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Salmon D, Badenhorst M, Clark B, Walters S, Sullivan SJ, Sole G. Unintended consequences - A qualitative exploration of baseline testing in community rugby concussion management. J Sci Med Sport 2024; 27:594-602. [PMID: 38811276 DOI: 10.1016/j.jsams.2024.05.003] [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] [Received: 11/15/2023] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Understanding key stakeholders' perceptions around the value of baseline testing, as well as barriers or facilitators experienced as part of the process, may assist with the decision-making process of whether to implement baseline testing in community sport. This study explored coaches', players' and physiotherapists' perceptions of the perceived value, barriers and facilitators of baseline testing as part of New Zealand Rugby's (NZR) community concussion initiative. DESIGN The study employed a pragmatic, qualitative descriptive design. METHODS Semi-structured interviews were used to explore participants' perceptions. In total, 73 individual interviews were conducted. The sample consisted of 36 players, 13 coaches and 24 physiotherapists involved in NZR's concussion management pathway. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. RESULTS In terms of perceived value, baseline testing was reported to play a role in i) facilitating a positive concussion culture; ii) positive perceptions of rugby and player safety and iii) enhancing concussion management as part of the pathway. Barriers and facilitators of the baseline testing process included i) stakeholder buy-in as critical driver of the process and ii) contextual and operational factors. Although contextual and operational challenges exist, these participants, as key stakeholders in the process, perceived the value of baseline testing to be more important than the barriers experienced. CONCLUSIONS The value of baseline testing extends beyond concussion assessment and management, by enhancing community concussion awareness, attitudes and player safety. The findings of this study may assist in the decision-making process around inclusion of pre-season baseline testing in community rugby.
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Affiliation(s)
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, New Zealand.
| | - Brooke Clark
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, New Zealand
| | | | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
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Hagopian M, Jorgensen MP, Lehmann H, O’Hagan F. Navigating uncertainty: exploring parents' knowledge of concussion management and neuropsychological baseline testing. Front Sports Act Living 2024; 6:1360329. [PMID: 38799030 PMCID: PMC11116697 DOI: 10.3389/fspor.2024.1360329] [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] [Received: 12/22/2023] [Accepted: 03/28/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Parents play an important role in preventing and managing sport-related concussions among youth sport participants. Research indicates that parents understand the severity and consequences associated with the injury but gaps exist in their knowledge of its management. Neuropsychological baseline testing (NBT) is a modality that has gained interest in youth sport to purportedly better manage concussion injuries. Little is known about parents' perspectives on the use of NBT in the management process. Methods The present qualitative study used Protection Motivation Theory as a guiding framework and employed focus groups (N = 2) with parents (N = 11) to gain insight into parents' perceptions and experiences with concussion management, specifically focusing on NBT. Results Inductive Content Analysis developed a core theme of navigating uncertainty. Participants expressed uncertainty about the nature of concussion and its management process, where concussion was not always easy to identify, youth were not always reliable reporters, and there was no prescribed or proscribed path for recovery. Personal experience and concussion management policy provided participants with a degree of certainty in managing concussions. Participants gave NBT mixed reviews in potentially promoting greater certainty but also held reservations about its usefulness in concussion management. Discussion We discuss findings relative to existing knowledge and theory in youth sport concussion and identify implications for practice.
