No cumulative effects for one or two previous concussions

Management of pediatric mild traumatic brain injury: a neuropsychological review from injury through recovery

Little scientific attention has been aimed at the non-acute clinical care of pediatric mild TBI. We propose a clinical management model focused on both evaluation and intervention from the time of injury through recovery. Intervention strategies are outlined using a framework encompassing four relevant domains: the individual youth, family, school, and athletics. Clinical management has primary value in its potential to speed recovery, minimize distress during the recovery process, and reduce the number of individuals who subjectively experience longer lasting postconcussive problems. With proper management, most children and adolescents sustaining an uncomplicated mild TBI can be expected to recover fully.

Prolonged neuropsychological impairments following a first concussion in female university soccer athletes

OBJECTIVE

Although research is accumulating on the cognitive sequelae from sports-related concussions in men, little to nothing is known about the prolonged cognitive outcome after a concussion in women. This point is important because recent evidence suggests that female athletes are at greater risk of sustaining a concussion.

DESIGN

We assessed cognitive functioning after a first concussion in female soccer players, 6 to 8 months after their injury. The first-time concussed athletes were compared with a group of age-matched teammates who had never experienced a concussion.

SETTING AND PARTICIPANTS

A total of 22 female university-level soccer players participated in the study.

MAIN OUTCOME MEASUREMENTS

Paper-and-pencil and computerized tasks were used to assess different neuropsychological functions.

RESULTS

Short- and long-term verbal memory, attention, and simple reaction time were normal. In contrast, compared with the control group, the concussed athletes were significantly slower on tasks that required decision making (complex reaction time), inhibition and flexibility (Stroop), and planning (Tour of London task).

CONCLUSIONS

The results of this study suggest that cognitive functions related to cognitive processing speed are most vulnerable to a sports-related concussion and are still impaired for a half year after injury in university-level female soccer players.

Course and predicting factors of lower-extremity injuries after running a marathon

OBJECTIVES

To investigate in recreational runners the 3 month prognosis of and medical consumption caused by running injuries occurring shortly before or during a marathon. Possible prognostic factors for persistent complaints were also evaluated.

DESIGN

Prospective cohort study.

SETTING

Rotterdam, the Netherlands.

PARTICIPANTS

One hundred sixty-five recreational marathon runners who reported a new running injury in the month before or during the Rotterdam Marathon 2005 and who were available for follow-up. ASSESSMENT OF DETERMINANTS: Demographic, running (training distance, frequency and duration, experience, etc), lifestyle (other sports, smoking), and injury-related factors were collected at baseline.

MAIN OUTCOME MEASUREMENTS

Persistent complaints of running injuries occurring in the month before or during the Rotterdam marathon at 3 month follow-up. Potential prognostic factors for persistent complaints were analyzed by multivariate logistic regression.

RESULTS

At 3 month follow-up, 25.5% of the 165 injured runners reported persistent complaints; they had little pain during exercise and almost no pain in rest. Of all 165 male runners, 27 (16.4%) visited a general practitioner because of their running injury and 40 (24.2%) visited a physiotherapist (218 times in total). Persistent complaints at 3 month follow-up were associated with non-musculoskeletal comorbidities [odds ratio (OR), 3.23; confidence interval (CI), 1.24-8.43], and calf injuries (OR, 0.37; CI, 0.13-1.05).

CONCLUSIONS

One quarter of the runners had persistent complaints of their marathon-related running injury at 3 month follow-up. However, the clinical and social consequences of the injuries seem to be relatively mild. Non-musculoskeletal comorbidities at baseline are related to poor recovery, whereas recovery is also location specific.

Concussion history is not a predictor of computerised neurocognitive performance

BACKGROUND

The long term effects of self reported concussion on neurocognitive functioning have been found to be variable.

OBJECTIVES

To evaluate cognitive performance on the Headminder concussion resolution index (CRI) and ImPACT assessment tests of subjects with and without a history of self reported concussion.

METHODS

A retrospective analysis was completed on 235 Headminder CRI baseline assessments and 264 ImPACT baseline assessments. Participants were divided into four groups on the basis of reported number of concussions (zero, one, two, or three). Multivariate analysis of variance was used to evaluate differences between the concussion history groups on the two computer based concussion assessment programs.

RESULTS

Multivariate analysis of variance indicated no significant difference between those with and without a history of concussion on the CRI (Lambda = 0.963, F((15, 627.05)) = 0.57, p = 0.898). It also revealed no significant differences between groups on the ImPACT test (Lambda = 0.951, F((12, 672.31)) = 1.07, p = 0.381).

CONCLUSIONS

The results suggest that either long term cognitive decrements may not be associated with a history of concussion or the decrements may be subtle and undetectable by these computer programs.

Management of concussion and post-concussion syndrome

Concussion and mild traumatic brain injury (mTBI) are common clinical problems. However, the literature is not consistent in defining how concussion and mTBI are related. Although most patients with concussion recover within days to weeks, approximately 10% develop persistent signs and symptoms of post-concussion syndrome (PCS). There are no scientifically established treatments for concussion or PCS and thus rest and cognitive rehabilitation are traditionally applied, with limited effectiveness. This article presents a clinical model to suggest that concussion evolves to become mTBI after PCS has developed, representing a more severe form of brain injury. The basic pathophysiology of concussion is presented, followed by a recommended approach to the clinical evaluation of concussion in the emergency department and the physician's office. We evaluate the limited evidence-based pharmacologic treatment of acute concussion symptoms and PCS symptoms and also discuss return to activity recommendations, with an emphasis on athletes. Lastly, we suggest a promising new direction for helping patients recover from PCS.

Concussion in Professional Football: Recovery of NFL and High School Athletes Assessed by Computerized Neuropsychological Testing—Part 12

OBJECTIVE

Acute recovery from concussion (mild traumatic brain injury) is assessed in samples of NFL and high school athletes evaluated within days of injury.

METHODS

All athletes were evaluated within days of injury using a computer-based neuropsychological test and symptom inventory protocol. Test performance was compared to preinjury baseline levels of a similar but not identical group of athletes who had undergone preseason testing. Statistical analyses were completed using Multivariate Analysis of Variance (MANOVA).

RESULTS

NFL athletes demonstrated a rapid neuropsychological recovery. As a group, NFL athletes returned to baseline performance in a week with the majority of athletes having normal performance two days after injury. High school athletes demonstrated a slower recovery than NFL athletes.

CONCLUSION

Computer-based neuropsychological testing was used within the overall medical evaluation and care of NFL athletes. As found in a prior study using more traditional neuropsychological testing, NFL players did not demonstrate decrements in neuropsychological performance beyond one week of injury. High school players demonstrated more prolonged neuropsychological effects of concussion.