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Siegel MA, Patetta MJ, Deshpande A, Orland MD, Hutchinson MR. Traumatic brain injuries in paediatric patients: individual vs. team sports-related hospitalizations. Res Sports Med 2024; 32:567-579. [PMID: 36647291 DOI: 10.1080/15438627.2023.2166412] [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: 08/12/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
Paediatric sport participation continues to increase in the United States, with a corresponding increase in sports-related concussions or traumatic brain injuries (TBIs). It is important to recognize which sports are at elevated risk and identify risk factors for hospital admission and length of stay (LOS). Paediatric patients (ages 5-18) from 2008 to 2014 were identified from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS). Eight hundred and ninety-four patients included those who were hospitalized with a TBI resulting from participation in an individual (451 patients) or team (443 patients) sport. We evaluated the differences in LOS and total charges between individual and team sports and found that compared to team sports, TBI patients in individual sports had significantly longer hospital stays compared to team sports (1.75 days versus 1.34 days, p < 0.001) and costlier ($27,333 versus $19,069, p < 0.001) hospital stays. This may be due to reduced awareness and reduced compliance with return-to-play protocols in individual sports. Safety education information at a young age, increased awareness of TBIs, and additional medical support for individual sports as well as team sports may help mitigate these findings.
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Affiliation(s)
- Matthew A Siegel
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael J Patetta
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Abhishek Deshpande
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark D Orland
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark R Hutchinson
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
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Tator CH, Moore C, Buso C, Huszti E, Li Q, Prentice EB, Khodadadi M, Scott O, Tartaglia CM. Cause of Concussion With Persisting Symptoms Is Associated With Long-Term Recovery and Symptom Type, Duration, and Number in a Longitudinal Cohort of 600 Patients. J Neurotrauma 2024; 41:1384-1398. [PMID: 38468550 DOI: 10.1089/neu.2023.0263] [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: 03/13/2024] Open
Abstract
It is important for patients and clinicians to know the potential for recovery from concussion as soon as possible after injury, especially in patients who do not recover completely in the first month and have concussion with persisting concussion symptoms (C+PCS). We assessed the association between the causes of concussion and recovery from C+PCS in a consecutive retrospective and prospective cohort of 600 patients referred to the Canadian Concussion Center (CCC) at Toronto Western Hospital. Data were obtained from clinical records and follow-up questionnaires and not from a standardized database. A novel method was used to assess long-term recovery, and multi-variable Cox proportional hazards models were used to assess relationships between cause of concussion and time to recovery. We examined the subsequent recovery of patients who had not recovered after at least one month from the time of concussion. Patients were grouped into the following four causes: sports and recreation (S&R, n = 312, 52%); motor vehicle collisions (MVC, n = 103, 17%); falls (n = 100, 17%); and being struck by an object including violence (SBOV, n = 85, 14%). The MVC group had the highest percentage of females (75.7%), the oldest participants (median: 40.0 [interquartile range (IQR):30.5-49.0] years), the most symptoms (median:11.0 [IQR:8.5-15.0]), and the longest symptom duration (median: 28.0 [IQR:12.0-56.00] months). In contrast, the S&R group had the highest percentage of males (58.1%), the youngest participants (median:20.0 [IQR:17.0-30.0] years), the best recovery outcome, and shortest symptom duration (median:22.0 [IQR:8.0-49.5] months). Significant differences among the four causes included age (p < 0.001), sex (p < 0.001), number of previous concussions (p < 0.001), history of psychiatric disorders (p = 0.002), and migraine (p = 0.001). Recovery from concussion was categorized into three groups: (1) Complete Recovery occurred in only 60 (10%) patients with median time 8.0 (IQR:3.5-18.0) months and included 42 S&R, 7 MVC, 8 falls, and 3 SBOV; (2) Incomplete Recovery occurred in 408 (68.0%) patients with persisting median symptom time of 5.0 (IQR:2.0-12.0) months; and (3) Unknown Recovery occurred in 132 (22.0%) patients and was because of lack of follow-up. In summary, the cause of C+PCS was associated with the type, number, and duration of symptoms and time required for recovery, although all causes of C+PCS produced prolonged symptoms in a large percentage of patients, which emphasizes the importance of concussions as a public health concern necessitating improved prevention and treatment strategies.
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Affiliation(s)
- Charles H Tator
- Canadian Concussion Centre, Division of Neurosurgery, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Connor Moore
- Canadian Concussion Centre, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Chloé Buso
- Canadian Concussion Centre, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Qixuan Li
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Emma B Prentice
- Canadian Concussion Centre, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Mohzgan Khodadadi
- Canadian Concussion Centre, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Olivia Scott
- Canadian Concussion Centre, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Carmela M Tartaglia
- Canadian Concussion Centre, Division of Neurology, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
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King D, Hume P, Clark T, Wethe J. Use of the concussion check protocol for concussion assessment in a female soccer team over two consecutive seasons in New Zealand. J Neurol Sci 2024; 460:123011. [PMID: 38615404 DOI: 10.1016/j.jns.2024.123011] [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: 02/18/2024] [Revised: 03/24/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
AIM Address deficiencies in access to sports sideline medical care by using a Concussion Check Protocol (CCP) for non-medically-trained people. METHOD A prospective observational cohort study was undertaken on a single amateur female club-based soccer team over two consecutive years in New Zealand utilising a non-medically trained support person termed a Safety officer. CCP is an extension of the King-Devick test with features such as warning signs and symptoms of concussion built into the application. All players suspected of having a potential concussive injury were tested on the match sideline. RESULTS The study overall incidence of match-related concussions was 20.8 (95% CI: 11.8 to 36.6) per 1000 match-hrs, with mean missed-match duration of 31 (95% CI: 27.9 to 34.1) days. Twelve players over the study had a significantly slower post-injury KD (49.9 [44.3 to 64.1]s; χ2(1) = 11.0; p = 0.0009; z = -2.9; p = 0.0033; d = 0.30) and/or reported symptoms, compared with their own baseline (47.2 [44.3 to 64.1]s). CCP had an overall sensitivity of 100% (95% CI: 73.5% to 100.0%), specificity of 100% (95% CI: 69.2% to 100.0%) and positive predictive value (PPV) of 100% (84.6% to 100.0%). CONCLUSION Sideline use of CCP was undertaken successfully by non-medically trained people and provided a reliable platform for concussion identification.
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Affiliation(s)
- Doug King
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand; Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Auckland, New Zealand; School of Science and Technology, University of New England, Armidale, NSW, Australia; Wolfson Research Institute for Health and Wellbeing, Department of Sport and Exercise Sciences, Durham University, Durham, UK; Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand.
| | - Patria Hume
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand; Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Auckland, New Zealand; Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand; Technology and Policy Lab - Law School, The University of Western Australia, Perth, Australia
| | - Trevor Clark
- International College of Management Sydney, Manly, New South Wales, Australia
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Smith MA, McNinch NL, Chaney D, Shauver L, Murray T, Kline P, Lesak A, Franco-MacKendrick L, Scott L, Logan K, Ichesco IK, Liebig C, Congeni J. Reduced Concussion Symptom Burden in Early Adolescent Athletes Using a Head-Neck Cooling Device. Clin J Sport Med 2024; 34:247-255. [PMID: 38180057 PMCID: PMC11042520 DOI: 10.1097/jsm.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/02/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To determine whether an investigational head-neck cooling device, Pro2cool, can better reduce symptom severity compared with standard postconcussion care in early adolescent athletes after a sports-related concussion. DESIGN Prospective, longitudinal, randomized trial design conducted over a 28-day period. SETTING Six pediatric medical centers in Ohio and Michigan. PARTICIPANTS The study enrolled 167 male and female 12- to 19-year-old athletes who experienced a sports-related concussion within 8 days of study enrollment and registering a Sports Concussion Assessment Tool 5 (SCAT5) composite score >7. INTERVENTIONS Pro2cool, an investigational head-neck cooling therapy device, was applied at 2 postinjury time points compared with postconcussion standard of care only. MAIN OUTCOME MEASURES Baseline SCAT5 composite symptom severity scores were determined for all subjects. Sports Concussion Assessment Tool 5 scores for concussed athletes receiving cooling treatment were analyzed across 6 independent postenrollment time points compared with subjects who did not receive cooling therapy and only standard care. Adverse reactions and participate demographics were also compared. RESULTS Athletes who received Pro2cool cooling therapy (n = 79) experienced a 14.4% greater reduction in SCAT5 symptom severity scores at the initial visit posttreatment, a 25.5% greater reduction at the 72-hour visit posttreatment, and a 3.4% greater reduction at the 10-day visit compared with subjects receiving only standard care (n = 88). Overall, 36 adverse events (increased blood pressure, decreased pulse, and dizziness) were reported, with 13 events associated with the device, of which 3 were classified as moderate in severity. CONCLUSIONS This study demonstrates the efficacy and safety of head and neck cooling for the management of concussion symptoms in adolescent athletes of an age group for which little to no prior data are available.
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Affiliation(s)
- Matthew A. Smith
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - Neil L. McNinch
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Danielle Chaney
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Lisa Shauver
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Tamara Murray
- Department of Sports Medicine, Akron Children's Hospital, Akron, Ohio
| | - Peyton Kline
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Alexandria Lesak
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | | | - Lora Scott
- Department of Sports Medicine, Dayton Children's Hospital, Dayton Ohio
| | - Kelsey Logan
- Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio; and
| | - Ingrid K. Ichesco
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | - Joseph Congeni
- Department of Sports Medicine, Akron Children's Hospital, Akron, Ohio
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Lima Santos JP, Kontos AP, Holland CL, Suss SJ, Stiffler RS, Bitzer HB, Colorito AT, Shaffer M, Skeba A, Iyengar S, Manelis A, Brent D, Shirtcliff EA, Ladouceur CD, Phillips ML, Collins MW, Versace A. The Role of Puberty and Sex on Brain Structure in Adolescents With Anxiety Following Concussion. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:285-297. [PMID: 36517369 DOI: 10.1016/j.bpsc.2022.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adolescence represents a window of vulnerability for developing psychological symptoms following concussion, especially in girls. Concussion-related lesions in emotion regulation circuits may help explain these symptoms. However, the contribution of sex and pubertal maturation remains unclear. Using the neurite density index (NDI) in emotion regulation tracts (left/right cingulum bundle [CB], forceps minor [FMIN], and left/right uncinate fasciculus), we sought to elucidate these relationships. METHODS No adolescent had a history of anxiety and/or depression. The Screen for Child Anxiety Related Emotional Disorders and Children's Depression Rating Scale were used at scan to assess anxiety and depressive symptoms in 55 concussed adolescents (41.8% girls) and 50 control adolescents with no current/history of concussion (44% girls). We evaluated if a mediation-moderation model including the NDI (mediation) and sex or pubertal status (moderation) could help explain this relationship. RESULTS Relative to control adolescents, concussed adolescents showed higher anxiety (p = .003) and lower NDI, with those at more advanced pubertal maturation showing greater abnormalities in 4 clusters: the left CB frontal (p = .002), right CB frontal (p = .011), FMIN left-sided (p = .003), and FMIN right-sided (p = .003). Across all concussed adolescents, lower NDI in the left CB frontal and FMIN left-sided clusters partially mediated the association between concussion and anxiety, with the CB being specific to female adolescents. These effects did not explain depressive symptoms. CONCLUSIONS Our findings indicate that lower NDI in the CB and FMIN may help explain anxiety following concussion and that adolescents at more advanced (vs less advanced) status of pubertal maturation may be more vulnerable to concussion-related injuries, especially in girls.
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Affiliation(s)
- João Paulo Lima Santos
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony P Kontos
- Department of Orthopaedic Surgery/UPMC Sports Concussion Program, University of Pittsburgh, Pennsylvania
| | - Cynthia L Holland
- Department of Orthopaedic Surgery/UPMC Sports Concussion Program, University of Pittsburgh, Pennsylvania
| | - Stephen J Suss
- Department of Orthopaedic Surgery/UPMC Sports Concussion Program, University of Pittsburgh, Pennsylvania
| | - Richelle S Stiffler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hannah B Bitzer
- Department of Psychology, Florida International University, Miami, Florida
| | - Adam T Colorito
- Department of Psychology, Florida International University, Miami, Florida
| | - Madelyn Shaffer
- Department of Psychology, Florida International University, Miami, Florida
| | - Alexander Skeba
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Satish Iyengar
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anna Manelis
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Brent
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Elizabeth A Shirtcliff
- Center for Translational Neuroscience and Department of Psychology, University of Oregon, Eugene, Oregon
| | - Cecile D Ladouceur
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary L Phillips
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael W Collins
- Department of Orthopaedic Surgery/UPMC Sports Concussion Program, University of Pittsburgh, Pennsylvania
| | - Amelia Versace
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Radiology, Magnetic Resonance Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Corwin DJ, Mandel F, McDonald CC, Barnett I, Arbogast KB, Master CL. Optimizing the Combination of Common Clinical Concussion Batteries to Predict Persistent Postconcussion Symptoms in a Prospective Cohort of Concussed Youth. Am J Sports Med 2024; 52:811-821. [PMID: 38305042 PMCID: PMC11033620 DOI: 10.1177/03635465231222936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Studies have evaluated individual factors associated with persistent postconcussion symptoms (PPCS) in youth concussion, but no study has combined individual elements of common concussion batteries with patient characteristics, comorbidities, and visio-vestibular deficits in assessing an optimal model to predict PPCS. PURPOSE To determine the combination of elements from 4 commonly used clinical concussion batteries and known patient characteristics and comorbid risk factors that maximize the ability to predict PPCS. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS We enrolled 198 concussed participants-87 developed PPCS and 111 did not-aged 8 to 19 years assessed within 14 days of injury from a suburban high school and the concussion program of a tertiary care academic medical center. We defined PPCS as a Post-Concussion Symptom Inventory (PCSI) score at 28 days from injury of ≥3 points compared with the preinjury PCSI score-scaled for younger children. Predictors included the individual elements of the visio-vestibular examination (VVE), Sport Concussion Assessment Tool, 5th Edition (SCAT-5), King-Devick test, and PCSI, in addition to age, sex, concussion history, and migraine headache history. The individual elements of these tests were grouped into interpretable factors using sparse principal component analysis. The 12 resultant factors were combined into a logistic regression and ranked by frequency of inclusion into the combined optimal model, whose predictive performance was compared with the VVE, initial PCSI, and the current existing predictive model (the Predicting and Prevention Postconcussive Problems in Pediatrics (5P) prediction rule) using the area under the receiver operating characteristic curve (AUC). RESULTS A cluster of 2 factors (SCAT-5/PCSI symptoms and VVE near point of convergence/accommodation) emerged. A model fit with these factors had an AUC of 0.805 (95% CI, 0.661-0.929). This was a higher AUC point estimate, with overlapping 95% CIs, compared with the PCSI (AUC, 0.773 [95% CI, 0.617-0.912]), VVE (AUC, 0.736 [95% CI, 0.569-0.878]), and 5P Prediction Rule (AUC, 0.728 [95% CI, 0.554-0.870]). CONCLUSION Among commonly used clinical assessments for youth concussion, a combination of symptom burden and the vision component of the VVE has the potential to augment predictive power for PPCS over either current risk models or individual batteries.
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Affiliation(s)
- Daniel J. Corwin
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Francesca Mandel
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ian Barnett
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Aljabri A, Halawani A, Ashqar A, Alageely O, Alhazzani A. The Efficacy of Vestibular Rehabilitation Therapy for Mild Traumatic Brain Injury: A Systematic Review and Meta-analysis. J Head Trauma Rehabil 2024; 39:E59-E69. [PMID: 37335202 DOI: 10.1097/htr.0000000000000882] [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: 06/21/2023]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI) or concussion is a common yet undermanaged and underreported condition. This systematic review and meta-analysis aim to determine the efficacy of vestibular rehabilitation therapy (VRT) as a treatment option for mTBI. METHOD This review and meta-analysis was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. It included randomized controlled trials and pre-VRT/post-VRT retrospective chart reviews. Records meeting the inclusion criteria were extracted from the following databases: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). RESULTS Eight articles met the inclusion criteria, from which 6 randomized controlled trials were included in the meta-analysis. VRT demonstrated significant improvement in decreasing perceived dizziness at the end of the intervention program as shown by Dizziness Handicap Inventory (DHI) scores (standardized mean difference [SMD] = -0.33, 95% confidence interval [CI]: -0.62 to -0.03, P = .03, I2 = 0%). However, no significant reduction in DHI was evident after 2 months of follow-up (SMD = 0.15, 95% CI: -0.23 to 0.52, P = .44, I2 = 0%). Quantitative analysis also depicted significant reduction in both Vestibular/Ocular Motor Screening (SMD = -0.40, 95% CI: -0.60 to -0.20, P < .0001, I2 = 0%) and Post-Concussion Symptom Scale (SMD= -0.39, 95% CI: -0.71 to -0.07, P = .02, I2 = 0%) following the intervention. Finally, there was no significant difference between intervention groups on Balance Error Scoring System scores (SMD = -31, 95% CI: -0.71 to 0.10, P = .14, I2 = 0%) and return to sport/function (95% CI: 0.32-30.80, P = .32, I2 = 82%). CONCLUSIONS Current evidence on the efficacy of VRT for mTBI is limited. This review and analysis provides evidence that supports the role of VRT in improving perceived symptoms following concussion. Although findings from this analysis suggest positive effects of VRT on included outcomes, the low certainty of evidence limits the conclusions drawn from this study. There is still a need for high-quality trials evaluating the benefit of VRT using a standardized approach.PROSPERO registration number: CRD42022342473.
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Affiliation(s)
- Ammar Aljabri
- Author Affiliations: College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia (Drs Aljabri, Ashqar, Alageely, and Halawani); King Abdullah International Medical Research Center, Jeddah, Saudi Arabia (Drs Aljabri, Ashqar, Alageely, and Halawani); and Neurosciences Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia (Dr Alhazzani)
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8
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Hou X, Zhang Y, Fei X, Zhou Q, Li J. Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3604-3618. [PMID: 36799499 DOI: 10.1177/03635465221142855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents. PURPOSE To rigorously examine adolescents' cognitive function after SRC. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted. RESULTS A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: d = -0.21, 95% CI, -0.37 to -0.05, P = .012; executive function: d = -0.56, 95% CI, -1.07 to -0.06, P = .028; and symptoms: d = 1.17, 95% CI, 0.13 to 2.22, P = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory (d = 0.10; 95% CI, 0.03 to 0.17; P = .008) and processing speed (d = 0.17; 95% CI, 0.10 to 0.24; P < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, P < .001; 99.94% of the variance in verbal memory, P < .001; 99.88% of the variance in visual memory, P < .001; 39.84% of the variance in symptoms, P = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC. CONCLUSION This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.
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Affiliation(s)
- Xianyun Hou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yu Zhang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xueyin Fei
- Sport Science School, Beijing Sport University, Beijing, China
| | - Qian Zhou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jie Li
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
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9
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Goldschmied N, Lambrecht J, Castro A, Langton H. Fighting to the death: Does hockey fighting in the NHL affect players' longevity? Scand J Med Sci Sports 2023; 33:1874-1880. [PMID: 37329148 DOI: 10.1111/sms.14432] [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: 01/09/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
Hockey is a sport known for its violent nature. Specifically, hockey fights have consistently been an integral part of the National Hockey League. Past research has demonstrated that players are likely to be involved in fighting as a mechanism to gain fan support, generate game momentum or enhance team camaraderie. However, fighting naturally has negative health ramifications. In the current study, we sought to investigate if players' involvement in hockey fights throughout their career was associated with shorter life spans. Previous mortality studies have not distinguished hockey fighting from other aggressive aspects of this sport (e.g., in game physical contact with other players). We conducted an archival study examining the frequency of hockey fighting during the 1957-1971 NHL seasons and player longevity. A Kaplan-Meier survival analysis log-rank method and a subsequent Cox regression accounting for correlates showed no relationship between an elevated number of fights and a reduced lifespan. The lack of effect may indeed demonstrate a negligible influence on long-term health consequences in the context of a generally very physical game. However, with the relatively moderate levels of fighting in the period studied we recommend that the association be explored also in a subsequent era when NHL fighting peaked.
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10
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Lima Santos JP, Jia-Richards M, Kontos AP, Collins MW, Versace A. Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6274. [PMID: 37444121 PMCID: PMC10341732 DOI: 10.3390/ijerph20136274] [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: 04/27/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
Emotional dysregulation symptoms following a concussion are associated with an increased risk for emotional dysregulation disorders (e.g., depression and anxiety), especially in adolescents. However, predicting the emergence or worsening of emotional dysregulation symptoms after concussion and the extent to which this predates the onset of subsequent psychiatric morbidity after injury remains challenging. Although advanced neuroimaging techniques, such as functional magnetic resonance imaging and diffusion magnetic resonance imaging, have been used to detect and monitor concussion-related brain abnormalities in research settings, their clinical utility remains limited. In this narrative review, we have performed a comprehensive search of the available literature regarding emotional regulation, adolescent concussion, and advanced neuroimaging techniques in electronic databases (PubMed, Scopus, and Google Scholar). We highlight clinical evidence showing the heightened susceptibility of adolescents to experiencing emotional dysregulation symptoms following a concussion. Furthermore, we describe and provide empirical support for widely used magnetic resonance imaging modalities (i.e., functional and diffusion imaging), which are utilized to detect abnormalities in circuits responsible for emotional regulation. Additionally, we assess how these abnormalities relate to the emotional dysregulation symptoms often reported by adolescents post-injury. Yet, it remains to be determined if a progression of concussion-related abnormalities exists, especially in brain regions that undergo significant developmental changes during adolescence. We conclude that neuroimaging techniques hold potential as clinically useful tools for predicting and, ultimately, monitoring the treatment response to emotional dysregulation in adolescents following a concussion.
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Affiliation(s)
- João Paulo Lima Santos
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
| | - Meilin Jia-Richards
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.P.K.); (M.W.C.)
| | - Michael W. Collins
- Department of Orthopaedic Surgery, UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.P.K.); (M.W.C.)
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
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11
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Crasta JE, Nebel MB, Svingos A, Tucker RN, Chen HW, Busch T, Caffo BS, Stephens J, Suskauer SJ. Rethinking recovery in adolescent concussions: Network-level functional connectivity alterations associated with motor deficits. Hum Brain Mapp 2023; 44:3271-3282. [PMID: 36999674 PMCID: PMC10171516 DOI: 10.1002/hbm.26280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
Adolescents who are clinically recovered from concussion continue to show subtle motor impairment on neurophysiological and behavioral measures. However, there is limited information on brain-behavior relationships of persistent motor impairment following clinical recovery from concussion. We examined the relationship between subtle motor performance and functional connectivity of the brain in adolescents with a history of concussion, status post-symptom resolution, and subjective return to baseline. Participants included 27 adolescents who were clinically recovered from concussion and 29 never-concussed, typically developing controls (10-17 years); all participants were examined using the Physical and Neurologic Examination of Subtle Signs (PANESS). Functional connectivity between the default mode network (DMN) or dorsal attention network (DAN) and regions of interest within the motor network was assessed using resting-state functional magnetic resonance imaging (rsfMRI). Compared to controls, adolescents clinically recovered from concussion showed greater subtle motor deficits as evaluated by the PANESS and increased connectivity between the DMN and left lateral premotor cortex. DMN to left lateral premotor cortex connectivity was significantly correlated with the total PANESS score, with more atypical connectivity associated with more motor abnormalities. This suggests that altered functional connectivity of the brain may underlie subtle motor deficits in adolescents who have clinically recovered from concussion. More investigation is required to understand the persistence and longer-term clinical relevance of altered functional connectivity and associated subtle motor deficits to inform whether functional connectivity may serve as an important biomarker related to longer-term outcomes after clinical recovery from concussion.
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Affiliation(s)
- Jewel E. Crasta
- Occupational Therapy DivisionThe Ohio State UniversityColumbusOhioUSA
| | - Mary Beth Nebel
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Adrian Svingos
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Robert N. Tucker
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
- Carle Illinois College of MedicineUniversity of Illinois at Urbana‐ChampaignChampaignILUSA
| | - Hsuan Wei Chen
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Tyler Busch
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Brian S. Caffo
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jaclyn Stephens
- Department of Occupational TherapyColorado State UniversityFort CollinsColoradoUSA
| | - