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Waltzman D, DePadilla L, Breiding M, Pierpoint L, Collins C. The Role of Level of Play in Concussions in High School Athletes. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:99-110. [PMID: 37566801 DOI: 10.1097/phh.0000000000001791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
OBJECTIVES To examine level of play (LOP) as a risk factor for concussion severity and recovery-related outcomes among high school athletes, stratified by sex, and among boys, by sport (football, non-football male sports). DESIGN/SETTING Secondary analysis of data collected through the High School Reporting Information Online surveillance system for academic years 2007-2008 through 2018-2019. PARTICIPANTS A total of 9916 concussions were reported between the academic years 2007-2008 and 2018-2019 from 9 sports (5189 from football; 2096 from non-football male sports; 2631 from female sports). MAIN OUTCOME MEASURE Examined the association between LOP (Freshman, Junior Varsity [JV], and Varsity teams) and concussion outcomes (number of concussion symptoms, symptom resolution time [SRT], and time to return to play [RTP]). RESULTS Compared with Varsity football athletes, concussed JV football athletes had on average 0.19 fewer concussion symptoms, longer SRT (>1 week vs <1 week: odds ratio [OR] = 1.3; 95% confidence interval [CI], 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.2-1.9; >3 weeks vs <1 week: OR = 1.6; 95% CI, 1.1-2.3). Compared with Varsity football athletes, Freshman football athletes had on average 0.48 fewer concussion symptoms, longer SRT (OR = 1.3; 95% CI, 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.1-2.0; >3 weeks vs <1 week: OR = 2.0; 95% CI, 1.3-3.0). Similarly, compared with female athletes on Varsity teams, concussed JV female athletes had longer RTP (1-3 weeks vs <1 week: OR = 1.8; 95% CI, 1.2-2.7). Trend analyses revealed an increase in the number of concussion symptoms between 2015-2016 and 2018-2019, a decrease between 2009-2010 and 2018-2019 for SRT of less than 1 week, and an increase between 2014-2015 and 2018-2019 for RTP of less than 1 week among Varsity football athletes. Among Varsity female athletes, there was a linear decrease during the study period for RTP of less than 1 week. CONCLUSIONS Despite a higher number of symptoms overall and in recent years, Varsity football players had shorter RTP than Freshman and JV athletes.
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Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Waltzman, DePadilla, and Breiding); Colorado School of Public Health, and University of Colorado School of Medicine, Aurora, Colorado (Dr Pierpoint); and Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, Indiana (Dr Collins)
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Ammendolia A, de Sire A, Lippi L, Ammendolia V, Spanò R, Reggiani A, Invernizzi M, Marotta N. Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Pilot Randomized Controlled Trial. Sports (Basel) 2023; 11:180. [PMID: 37755857 PMCID: PMC10537008 DOI: 10.3390/sports11090180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Acute lateral ankle sprains are common injuries among athletes, but the optimal treatment strategies in elite athletes are still debated. This proof-of-concept study aimed to assess the impact of cryo-ultrasound therapy on the short-term recovery of football players with acute lateral ankle sprains. METHODS Semi-professional football players with grade I or II lateral ankle sprains were randomly assigned to the experimental group (receiving cryo-ultrasound therapy combined with conventional physical therapy) or control group (sham cryo-ultrasound therapy combined with conventional physical therapy). Pain intensity and physical functioning were assessed by the Numeric Rating Scale (NRS) and Foot and Ankle Disability Index (FADI) at baseline (T0) at the end of treatment (T1), after one month (T2), and two months after treatment (T3). RESULTS After the study intervention, significant between groups differences were reported in terms of pain relief (NRS: 4.08 ± 1.29 vs. 5.87 ± 1.19; p = 0.003) and physical function (FADI: 50.9 ± 10.3 vs. 38.3 ± 11.5; p = 0.021). However, no significant between group differences were reported at T2 and T3. No adverse effects were reported. CONCLUSIONS Cryo-ultrasound therapy combined with conventional physical therapy can accelerate recovery and early return to sport in elite football players with acute lateral ankle sprains. While this study contributes valuable insights into the potential benefits of cryo-ultrasound therapy, further investigations with a longer follow-up are needed to validate and optimize the application of physical agent modalities in the management of ankle injuries.
