in football and basketball. Most injuries occurred during competition, compared with training, joint sprains were the most common type of injury (28%), followed by muscle strains (19%). Men suffered most of the injuries (79% vs. 21% for women). Similarly, men sustained more illnesses than women (57% vs. 43%). Most illnesses affected the respiratory system (67%), and infection was the most common cause of illness (84%) in participating athletes. Conclusion These findings are similar to previous events in other parts of the world. However, unique ailments, not previously reported on, were discovered. Epidemiological data from this study can be inferred to athletes who compete in similar multi-sport events in the Indian Ocean region.
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28
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Kaufman MW, Su CA, Trivedi NN, Lee MK, Nelson GB, Cupp SA, Voos JE. The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202106000-00001. [PMID: 34101673 DOI: 10.2106/jbjs.rvw.20.00108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Concussion is a complex pathophysiologic process that affects the brain; it is induced by biomechanical forces, with alteration in mental status with or without loss of consciousness. » Concussion assessment tools may be broadly categorized into (1) screening tests such as the SAC (Standardized Assessment of Concussion), the BESS (Balance Error Scoring System), and the King-Devick (KD) test; (2) confirmatory tests including the SCAT (Sport Concussion Assessment Tool), the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), and the VOMS (Vestibular Oculomotor Screening); and (3) objective examinations such as brain network activation (BNA) analysis, imaging studies, and physiologic markers. » The KD, child SCAT3 (cSCAT3), child ImPACT (cImPACT), and VOMS tests may be used to evaluate for concussion in the pediatric athlete. » Future work with BNA, functional magnetic resonance imaging, diffusion tensor imaging, and serum biomarkers may provide more objective assessment of concussion, neurologic injury, and subsequent recovery.
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Affiliation(s)
| | - Charles A Su
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nikunj N Trivedi
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michelle K Lee
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Grant B Nelson
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sean A Cupp
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James E Voos
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
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29
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Smith AM, Alford PA, Aubry M, Benson B, Black A, Brooks A, Burke C, D'Arcy R, Dodick D, Eaves M, Eickhoff C, Erredge K, Farrell K, Finnoff J, Fraser DD, Giza C, Greenwald RM, Hoshizaki B, Huston J, Jorgensen J, Joyner M, Krause D, LaVoi N, Leaf M, Leddy J, Margarucci K, Margulies S, Mihalik J, Munce T, Oeur A, Prideaux C, Roberts WO, Shen F, Soma D, Tabrum M, Stuart MB, Wethe J, Whitehead J, Wiese-Bjornstal D, Stuart MJ. Proceedings From the Ice Hockey Summit III: Action on Concussion. Clin J Sport Med 2021; 31:e150-e160. [PMID: 31842055 DOI: 10.1097/jsm.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/28/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these 5 objectives: (1) describe sport related concussion (SRC) epidemiology; (2) classify prevention strategies; (3) define objective, diagnostic tests; (4) identify treatment; and (5) integrate science and clinical care into prioritized action plans and policy. METHODS Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches, and officials) voted to prioritize these action items in the final Summit session. RESULTS To (1) establish a national and international hockey database for SRCs at all levels; (2) eliminate body checking in Bantam youth hockey games; (3) expand a behavior modification program (Fair Play) to all youth hockey levels; (4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues; (5) establish objective tests to diagnose concussion at point of care; and (6) mandate baseline testing to improve concussion diagnosis for all age groups. CONCLUSIONS Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity, and consequences of concussion in the sport of ice hockey.