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Affiliation(s)
- Matthew Hagopian
- Department of Psychology, Trent University, Peterborough, ON, Canada
| | - Michael P. Jorgensen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Hugo Lehmann
- Department of Psychology, Trent University, Peterborough, ON, Canada
| | - Fergal O’Hagan
- Department of Psychology, Trent University, Peterborough, ON, Canada
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Woods D, Pebler P, Johnson DK, Herron T, Hall K, Blank M, Geraci K, Williams G, Chok J, Lwi S, Curran B, Schendel K, Spinelli M, Baldo J. The California Cognitive Assessment Battery (CCAB). Front Hum Neurosci 2024; 17:1305529. [PMID: 38273881 PMCID: PMC10809797 DOI: 10.3389/fnhum.2023.1305529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction We are developing the California Cognitive Assessment Battery (CCAB) to provide neuropsychological assessments to patients who lack test access due to cost, capacity, mobility, and transportation barriers. Methods The CCAB consists of 15 non-verbal and 17 verbal subtests normed for telemedical assessment. The CCAB runs on calibrated tablet computers over cellular or Wi-Fi connections either in a laboratory or in participants' homes. Spoken instructions and verbal stimuli are delivered through headphones using naturalistic text-to-speech voices. Verbal responses are scored in real time and recorded and transcribed offline using consensus automatic speech recognition which combines the transcripts from seven commercial ASR engines to produce timestamped transcripts more accurate than those of any single ASR engine. The CCAB is designed for supervised self-administration using a web-browser application, the Examiner. The Examiner permits examiners to record observations, view subtest performance in real time, initiate video chats, and correct potential error conditions (e.g., training and performance failures, etc.,) for multiple participants concurrently. Results Here we describe (1) CCAB usability with older (ages 50 to 89) participants; (2) CCAB psychometric properties based on normative data from 415 older participants; (3) Comparisons of the results of at-home vs. in-lab CCAB testing; (4) We also present preliminary analyses of the effects of COVID-19 infection on performance. Mean z-scores averaged over CCAB subtests showed impaired performance of COVID+ compared to COVID- participants after factoring out the contributions of Age, Education, and Gender (AEG). However, inter-cohort differences were no longer significant when performance was analyzed with a comprehensive model that factored out the influences of additional pre-existing demographic factors that distinguished COVID+ and COVID- cohorts (e.g., vocabulary, depression, race, etc.,). In contrast, unlike AEG scores, comprehensive scores correlated significantly with the severity of COVID infection. (5) Finally, we found that scoring models influenced the classification of individual participants with Mild Cognitive Impairment (MCI, z-scores < -1.50) where the comprehensive model accounted for more than twice as much variance as the AEG model and reduced racial bias in MCI classification. Discussion The CCAB holds the promise of providing scalable laboratory-quality neurodiagnostic assessments to underserved urban, exurban, and rural populations.
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Affiliation(s)
- David Woods
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - Peter Pebler
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - David K Johnson
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Timothy Herron
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
- VA Northern California Health Care System, Martinez, CA, United States
| | - Kat Hall
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - Mike Blank
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | - Kristi Geraci
- NeuroBehavioral Systems Inc., Berkeley, CA, United States
| | | | - Jas Chok
- VA Northern California Health Care System, Martinez, CA, United States
| | - Sandy Lwi
- VA Northern California Health Care System, Martinez, CA, United States
| | - Brian Curran
- VA Northern California Health Care System, Martinez, CA, United States
| | - Krista Schendel
- VA Northern California Health Care System, Martinez, CA, United States
| | - Maria Spinelli
- VA Northern California Health Care System, Martinez, CA, United States
| | - Juliana Baldo
- VA Northern California Health Care System, Martinez, CA, United States
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Keyser-Marcus L, Ramey T, Bjork JM, Martin CE, Sabo R, Moeller FG. Initial Validation of a Behavioral Phenotyping Model for Substance Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:14. [PMID: 38276802 PMCID: PMC10815773 DOI: 10.3390/ijerph21010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024]
Abstract
Standard nosological systems, such as DSM-5 or ICD-10, are relied upon as the diagnostic basis when developing treatments for individuals with substance use disorder (SUD). Unfortunately, the vast heterogeneity of individuals within a given SUD diagnosis results in a variable treatment response and/or difficulties ascertaining the efficacy signal in clinical trials of drug development. Emerging precision medicine methods focusing on targeted treatments based on phenotypic subtypes rather than diagnosis are being explored as alternatives. The goal of the present study was to provide initial validation of emergent subtypes identified by an addiction-focused phenotyping battery. Secondary data collected as part of a feasibility study of the NIDA phenotyping battery were utilized. Participants completed self-report measures and behavioral tasks across six neurofunctional domains. Exploratory and confirmatory factor analysis (EFA/CFA) were conducted. A three-factor model consisting of negative emotionality, attention/concentration, and interoception and mindfulness, as well as a four-factor model adding a second negative emotion domain, emerged from the EFA as candidate models. The CFA of these models did not result in a good fit, possibly resulting from small sample sizes that hindered statistical power.
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Affiliation(s)
- Lori Keyser-Marcus
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Tatiana Ramey
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse (NIDA), Gaithersburg, MD 20877, USA
| | - James M. Bjork
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - Roy Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - F. Gerard Moeller
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
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Symons GF, O’Brien WT, Abel L, Chen Z, Costello DM, O’Brien TJ, Kolbe S, Fielding J, Shultz SR, Clough M. Monitoring the acute and subacute recovery of cognitive ocular motor changes after a sports-related concussion. Cereb Cortex 2022; 33:5276-5288. [PMID: 36300614 DOI: 10.1093/cercor/bhac416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Identifying when recovery from a sports-related concussion (SRC) has occurred remains a challenge in clinical practice. This study investigated the utility of ocular motor (OM) assessment to monitor recovery post-SRC between sexes and compared to common clinical measures. From 139 preseason baseline assessments (i.e. before they sustained an SRC), 18 (12 males, 6 females) consequent SRCs were sustained and the longitudinal follow-ups were collected at 2, 6, and 13 days post-SRC. Participants completed visually guided, antisaccade (AS), and memory-guided saccade tasks requiring a saccade toward, away from, and to a remembered target, respectively. Changes in latency (processing speed), visual–spatial accuracy, and errors were measured. Clinical measures included The Sports Concussion Assessment Tool, King-Devick test, Stroop task, and Digit span. AS latency was significantly longer at 2 days and returned to baseline by 13-days post-SRC in females only (P < 0.001). Symptom numbers recovered from 2 to 6 days and 13 days (P < 0.05). Persistently poorer AS visual–spatial accuracy was identified at 2, 6 and 13 days post-SRC (P < 0.05) in both males and females but with differing trajectories. Clinical measures demonstrated consistent improvement reminiscent of practice effects. OM saccade assessment may have improved utility in tracking recovery compared to conventional measures and between sexes.
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Affiliation(s)
- Georgia F Symons
- Monash University Department of Neuroscience, , The Alfred Centre, 99 Commercial Road, Melbourne, Victoria (VIC) 3004, Australia
| | - William T O’Brien
- Monash University Department of Neuroscience, , The Alfred Centre, 99 Commercial Road, Melbourne, Victoria (VIC) 3004, Australia
| | - Larry Abel
- Department of Optometry and Vision science, The University of Melbourne , Grattan street, Parkville, Victoria (VIC) 3010, Australia
| | - Zhibin Chen
- Monash University Department of Neuroscience, , The Alfred Centre, 99 Commercial Road, Melbourne, Victoria (VIC) 3004, Australia
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital , Grattan street, Parkville, Victoria (VIC) 3010, Australia
| | - Daniel M Costello
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital , Grattan street, Parkville, Victoria (VIC) 3010, Australia
| | - Terence J O’Brien
- Monash University Department of Neuroscience, , The Alfred Centre, 99 Commercial Road, Melbourne, Victoria (VIC) 3004, Australia
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital , Grattan street, Parkville, Victoria (VIC) 3010, Australia
| | - Scott Kolbe
- Monash University Department of Neuroscience, , The Alfred Centre, 99 Commercial Road, Melbourne, Victoria (VIC) 3004, Australia
| | - Joanne Fielding
- Monash University Department of Neuroscience, , The Alfred Centre, 99 Commercial Road, Melbourne, Victoria (VIC) 3004, Australia
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital , Grattan street, Parkville, Victoria (VIC) 3010, Australia
| | - Sandy R Shultz
- Monash University Department of Neuroscience, , The Alfred Centre, 99 Commercial Road, Melbourne, Victoria (VIC) 3004, Australia
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital , Grattan street, Parkville, Victoria (VIC) 3010, Australia
- Department of Nursing, Health and Huan services, Vancouver Island University , 900 Fifth St, Nanaimo, British Columbia (BC), V9R 6S5, Canada
| | - Meaghan Clough
- Monash University Department of Neuroscience, , The Alfred Centre, 99 Commercial Road, Melbourne, Victoria (VIC) 3004, Australia
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