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Affiliation(s)
- Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Integrated Activities Research and Innovation Department (DAIRI), Translational Medicine, Hospital SS. Antonio Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Valerio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
| | - Riccardo Spanò
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.A.); (V.A.); (R.S.)
| | - Andrea Reggiani
- Physical and Rehabilitative Medicine, Casa di Cura La Madonnina, 20122 Milan, Italy;
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Integrated Activities Research and Innovation Department (DAIRI), Translational Medicine, Hospital SS. Antonio Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Physical and Rehabilitative Medicine, Department of Experimental and Clinical Medicine, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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Miner D, Harper B. Combined Neurocognitive and Exercise Tolerance Testing Improves Objectivity of Buffalo Concussion Treadmill Test. J Sport Rehabil 2023:1-7. [PMID: 36940684 DOI: 10.1123/jsr.2022-0354] [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: 09/30/2022] [Revised: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 03/23/2023]
Abstract
CONTEXT The Buffalo Concussion Treadmill Test (BCTT) is a standard assessment of exercise tolerance utilized for exercise prescription following concussion and to inform decisions regarding return to play. One limitation of the BCTT is that interpretation of test results is dependent on individuals' self-report of symptom exacerbation with exertion. Symptoms following concussion are significantly underreported or unreported. Combining objective neurocognitive assessment with exercise tolerance testing may enable clinicians to objectively identify those requiring further assessment or rehabilitation before return to play. The purpose of this study was to investigate how performance on a neurocognitive assessment battery is affected by provocative exercise testing. DESIGN Prospective cohort study, pretest/posttest. METHODS A total of 30 participants included 13 women (43.3%), age 23.4 (1.93) years, height 173.56 (10) cm, weight 77.35 (16.3) kg, and 11 (36.7%) with history of concussion. All participants completed a neurocognitive assessment battery, including the Stroop Test and standardized assessments of working memory, attention, and information processing speed/accuracy in single-task (seated position) and dual-task conditions (walking on a treadmill at 2.0 miles per hour). The neurocognitive assessment battery was performed at baseline and after the standard BCTT test protocol. RESULTS BCTT: Average percentage of heart rate maximum (%HRmax) = 93.97% (4.8%); average maximum rating of perceived exertion = 18.6 (1.5). Time-based performance in single-task and dual-task conditions significantly improved from baseline (P < .05) following maximal exercise testing on the BCTT for the following neurocognitive assessments: concentration-reverse digits, Stroop congruent, and Stroop incongruent. CONCLUSIONS Healthy participants demonstrated improvements across multiple domains of neurocognitive performance following the exercise tolerance testing on the BCTT. Understanding normal responses in neurocognitive performance for healthy individuals following exercise tolerance testing may allow clinicians to more objectively monitor the trajectory of recovery following sports-related concussion.