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Affiliation(s)
| | - Patrick A Alford
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Mark Aubry
- Ottawa Sports Medicine Center, Ottawa, ON, Canada
| | - Brian Benson
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Amanda Black
- Sport Injury Prevention Research Center, University of Calgary, Calgary, AB, Canada
| | - Alison Brooks
- Department of Orthopedic Surgery, University of Wisconsin, Madison, Wisconsin
| | - Charles Burke
- Brook & Bradley Orthopedics, University of Pittsburgh at St. Margaret, Pittsburgh, Pennsylvania
| | - Ryan D'Arcy
- School of Engineering Science, Advances Neuroimaging, Siman Fraser University, Burnaby, BC, Canada
| | - David Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Michael Eaves
- Men's Ice Hockey, St. Olaf College, Northfield, Minnesota
| | - Chad Eickhoff
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
| | | | | | - Jonathan Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Douglas D Fraser
- Department of Pediatrics, Physiology/Pharmacology/Clinical Neuroscience, University of Western Ontario, London, ON, Canada
| | - Christopher Giza
- Department of Neurosurgery, Brain Research Institute, University of California Los Angeles Health, Los Angeles, California
| | - Richard M Greenwald
- Department of Biomechanics, Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | | | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - David Krause
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Nicole LaVoi
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Matthew Leaf
- Officiating Program, USA Hockey, Colorado Springs, Colorado
| | - John Leddy
- Department of Orthopedics, University at Buffalo, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | | | - Susan Margulies
- Department of Biomedical Engineering, Georgia School of Technology, Atlanta, Georgia
| | - Jason Mihalik
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thayne Munce
- Sports Medicine Center, Sanford Medical Center, Sioux Falls, South Dakota
| | - Anna Oeur
- Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Cara Prideaux
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - William O Roberts
- Department of Family Medicine and Community Health University of Minnesota, Minneapolis, Minnesota
| | - Francis Shen
- University of Minnesota Law School, University of Minnesota, Minneapolis, Minnesota
| | - David Soma
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mark Tabrum
- Coaching Education, USA Hockey, Colorado Springs, Colorado
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Kent JB, Sasser P, Austin AV, MacKnight JM. Are you missing a concussion by watching American football? Video analysis of ball location in a Division 1 football program. Brain Inj 2021; 35:880-885. [PMID: 33896298 DOI: 10.1080/02699052.2021.1917658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Action in a football game occurs quickly. Medical staff can miss a sport-related concussion (SRC) if they do not observe it directly. The objective of this study is to determine if SRCs occur more frequently at ball than away from ball during gameplay. Game-specific concussion statistics can enhance medical provider care of athletes. METHODS We used gameplay videos of an NCAA Division I football program to analyze SRCs and determine the primary tackler or ball handler during each concussion play. We compared the relative risk of SRCs for the primary ball handlers/tacklers to that of the other 10 players on the same team during that play. RESULTS Over 10 seasons, 26 SRCs occurred at ball for the primary ball handler/tackler position (0.22 SRCs/game) versus 16 away from ball (0.13 SRCs/game). The relative risk of an SRC according to exposure (at ball) vs. no exposure (away from ball) was 16.2 (CI 8.7-30.2, P < .05). Special teams had more SRCs away from ball than at ball, but this was not significant (relative risk 3.32, CI 0.90-12.3, P > .05). CONCLUSIONS The study provides medical staff guidance to more efficiently identify in-game SRCs and supports evidence for rules changes.
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Affiliation(s)
- Jeremy B Kent
- Department of Family Medicine, Team Physician, UVa Sports Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Phillip Sasser
- Department of Pediatrics, University of Wisconsin Health, Madison, WI, USA
| | - Ashley V Austin
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - John M MacKnight
- Team Physician and Medical Director, UVA Sports Medicine, University of Virginia Health System, Charlottesville, VA, USA
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Cheever K, McDevitt J, Phillips J, Kawata K. The Role of Cervical Symptoms in Post-concussion Management: A Systematic Review. Sports Med 2021; 51:1875-1891. [PMID: 33891292 DOI: 10.1007/s40279-021-01469-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with cervicogenic symptoms following a concussion have shown a disproportionate rate of delayed symptom resolution. However, the prevalence of cervicogenic symptoms in the acute stages following a concussion and the percentage of those patients who continue on to suffer delayed symptom resolution is poorly described in the literature. OBJECTIVES To provide a comprehensive report on the clinical prevalence, diagnostic methods, and potential treatment options for cervicogenic symptoms that are elicited during acute and chronic phases following a concussion. METHODS Electronic searches were conducted in PubMed, SPORTDiscus, ICL, CINAHL and PEDro, from inception to May 2020, to identify original research articles on concussion involving cervicogenic symptoms. We assessed each included article for risk of bias, methodological quality, level of evidence and evidence quality. The articles were categorized into three topics: (1) prevalence of post-concussion cervicogenic symptoms; (2) diagnostic testing for cervicogenic symptoms, and (3) treatment techniques for cervicogenic symptoms. RESULTS The initial review resulted in 1443 abstracts, of which 103 abstracts met the inclusion criteria of our research. After the review of full text, 80 articles were excluded, which resulted in a total of 23 articles for this systematic review. Prevalence of cervicogenic symptoms in the acute stages ranged from 7 to 69% and increased to 90% in patients experiencing persistent post-concussive symptoms. Neck pain at initial evaluation increased risk of developing persistent post-concussive symptoms (PPCS) by 2.58-6.38 times. Patient-reported outcome measures (e.g., Neck Disability Index, Dizziness Handicap Inventory, and Rivermead Post-Concussion Questionnaire) can identify patients with cervicogenic symptoms that should be further differentiated by clinical testing. Lastly, treatment using graded cervical manual therapy has shown to reduce time to symptom resolution and medical clearance. CONCLUSIONS Cervicogenic symptoms are prevalent in the acute and chronic stages following concussion, which if not diagnosed appropriately increase the likelihood of PPCS. Several clinical tests are available to help differentiate cervicogenic symptoms; however, lack of awareness and hesitation by practitioners limits their use. More randomized controlled trials are necessary to evaluate the effectiveness of cervical specific treatment programs for PPCS.
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Affiliation(s)
- Kelly Cheever
- Department of Kinesiology, College for Health, Community and Policy, University of Texas at San Antonio, One UTSA cir, San Antonio, TX, 78429, USA.
| | - Jane McDevitt
- Depart of Health and Rehabilitation Science, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Jacqueline Phillips
- Department of Kinesiology, College of Public, Health Temple University, Philadelphia, PA, USA
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
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32
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Falvey É, Tucker R, Fuller G, Raftery M. Head injury assessment in rugby union: clinical judgement guidelines. BMJ Open Sport Exerc Med 2021; 7:e000986. [PMID: 33981448 PMCID: PMC8061850 DOI: 10.1136/bmjsem-2020-000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Abstract
Background/aim Clinical judgement is a recognised component of a complete off-field concussion assessment. This study identifies guidance criteria for team medical staff when using clinical judgement in their decision-making process during the World Rugby off-field concussion-assessment screen (HIA1). Methods Retrospective study of examining doctor clinical judgement in 1149 HIA1 assessments after a meaningful head impact event completed on rugby union players participating in elite-level international and national competitions between September 2015 and June 2018. We assessed (1) an abnormal subtest result as worse performance compared with preseason baseline values; (2) the proportion of cases where clinicians overruled abnormal HIA1 assessment subtest results and (3) made recommendations on how clinical judgement decisions may be made more safely based on the accuracy of clinical judgement decisions assessed against the final concussion diagnosis. Results One or more subtests were abnormal compared with baseline values in 857 of 1149 HIA1 assessments. Clinical judgement was used to return players to the game despite abnormal subtest results on 424 out of 857 occasions (49%). In a significant majority of cases 356/424 (84%), clinical judgement decisions were correct, with players later cleared of a concussion. An application of guided clinical judgement potentially decreased false negative assessments by 33% (21/63). Conclusions Clinical judgement should be applied in the diagnosis of concussion but done so cautiously. We propose doctors should only use clinical judgement to overrule either one of; or a combination of (1) an abnormal tandem gait and (2) one abnormal cognitive test.
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Affiliation(s)
- Éanna Falvey
- Medical Department, World Rugby Limited, Dublin, Ireland.,College of Medcine & Health, University College Cork, Cork, Ireland
| | - Ross Tucker
- Medical Department, World Rugby Limited, Dublin, Ireland
| | - Gordan Fuller
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Martin Raftery
- Medical Department, World Rugby Limited, Dublin, Ireland
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Rosenbloom C, Broman D, Chu W, Chatterjee R, Okholm Kryger K. Sport-related concussion practices of medical team staff in elite football in the United Kingdom, a pilot study. SCI MED FOOTBALL 2021; 6:127-135. [DOI: 10.1080/24733938.2021.1892174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Craig Rosenbloom
- The Football Association, Technical Directorate, Burton-upon-Trent, UK
- Queen Mary University of London, Sport and Exercise Medicine, London, UK
| | | | - Wing Chu
- Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
| | - Robin Chatterjee
- Institute of Sport, Exercise and Health, London, UK
- British Association of Sport and Exercise Medicine, 3 Jetstream Dr, Doncaster, UK
| | - Katrine Okholm Kryger
- Queen Mary University of London, Sport and Exercise Medicine, London, UK
- St Mary’s University, Faculty of Sport, Health and Applied Science, London, UK
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Lallenec LM, Saw AE, Kountouris A, Saw R, Orchard J. Concussion in cricket: Clinical findings using Sport Concussion Assessment Tool and recovery timeframes. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/2059700221993322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To retrospectively review data of concussed and non-concussed elite cricket athletes following head impact to describe which clinical features on the day of injury are associated with concussion diagnosis. A secondary aim was to describe the recovery time of concussed athletes. Design Retrospective cohort study. Methods This study reviewed five seasons of Sport Concussion Assessment Tool (SCAT) data and clinical records for elite male and female cricket athletes who sustained a head impact during a cricket match or training. Results Data from 30 concussed and 37 non-concussed athletes were compared. Symptoms of ‘don’t feel right’ and ‘feeling slowed down’ had the strongest clinical utility for a concussion diagnosis post head impact. Concussed athletes reported a significantly lower ‘percent of normal’ (median 60%, IQR 60–90%) compared to athletes who sustained a non-concussive head impact (median 99%, IQR 95–100%, p = 0.003). No other component of the SCAT distinguished concussed from non-concussed athletes on day of injury. Concussed athletes typically experienced symptom resolution within 2–8 days and completed a graded return to play protocol within 4–14 days. No differences in SCAT findings or recovery times were observed between genders. Conclusion The SCAT may be used as a clinical tool to assist in diagnosis of concussionin elite cricket athletes. The components of the SCAT with the greatest clinical utility on day of injury were athlete-reported symptoms and ‘percent of normal’. Concussed cricket athletes typically complete their graded return to play protocol within 14 days however individualised management is paramount.
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Affiliation(s)
| | - Anna E Saw
- Cricket Australia, Jolimont, VIC, Australia
| | - Alex Kountouris
- Cricket Australia, Jolimont, VIC, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC, Australia
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Davis GA, Makdissi M, Bloomfield P, Clifton P, Cowie C, Echemendia R, Falvey EC, Fuller GW, Green GA, Harcourt P, Hill J, Leahy K, Loosemore MP, McCrory P, McGoldrick A, Meeuwisse W, Moran K, Nagahiro S, Orchard JW, Pugh J, Raftery M, Sills AK, Solomon GS, Valadka AB. Concussion Guidelines in National and International Professional and Elite Sports. Neurosurgery 2021; 87:418-425. [PMID: 32232354 DOI: 10.1093/neuros/nyaa057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/11/2020] [Indexed: 11/13/2022] Open
Abstract
The Berlin statement on sport-related concussion was published in 2017 using evidence-based recommendations. We aimed to examine (1) the implementation of, distribution and education based on the Berlin recommendations, and the development of sport-specific protocols/guidelines among professional and elite sports, (2) the implementation of guidelines at the community level, (3) translation of guidelines into different languages, and (4) research activities. Senior medical advisers and chief medical officers from Australian Football League, All Japan Judo Federation, British Horseracing Authority, Cricket Australia, Fédération Equestre Internationale, Football Association, Gaelic Athletic Association, International Boxing Association, Irish Horseracing Regulatory Board, Major League Baseball, National Football League, National Hockey League, National Rugby League, and World Rugby completed a questionnaire. The results demonstrated that all 14 sporting organizations have published concussion protocols/guidelines based on the Berlin recommendations, including Recognize, Removal from play, Re-evaluation, Rest, Recovery, and Return to play. There is variable inclusion of Prolonged symptoms. Prevention and Risk reduction and Long-term effects are addressed in the guidelines, rules and regulations, and/or sport-specific research. There is variability in education programs, monitoring compliance with guidelines, and publication in other languages. All sporting bodies are actively involved in concussion research. We conclude that the Berlin recommendations have been included in concussion protocols/guidelines by all the sporting bodies, with consistency in the essential components of the recommendations, whilst also allowing for sport- and regional-specific variations. Education at the elite, community, and junior levels remains an ongoing challenge, and future iterations of guidelines may consider multiple language versions, and community- and junior-level guidelines.
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Affiliation(s)
- Gavin A Davis
- Australian Football League Concussion Working Group, Melbourne, Australia
| | | | | | | | - Charlotte Cowie
- The Football Association, St George's Park, Needwood, England
| | | | | | - Gordon Ward Fuller
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | | | | | - Jerry Hill
- British Horseracing Authority, London, United Kingdom
| | - Kevin Leahy
- Gaelic Athletic Association, Dublin, Ireland
| | - Mike P Loosemore
- Institute Sport Exercise & Health, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
| | | | | | | | - Kevin Moran
- Gaelic Athletic Association, Dublin, Ireland
| | | | - John W Orchard
- School of Public Health, University of Sydney, NSW, Australia
| | - Jennifer Pugh
- The Irish Horseracing Regulatory Body, The Curragh, Ireland
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Abstract
This article focuses on 3 concepts that continue to be investigated in the search for the holy grail of concussion-a valid diagnostic test. Imaging advances are discussed with optimism that functional MRI and diffusion tensor imaging may be available clinically. Biomarkers and the use of genetic tests are covered. Sideline accelerometer use may help steer discussions of head trauma risk once technology exists to accurately estimate acceleration of the brain. In the meantime, strategies including allowing athletes to be substituted out of games for an evaluation and video review in elite sports can improve recognition of sports-related concussion.
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Affiliation(s)
- Hamish Kerr
- Sports Medicine, Department of Medicine, Albany Medical College, 1019 New Loudon Road, Cohoes, NY 12047, USA.
| | - Bjørn Bakken
- Department of Medicine, Albany Medical Center, 1019 New Loudon Road, Cohoes, NY 12047, USA
| | - Gregory House
- Department of Family and Community Medicine, Albany Medical Center, 391 Myrtle Avenue, Albany, NY 12208, USA
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Anderson FL, Hellwinkel JE, Montjoy M, Levi M, Tu B, Noble JM, Ahmad CS, Bottiglieri TS. Change in Heart Rate Variability after Concussion in a Collegiate Soccer Player. Neurotrauma Rep 2020; 1:88-92. [PMID: 34223534 PMCID: PMC8240878 DOI: 10.1089/neur.2020.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Athletes are known to under-report concussion symptoms due to competitive disincentives to report and conflation of concussion symptoms with other conditions associated with rigorous participation in sports. A quantitative biomarker for concussion has the potential to decrease the reliance on inconsistent patient-reported symptoms for the diagnosis of concussion. The objective of this project was to monitor heart rate variability (HRV) patterns of in-season athletes as a potential biomarker for concussion. Twenty in-season National Collegiate Athletic Association (NCAA) Division 2 collegiate soccer players were given a wristband heart rate sensor with instructions to wear the band full time (24/7) for the entire fall season (approximately 3 months). The athletes were prompted by email to complete a weekly survey on the severity and frequency of any concussion symptoms. The survey and HRV data were de-identified for confidentiality, and to increase the likelihood of accurate reporting the athletes were told their responses would not be used to disqualify them from athletics. Our hypothesis was that HRV would be diminished in those with recent concussion. One athlete (5% of the cohort) sustained a concussion during the study period. A marked decrease in HRV was identified 7 days following the concussion, which eventually returned to baseline. This normalization of HRV followed the timing of resolution of concussion symptoms. Participants who did not sustain a concussion exhibited minimal variance in HRV over time. This preliminary study shows that HRV has potential as a biomarker for symptom resolution after clinically apparent concussion. HRV is unlikely to serve as a concussion diagnostic due to the 7-day lag in HRV change after concussion.
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Affiliation(s)
- Forrest L Anderson
- Department of Orthopedics, Columbia University Medical Center, New York, New York, USA
| | - Justin E Hellwinkel
- Department of Orthopedics, Columbia University Medical Center, New York, New York, USA
| | - Marguerite Montjoy
- Department of Orthopedics, Columbia University Medical Center, New York, New York, USA
| | - Max Levi
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Bin Tu
- Columbia Comprehensive Epilepsy Center, Columbia University, New York, New York, USA
| | - James M Noble
- Department of Neurology, Taub Institute for Research on Alzheimer Disease and the Aging Brain, and G.H. Sergievsky Center, Columbia University, New York, New York, USA
| | - Christopher S Ahmad
- Department of Orthopedics, Columbia University Medical Center, New York, New York, USA
| | - Thomas S Bottiglieri
- Department of Orthopedics, Columbia University Medical Center, New York, New York, USA
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Pender SC, Smith AM, Finnoff JT, Huston J, Stuart MJ. Concussions in Ice Hockey - Moving Toward Objective Diagnoses and Point-of-care Treatment: A Review. Curr Sports Med Rep 2020; 19:380-386. [PMID: 32925378 DOI: 10.1249/jsr.0000000000000752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The incidence of sport-related concussion coupled with a doubling of the participation rate in youth hockey over the past two decades provides impetus for the review of the most promising concussion treatment options. This narrative review summarizes the future treatment options for sport-related concussions in ice hockey, while acknowledging their generalizability to concussion in all sports. Symptom assessment, sign observation, as well as cognitive and balance testing, have historically been used to diagnose a concussion. These methods continue to improve, but the need for effective treatments is clear. Pharmacologic, transcranial light, and nutritional supplement treatment options for concussion warranting further investigation have been identified. Dimethyl fumarate is an immunomodulatory compound thought to trigger antioxidant gene expression. Memantine reduces apoptosis and astrogliosis by inhibiting the calcium influx into cells normally caused by glutamate's activation of N-methyl-D-aspartate receptors. Thioredoxin-mimetic peptides and transcranial photobiomodulation temper the effects of the energy crisis by acting as free radical scavengers. In addition, seven neuroprotective nutritional supplements have been identified: berberine, creatine, curcumin, melatonin, omega-3 fatty acids, resveratrol, and vitamins. An estimated US $1.1 billion has been spent on unsuccessful traumatic brain injury clinical trials. As our ability to accurately diagnose concussion improves, dimethyl fumarate, memantine, thioredoxin-mimetic peptides, transcranial photobiomodulation, and nutritional supplements (berberine, creatine, curcumin, melatonin, omega-3 fatty acids, resveratrol, and vitamins) warrant further preclinical and clinical examination in advancing the treatment of sport-related concussions.
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Affiliation(s)
- Sara C Pender
- School of Medicine, University College Dublin, Dublin, IRELAND
| | | | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - John Huston
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN
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Ledreux A, Pryhoda MK, Gorgens K, Shelburne K, Gilmore A, Linseman DA, Fleming H, Koza LA, Campbell J, Wolff A, Kelly JP, Margittai M, Davidson BS, Granholm AC. Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers. Front Neurosci 2020; 14:761. [PMID: 32848549 PMCID: PMC7406890 DOI: 10.3389/fnins.2020.00761] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
Concussion or mild traumatic brain injury (mTBI) in athletes can cause persistent symptoms, known as post-concussion syndrome (PCS), and repeated injuries may increase the long-term risk for an athlete to develop neurodegenerative diseases such as chronic traumatic encephalopathy (CTE), and Alzheimer's disease (AD). The Center for Disease Control estimates that up to 3.8 million sport-related mTBI are reported each year in the United States. Despite the magnitude of the phenomenon, there is a current lack of comprehensive prognostic indicators and research has shown that available monitoring tools are moderately sensitive to short-term concussion effects but less sensitive to long-term consequences. The overall aim of this review is to discuss novel, quantitative, and objective measurements that can predict long-term outcomes following repeated sports-related mTBIs. The specific objectives were (1) to provide an overview of the current clinical and biomechanical tools available to health practitioners to ensure recovery after mTBIs, (2) to synthesize potential biological mechanisms in animal models underlying the long-term adverse consequences of mTBIs, (3) to discuss the possible link between repeated mTBI and neurodegenerative diseases, and (4) to discuss the current knowledge about fluid biomarkers for mTBIs with a focus on novel exosomal biomarkers. The conclusions from this review are that current post-concussion clinical tests are not sufficiently sensitive to injury and do not accurately quantify post-concussion alterations associated with repeated mTBIs. In the current review, it is proposed that current practices should be amended to include a repeated symptom inventory, a cognitive assessment of executive function and impulse control, an instrumented assessment of balance, vestibulo-ocular assessments, and an improved panel of blood or exosome biomarkers.
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Affiliation(s)
- Aurélie Ledreux
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
| | - Moira K. Pryhoda
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Kim Gorgens
- Graduate School of Professional Psychology, University of Denver, Denver, CO, United States
| | - Kevin Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Anah Gilmore
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
| | - Daniel A. Linseman
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
- Biological Sciences, University of Denver, Denver, CO, United States
| | - Holly Fleming
- Biological Sciences, University of Denver, Denver, CO, United States
| | - Lilia A. Koza
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
- Biological Sciences, University of Denver, Denver, CO, United States
| | - Julie Campbell
- Pioneer Health and Performance, University of Denver, Denver, CO, United States
| | - Adam Wolff
- Denver Neurological Clinic, Denver, CO, United States
| | - James P. Kelly
- Marcus Institute for Brain Health, Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Martin Margittai
- Department of Chemistry and Biochemistry, University of Denver, Denver, CO, United States
| | - Bradley S. Davidson
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
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O'Reilly M, Mahon S, Reid D, Hume P, Hardaker N, Theadom A. Knowledge, attitudes, and behavior toward concussion in adult cyclists. Brain Inj 2020; 34:1175-1182. [PMID: 32683900 DOI: 10.1080/02699052.2020.1793386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine knowledge, attitudes, and behavior toward concussion in cyclists and to identify predictors of concussion knowledge. METHODS Cycling organizations sent members a web link to online information about the study and a questionnaire. Anyone aged >16 years, living in New Zealand and engaged in a cycling activity was invited to participate. The 36-item questionnaire included sociodemographics, knowledge about concussion, helmet use, and personal concussion history. Data were collected between 15/05/19 and 30/06/19. A multiple linear regression model identified factors associated with levels of concussion knowledge. RESULTS The questionnaire was completed by 672 participants aged between 16 and 82 years (x̄ = 48.6 years). Knowledge of concussion was high. However, knowledge that helmets are not able to prevent concussion was low and time to return to sport after injury was variable. Knowledge did not always translate to seeking of medical attention or replacement of helmet behavior. Younger age and having sustained at least one prior concussion were associated with higher levels of concussion knowledge F(df = 3) = 8.81, p < .001. CONCLUSIONS Knowledge and attitudes toward concussion were positive. However, knowledge gaps and discrepancies between attitudes and behavior were identified. Consistent, clear messages are needed around return to sport timeframes.
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Affiliation(s)
- Maureen O'Reilly
- TBI Network, Auckland University of Technology , Auckland, New Zealand
| | - Susan Mahon
- TBI Network, Auckland University of Technology , Auckland, New Zealand
| | - Duncan Reid
- Sports Performance Research Institute New Zealand, Faculty of Health and Environmental Science, Auckland University of Technology , Auckland, New Zealand
| | - Patria Hume
- TBI Network, Auckland University of Technology , Auckland, New Zealand.,Sports Performance Research Institute New Zealand, Faculty of Health and Environmental Science, Auckland University of Technology , Auckland, New Zealand
| | - Natalie Hardaker
- Injury Prevention, Accident and Compensation Corporation , Wellington, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology , Auckland, New Zealand
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Kent JB, Wood CL, Pugh K, Statuta SM, MacKnight JM. The medical observer in American football: a survey of use and efficacy. Brain Inj 2020; 34:1100-1105. [DOI: 10.1080/02699052.2020.1782473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jeremy B. Kent
- Department of Family Medicine, Team Physician, UVa Sports Medicine, University of Virginia Health System, Charlottesville, Virginia, Virginia, USA
| | - Colton L. Wood
- Primary Care Sports Medicine Fellow, Department of Family Medicine, University of North Carolina, Chapel Hill, North Caroline, USA
| | - Kelli Pugh
- Associate Athletics Director for Sports Medicine, University of Virginia, Charlottesville, Charlottesville, Virginia, USA
| | - Siobhan M. Statuta
- Family Medicine and Physical Medicine and Rehabilitation, University of Virginia Health System, Charlottesville, Virginia, USA
| | - John M. MacKnight
- Internal Medicine & Orthopaedic Surgery, Team Physician and Medical Director, UVA Sports Medicine, University of Virginia Health System
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Concussion knowledge, attitudes and behaviour in equestrian athletes. J Sci Med Sport 2020; 23:1055-1061. [PMID: 32471785 DOI: 10.1016/j.jsams.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine knowledge, attitudes and behaviour towards concussion in adult equestrian athletes. DESIGN Nationwide, cross-sectional, questionnaire. METHODS Participants were recruited via advertisements circulated through social media, community presentations and equestrian organisations. Participants were sent a web link to an online questionnaire previously designed for high school athletes and modified to ensure relevance to equestrian activities. The percentage of correct responses per item and a total knowledge score were calculated. Differences in concussion knowledge by age, sex, level of experience and previous history of concussion were explored using t-tests, 95% confidence intervals (CI) and effect sizes. RESULTS The questionnaire was completed by 1486 participants (Mean age=39.1±15.4). Knowledge of what concussion was, how to recognise it and key symptoms (except poor sleep) was high (>80%). In contrast, awareness of guidelines was moderate (56%) and inability of helmets to prevent concussion was low (12%). Significantly higher levels of knowledge of concussion were identified in females compared with males (t=-6.55 p<0.001, 95%CI=-3.26 to -1.75). The majority (87%) of participants reported that a helmet should be replaced after a fall, yet 46% reported re-using a helmet following a hit to the head. CONCLUSIONS Knowledge of and attitudes towards concussion were positive. However, there were knowledge gaps and discrepancies between some attitudes and behaviour on some aspects of concussion. Targeted campaigns to promote awareness of concussion and improve recognition and onward management are needed. Education related to equestrian activities such as helmet use and injury mechanisms is needed to change behaviour and minimise the risk of injury.
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Gardner AJ. Commentary: Sensitivity and Specificity of On-Field Visible Signs of Concussion in the National Football League. Neurosurgery 2020; 87:E298-E300. [DOI: 10.1093/neuros/nyaa158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Local Health District Sports Concussion Program, Waratah, New South Wales, Australia
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Gates JK, Lin CY. Head and Spinal Injuries in Equestrian Sports: Update on Epidemiology, Clinical Outcomes, and Injury Prevention. Curr Sports Med Rep 2020; 19:17-23. [PMID: 31913919 DOI: 10.1249/jsr.0000000000000674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Equestrian sports represent a variety of activities involving a horse and rider. Due to the unpredictable nature of horses, their height, and potential high speeds involved, equestrian athletes are at risk of head and spinal injuries. This review describes the epidemiology, injury mechanisms, and risk factors for equestrian sports-related head and spinal injuries. Traumatic brain injuries, including concussions, are more common than spinal injuries. Both injury types are most commonly related to a rider fall from a horse. Spinal injuries are less common but are associated with potentially significant neurological morbidity when spinal cord injury occurs. An improved understanding of preventable injury mechanisms, increased certified helmet use, improved helmet technologies, and educational outreach may help to address the risk of head and spinal injuries in equestrian sports.
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Austin AV, Sasser P, Tanabe K, MacKnight JM, Kent JB. Video Analysis of Concussion Exposures in a National Collegiate Athletic Association Division I Football Team. Orthop J Sports Med 2020; 8:2325967120903294. [PMID: 32166091 PMCID: PMC7052463 DOI: 10.1177/2325967120903294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/06/2019] [Indexed: 01/12/2023] Open
Abstract
Background: Research into improving player safety of sport-related concussion (SRC) in
American football has been an ongoing endeavor. In an attempt to better
understand the incidence of SRCs in American football, research has focused
on the characteristics of SRC during gameplay. Determining SRC specifics and
assessing them quantitatively can help identify high-risk scenarios and
predict exposure risk. Purpose: To identify and assess the incidence of SRCs in a National Collegiate
Athletic Association football team by comparing field location, player
positions, collision partners, and player cues. Study Design: Descriptive epidemiology study. Methods: We used physician sideline reports of diagnosed concussions from a Division I
football team from September 2010 to December 2018. Game videos were
analyzed to identify the field location where the SRC occurred, collision
partner, and player behavior postconcussion. The incidence of in-game SRCs
by position was also assessed. We used the “words of estimative probability”
model to categorize each concussion as certain, almost certain,
probable, or even on the basis of our
confidence in identifying them using game film. Results: This study examined 44 SRCs that occurred over 9 seasons. The SRC incidence
was significantly higher in the middle defense (5-20 yards from the line of
scrimmage) compared with all other field locations (relative risk, 2.46; 95%
CI, 1.14-5.29; P < .05). In-game collision partners were
most commonly defensive backs. The most common player cue was a hand to
helmet/face mask. The positions with the highest SRC incidence by
athlete-exposure, game position, and position play belonged to the defensive
backs, wide receivers, and running backs. Conclusion: The middle defense had a significantly higher incidence of SRCs than all
other field locations. We pose a new method to categorize concussions during
video analysis by using words of estimative probability. Knowledge of SRC
gameplay characteristics can potentially guide the medical staff and medical
observer to better identify them.
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Affiliation(s)
- Ashley V Austin
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Phillip Sasser
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kawai Tanabe
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - John M MacKnight
- Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jeremy B Kent
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Stillman AM, Madigan N, Torres K, Swan N, Alexander MP. Subjective Cognitive Complaints in Concussion. J Neurotrauma 2020; 37:305-311. [DOI: 10.1089/neu.2018.5925] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexandra M. Stillman
- Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, Massachusetts
| | - Nancy Madigan
- Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, Massachusetts
| | - Karen Torres
- University of Washington School of Medicine, Seattle, Washington
| | - Natasha Swan
- Integrated/Base Operational Support Team, Joint Base Elmendorf-Richardson, Anchorage, Alaska
| | - Michael P. Alexander
- Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, Massachusetts
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The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study. SPORTS MEDICINE-OPEN 2020; 6:2. [PMID: 31919687 PMCID: PMC6952482 DOI: 10.1186/s40798-019-0231-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022]
Abstract
Background Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), have been recommended to identify possible concussion following a head impact where the consequences are unclear. However, real-life performance, and diagnostic accuracy of constituent sub-tests, have not been well characterized. Methods A retrospective cohort study was performed in elite Rugby Union competitions between September 2015 and June 2018. The study population comprised consecutive players identified with a head impact event undergoing off-field assessments with the World Rugby Head Injury Assessment (HIA01) screening tool, an abridged version of the SCAT3. Off-field screening performance was investigated by evaluating real-life removal-from-play outcomes and determining the theoretical diagnostic accuracy of the HIA01 tool, and individual sub-tests, if player-specific baseline or normative sub-test thresholds were strictly applied. The reference standard was clinically diagnosed concussion determined by serial medical assessments. Results One thousand one hundred eighteen head impacts events requiring off-field assessments were identified, resulting in 448 concussions. Real-life removal-from-play decisions demonstrated a sensitivity of 76.8% (95% CI 72.6–80.6) and a specificity of 86.6% (95% CI 83.7–89.1) for concussion (AUROC 0.82, 95% CI 0.79–0.84). Theoretical HIA01 tool performance worsened if pre-season baseline values (sensitivity 89.6%, specificity 33.9%, AUROC 0.62, p < 0.01) or normative thresholds (sensitivity 80.4%, specificity 69.0%, AUROC 0.75, p < 0.01) were strictly applied. Symptoms and clinical signs were the HIA01 screening tool sub-tests most predictive for concussion; with immediate memory and tandem gait providing little additional diagnostic value. Conclusions These findings support expert recommendations that clinical judgement should be used in the assessment of athletes following head impact events. Substitution of the tandem gait and 5-word immediate memory sub-tests with alternative modes could potentially improve screening tool performance.
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A Look Ahead. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
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49
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Dec KL, Kelly KC, Gilman JB. Management of Adult Sports Concussion. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Mack C, Myers E, Barnes R, Solomon G, Sills A. Engaging Athletic Trainers in Concussion Detection: Overview of the National Football League ATC Spotter Program, 2011-2017. J Athl Train 2019; 54:852-857. [PMID: 31415183 DOI: 10.4085/1062-6050-181-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assist sideline medical staff and to augment detection of concussion in National Football League (NFL) players during preseason and regular season games via the use of certified athletic trainer (ATC) spotters. BACKGROUND Detecting concussive injuries in contact-sport athletes can be a challenging task for health care providers on the sideline. Over the past 8 years, professional sport leagues have begun to use additional sets of eyes (medical spotters along with video review) to help identify athletes with possible concussive injuries. DESCRIPTION The NFL first began a program using spotters in 2011, and the ATC Spotter Program has undergone systematic enhancements each year. This article describes the evolution of the ATC Spotter Program, the requirements and training of its participants, and the program data available to date. Directions for future improvement and research are addressed. CLINICAL ADVANTAGES The use of ATC spotters stationed in the broadcast booth has enhanced the real-time detection of concussed players in the NFL.
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Affiliation(s)
| | | | | | - Gary Solomon
- National Football League, New York, NY.,Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN
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