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Affiliation(s)
- Daniel Miner
- Department of Physical Therapy, Radford University Carilion, Roanoke, VA,USA
| | - Brent Harper
- Department of Physical Therapy, Chapman University, Irvine, CA,USA
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Zuckerman SL, Yengo-Kahn AM, Tang AR, Bailes JE, Beauchamp K, Berger MS, Bonfield CM, Camarata PJ, Cantu RC, Davis GA, Ellenbogen RG, Ellis MJ, Feuer H, Guazzo E, Harris OA, Heppner P, Honeybul S, Manley G, Maroon JC, Miele VJ, Nahed BV, Okonkwo DO, Oppenlander ME, Petty J, Sabin HI, Samadani U, Sherburn EW, Sheridan M, Tator CH, Theodore N, Timmons SD, Woodworth GF, Solomon GS, Sills AK. Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight. Neurosurgery 2021; 88:E495-E504. [PMID: 33693899 DOI: 10.1093/neuros/nyab041] [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: 07/07/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sport-related structural brain injury (SRSBI) is intracranial pathology incurred during sport. Management mirrors that of non-sport-related brain injury. An empirical vacuum exists regarding return to play (RTP) following SRSBI. OBJECTIVE To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. METHODS A systematic literature review of SRSBI from 2012 to present in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a cross-sectional survey of RTP in SRSBI by 31 international neurosurgeons was conducted. RESULTS Of 27 included articles out of 241 systematically reviewed, 9 (33.0%) case reports provided RTP information for 12 athletes. To assess expert opinion, 31 of 32 neurosurgeons (96.9%) provided survey responses. For acute, asymptomatic SRSBI, 12 (38.7%) would not operate. Of the 19 (61.3%) who would operate, midline shift (63.2%) and hemorrhage size > 10 mm (52.6%) were the most common indications. Following SRSBI with resolved hemorrhage, with or without burr holes, the majority of experts (>75%) allowed RTP to high-contact/collision sports at 6 to 12 mo. Approximately 80% of experts did not endorse RTP to high-contact/collision sports for athletes with persistent hemorrhage. Following craniotomy for SRSBI, 40% to 50% of experts considered RTP at 6 to 12 mo. Linear regression revealed that experts allowed earlier RTP at higher levels of play (β = -0.58, 95% CI -0.111, -0.005, P = .033). CONCLUSION RTP decisions following structural brain injury in athletes are markedly heterogeneous. While individualized RTP decisions are critical, aggregated expert opinions from 31 international sports neurosurgeons provide key insight. Level of play was found to be an important consideration in RTP determinations.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan R Tang
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julian E Bailes
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Kathryn Beauchamp
- Division of Neurological Surgery, Denver Health Medical Center, Department of Neurological Surgery University of Colorado, Denver, Colorado, USA
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Christopher M Bonfield
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul J Camarata
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Gavin A Davis
- Department of Neurosurgery, Austin and Cabrini Health, Melbourne, Australia
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Michael J Ellis
- Department of Surgery and Pediatrics, Section of Neurosurgery, University of Manitoba, Pan Am Concussion Program, Winnipeg, Canada
| | - Hank Feuer
- Player Health and Safety Department, National Football League, New York, New York, USA
| | - Eric Guazzo
- Department of Neurosurgery, Townsville University Hospital, Townsville, Australia
| | - Odette A Harris
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Peter Heppner
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth Western Australia
| | - Geoff Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Joseph C Maroon
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vincent J Miele
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark E Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jerry Petty
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA
| | | | - Uzma Samadani
- Division of Neurosurgery, Minneapolis VAMC; Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eric W Sherburn
- The Center for Concussion, University of Oklahoma College of Medicine, Tulsa, Oklahoma, USA
| | - Mark Sheridan
- Department of Neurosurgery, Liverpool Hospital, Liverpool, Australia
| | - Charles H Tator
- Canadian Concussion Centre and Division of Neurosurgery, Toronto Western Hospital and University of Toronto, Toronto, Canada
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - Shelly D Timmons
- Department of Neurological Surgery, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, USA
| | - Graeme F Woodworth
- Department of Neurosurgery & R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Player Health and Safety Department, National Football League, New York, New York, USA
| | - Allen K Sills
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Player Health and Safety Department, National Football League, New York, New York, USA
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DeMatteo C, Randall S, Falla K, Lin CY, Giglia L, Mazurek MF, Koelink E. Concussion Management for Children Has Changed: New Pediatric Protocols Using the Latest Evidence. Clin Pediatr (Phila) 2020; 59:5-20. [PMID: 31625406 DOI: 10.1177/0009922819879457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Return to activity (RTA) and return to school (RTS) are important issues in pediatric concussion management. This study aims to update CanChild's 2015 RTA and RTS protocols, on the basis of empirical data and feedback collected from our recently completed prospective cohort study, focusing on concussed children and their caregivers; systematic review of evidence published since 2015; and consultation with concussion management experts. The new protocols highlight differences from the earlier versions, mainly, (1) symptom strata to allow quicker progression for those who recover most quickly; (2) a shortened rest period (24-48 hours) accompanied by symptom-guided activity; (3) the recommendation that children progress through the stages before they are symptom free, if symptoms have decreased and do not worsen with activity; (4) specific activity suggestions at each stage of the RTA protocol; (5) recommendations for the amount of time to spend per stage; and (6) integration of RTS and RTA.
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Affiliation(s)
- Carol DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Randall
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Katie Falla
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Chia-Yu Lin
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,ARiEAL, Centre for Advanced Research in Experimental & Applied Linguistics, McMaster University, Hamilton, Ontario, Canada
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Michael F Mazurek
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Eric Koelink
- Division of Emergency Medicine, Department of Pediatrics, McMaster University Medical Centre and McMaster University, Hamilton, Ontario, Canada
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Dech RT, Bishop SA, Neary JP. Why exercise may be beneficial in concussion rehabilitation: A cellular perspective. J Sci Med Sport 2019; 22:1090-1096. [PMID: 31349959 DOI: 10.1016/j.jsams.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 05/20/2019] [Accepted: 06/21/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Concussion diagnosis and rehabilitation management has become a prevalent area of research, and yet much is still unknown about these complex injuries. Historically, exercise prescription post-concussion was conservatively used for rehabilitation due to the suspected harmful effects that exercise can have on damaged neurons, and increase in symptoms. However, there has been a shift to implement exercise earlier into recovery as several studies have demonstrated positive outcomes. OBJECTIVE The objective of this literature review is to update the reader about new advances in concussion research related to the beneficial effects of physical activity from both a neurometabolic and a broader physiological perspective, using gene expression as a vehicle to demonstrate why and how physical activity has the capacity to optimize recovery from a cellular perspective. To further this clinical guideline, the evidence must continue to support these positive outcomes from an inductive and deductive physiologic approach (i.e., the clinical evidence aligned from a micro- to macroscopic approach and vice versa). DESIGN Narrative review. METHODS Pubmed and Medline were used with the following key words: concussion and, physical activity, neurometabolic, gene regulation, trauma, nervous system, mild head injury, acute exercise, cellular physiology and pathophysiology. CONCLUSION It is our contention that understanding the cellular perspective will help guide clinical management, and promote research into post-concussion exercise.
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Affiliation(s)
- Ryan T Dech
- Faculty of Kinesiology & Health Studies, University of Regina, Canada
| | - Scott A Bishop
- Faculty of Kinesiology & Health Studies, University of Regina, Canada
| | - J Patrick Neary
- Faculty of Kinesiology & Health Studies, University of Regina, Canada.
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D'Lauro C, Johnson BR, McGinty G, Allred CD, Campbell DE, Jackson JC. Reconsidering Return-to-Play Times: A Broader Perspective on Concussion Recovery. Orthop J Sports Med 2018; 6:2325967118760854. [PMID: 29568786 PMCID: PMC5858632 DOI: 10.1177/2325967118760854] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Return-to-play protocols describe stepwise, graduated recoveries for safe return from concussion; however, studies that comprehensively track return-to-play time are expensive to administer and heavily sampled from elite male contact-sport athletes. Purpose: To retrospectively assess probable recovery time for collegiate patients to return to play after concussion, especially for understudied populations, such as women and nonelite athletes. Study Design: Cohort study; Level of evidence, 3. Methods: Medical staff at a military academy logged a total of 512 concussion medical records over 38 months. Of these, 414 records included complete return-to-play protocols with return-to-play time, sex, athletic status, cause, and other data. Results: Overall mean return to play was 29.4 days. Sex and athletic status both affected return-to-play time. Men showed significantly shorter return to play than women, taking 24.7 days (SEM, 1.5 days) versus 35.5 days (SEM, 2.7 days) (P < .001). Intercollegiate athletes also reported quicker return-to-play times than nonintercollegiate athletes: 25.4 days (SEM, 2.6 days) versus 34.7 days (SEM, 1.6 days) (P = .002). These variables did not significantly interact. Conclusion: Mean recovery time across all groups (29.4 days) showed considerably longer return to play than the most commonly cited concussion recovery time window (7-10 days) for collegiate athletes. Understudied groups, such as women and nonelite athletes, demonstrated notably longer recovery times. The diversity of this sample population was associated with longer return-to-play times; it is unclear how other population-specific factors may have contributed. These inclusive return-to-play windows may indicate longer recovery times outside the population of elite athletes.
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Affiliation(s)
- Christopher D'Lauro
- Department of Behavioral Science and Leadership, United States Air Force Academy, Colorado, USA
| | - Brian R Johnson
- Department of Behavioral Science and Leadership, United States Air Force Academy, Colorado, USA
| | - Gerald McGinty
- Sports Medicine, Athletic Department, United States Air Force Academy, Colorado, USA
| | - C Dain Allred
- 10th Medical Group, United States Air Force Academy, Colorado, USA
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Stovitz SD, Weseman JD, Hooks MC, Schmidt RJ, Koffel JB, Patricios JS. What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review. Curr Sports Med Rep 2017; 16:50-55. [PMID: 28067742 DOI: 10.1249/jsr.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.
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Affiliation(s)
- Steven D Stovitz
- 1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; 2University of Minnesota Medical School, Minneapolis, MN; 3Bio-Medical Library, University of Minnesota, Minneapolis, MN; 4Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and 5Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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DeMatteo C, Stazyk K, Giglia L, Mahoney W, Singh SK, Hollenberg R, Harper JA, Missiuna C, Law M, McCauley D, Randall S. A Balanced Protocol for Return to School for Children and Youth Following Concussive Injury. Clin Pediatr (Phila) 2015; 54:783-92. [PMID: 25601958 DOI: 10.1177/0009922814567305] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Few protocols exist for returning children/youth to school after concussion. Childhood concussion can significantly affect school performance, which is vital to social development, academic learning, and preparation for future roles. The goal of this knowledge translation research was to develop evidence based materials to inform physicians about pediatric concussion. METHODS The Return to School (RTS) concussion protocol was developed following the National Institute for Health and Care Excellence procedures. RESULTS Based on a scoping review, and stakeholder opinions, an RTS protocol was developed for children/youth. This unique protocol focuses on school adaptation in 4 main areas: (a) timetable/attendance, (b) curriculum, (c) environmental modifications, and (d) activity modifications. CONCLUSION A balance of cognitive rest and timely return to school need to be considered for returning any student to school after a concussion. Implementation of these new recommendations may be an important tool in prevention of prolonged absence from school and academic failure while supporting brain recovery.
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Affiliation(s)
| | | | - Lucy Giglia
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, ON, Canada
| | - William Mahoney
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, ON, Canada
| | - Sheila K Singh
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, ON, Canada
| | - Robert Hollenberg
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, ON, Canada
| | | | | | - Mary Law
- McMaster University, Hamilton, Ontario, Canada
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DeMatteo C, Stazyk K, Singh SK, Giglia L, Hollenberg R, Malcolmson CH, Mahoney W, Harper JA, Missiuna C, Law M, McCauley D. Development of a conservative protocol to return children and youth to activity following concussive injury. Clin Pediatr (Phila) 2015; 54:152-63. [PMID: 25422524 DOI: 10.1177/0009922814558256] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Consensus-based guidelines exist for adult athletes returning to play after concussion, but there are no protocols developed specifically for children. The goal of this knowledge translation research was to develop evidence-based materials to inform physicians about pediatric concussion. METHODS A pediatric concussion protocol was developed based on the National Institute for Health and Care Excellence procedures. RESULTS This return to activity protocol was developed to guide management when children/youth sustain a concussion. The protocol incorporated 3 main themes: (a) a protocol must include return to all activity, including sport and school; (b) existing consensus-based adult protocols are not appropriate for children; and (c) a more conservative protocol is needed. After pilot testing, the developed protocol is being used across Ontario. CONCLUSION Implementation of these new pediatric recommendations is an important addition to prevention of subsequent concussions during vulnerable recovery periods, with potential to facilitate recovery by preventing prolonged symptomatology, and secondary sequelae.
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Affiliation(s)
| | | | - Sheila K Singh
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lucy Giglia
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Robert Hollenberg
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Charles H Malcolmson
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - William Mahoney
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | | | - Mary Law
- McMaster University, Hamilton, Ontario, Canada
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Concannon LG, Kaufman MS, Herring SA. Counseling athletes on the risk of chronic traumatic encephalopathy. Sports Health 2014; 6:396-401. [PMID: 25177414 PMCID: PMC4137675 DOI: 10.1177/1941738114530958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context: Chronic traumatic encephalopathy (CTE) is a rare progressive neurologic disorder that can manifest as a combination of cognitive, mood and behavioral, and neurologic symptoms. Despite clinically apparent symptoms, there is no imaging or other diagnostic test that can confirm diagnosis in living subjects. Diagnosis can only be confirmed postmortem by specific histopathologic features within the brain tissue identified on autopsy. CTE represents a unique tauopathy that is distinct from other neurodegenerative diseases. Evidence Acquisition: PubMed was searched from 1990 to 2013 for sport concussion and chronic traumatic encephalopathy. Articles were also identified from bibliographies of recent reviews and consensus statements. Study Design: Clinical review. Level of Evidence: Level 5. Results: Although CTE is postulated to occur as a result of repetitive mild traumatic brain injury, the specific etiology and risk factors have not yet been elucidated, and postmortem diagnosis makes causality difficult to determine. Conclusion: When counseling athletes and families about the potential association of recurrent concussions and the development of CTE, discussion of proper management of concussion is cornerstone. Unfortunately, to date, there is no equipment that can prevent concussions; however, rule changes and legislation may decrease the risk. It is imperative that return to play is medically supervised by a provider trained in the management of concussion and begins only once symptoms have resolved. In addition, athletes with permanent symptoms should be retired from contact sport.
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Affiliation(s)
- Leah G Concannon
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Marla S Kaufman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington ; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington ; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington ; Department of Neurological Surgery, University of Washington, Seattle, Washington
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DeMatteo C, McCauley D, Stazyk K, Harper J, Adamich J, Randall S, Missiuna C. Post-concussion return to play and return to school guidelines for children and youth: a scoping methodology. Disabil Rehabil 2014; 37:1107-12. [PMID: 25144831 DOI: 10.3109/09638288.2014.952452] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The objective of this study was to identify and describe management strategies to ensure safe return to activity (RTA) and return to school (RTS) of children with mild traumatic brain injury (MTBI) and determine whether they are evidence-based. METHODS A scoping methodology was conducted using research published between 1990 and 2013, gray literature and clinical expertise. Once the data had been charted, an expert panel of physicians and clinicians was consulted to inform and validate study findings. An analytical and thematic framework was used to examine the study findings. RESULTS A total of 400 potentially relevant published articles, 100 websites and 24 iPad Applications were found. Ten articles and three web-based resources met inclusion criteria and were included in the final review. Nine articles recommended a more conservative approach to RTA, as well as identified a step-wise or severity-oriented approach. General recommendations were also found regarding safe RTS. One study recommended a stepwise RTS protocol for children. CONCLUSIONS This scoping methodology determined that the most comprehensive guidelines for management are focused on adults. Evidence concerning prolonged recovery patterns in children and the impact of concussion on the developing brain suggests that pediatric-specific guidelines are needed for RTA and RTS after MTBI/concussion. IMPLICATIONS FOR REHABILITATION Although concussion in children is an increasing concern, it has been determined that the most comprehensive guidelines for management are focused on adults. These guidelines are primarily consensus-based and are not proven fact through quality research. Evidence concerning prolonged recovery patterns in youth and the impact of concussion on the developing brain suggest that pediatric guidelines should be more conservative than for adults. Therefore, pediatric-specific guidelines need to be developed for return to activity and return to school after MTBI/concussion.
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Affiliation(s)
- Carol DeMatteo
- School of Rehabilitation Science, McMaster University , Hamilton, Ontario , Canada , and
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Abstract
Increased awareness of adolescent sport concussions has led to legislation requiring a medical professional's permission to return to play. These patient-specific and evidence-based recommendations for nurse practitioners will ensure safe return to play decisions.
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Patterson ZR, Holahan MR. Understanding the neuroinflammatory response following concussion to develop treatment strategies. Front Cell Neurosci 2012; 6:58. [PMID: 23248582 PMCID: PMC3520152 DOI: 10.3389/fncel.2012.00058] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 11/27/2012] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injuries (mTBI) have been associated with long-term cognitive deficits relating to trauma-induced neurodegeneration. These long-term deficits include impaired memory and attention, changes in executive function, emotional instability, and sensorimotor deficits. Furthermore, individuals with concussions show a high co-morbidity with a host of psychiatric illnesses (e.g., depression, anxiety, addiction) and dementia. The neurological damage seen in mTBI patients is the result of the impact forces and mechanical injury, followed by a delayed neuroimmune response that can last hours, days, and even months after the injury. As part of the neuroimmune response, a cascade of pro- and anti-inflammatory cytokines are released and can be detected at the site of injury as well as subcortical, and often contralateral, regions. It has been suggested that the delayed neuroinflammatory response to concussions is more damaging then the initial impact itself. However, evidence exists for favorable consequences of cytokine production following traumatic brain injuries as well. In some cases, treatments that reduce the inflammatory response will also hinder the brain's intrinsic repair mechanisms. At present, there is no evidence-based pharmacological treatment for concussions in humans. The ability to treat concussions with drug therapy requires an in-depth understanding of the pathophysiological and neuroinflammatory changes that accompany concussive injuries. The use of neurotrophic factors [e.g., nerve growth factor (NGF)] and anti-inflammatory agents as an adjunct for the management of post-concussion symptomology will be explored in this review.
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Current world literature. Curr Opin Pediatr 2012; 24:770-9. [PMID: 23146873 DOI: 10.1097/mop.0b013e32835af8de] [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: 11/26/2022]
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Tomei KL, Doe C, Prestigiacomo CJ, Gandhi CD. Comparative analysis of state-level concussion legislation and review of current practices in concussion. Neurosurg Focus 2012. [PMID: 23199423 DOI: 10.3171/2012.9.focus12280] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Forty-two states and the District of Columbia have passed legislation based on the Lystedt law of Washington state, enacted in 2009 to protect young athletes who have sustained a concussion. The aim of this study was to note the several similarities and differences among the various laws.
Methods
Concussion legislation was compared for 50 states and the District of Columbia. Evaluation parameters of this study included stipulations of concussion education, criteria for removal from play, requirements for evaluation and return to play after concussion, and individuals required to assess young athletes. Other parameters that were not consistent across states were also noted.
Results
Forty-three states and the District of Columbia have passed concussion legislation, and an additional 4 states have pending legislation. All states with existing legislation support concussion education for coaches; however, only 48% require coaches to undergo formal education. Athletes must be educated on concussion in 86% of states and parents in 88.7%. Suspicion of concussion is a criterion for removal from play in 75% of states; signs and symptoms of concussion are criteria for removal from play in 16% of states. The individuals allowed to evaluate and clear an athlete for return to play differ greatly among states.
Conclusions
Injury prevention legislation holds historical precedent, and given the increasing attention to long-term sequelae of repeated head trauma and concussion, concussion legislation has been rapidly passed in 43 states and the District of Columbia. Although the exact stipulations of these laws vary among states, the overall theme is to increase recognition of concussion in young athletes and ensure that they are appropriately cleared for return to play after concussion.
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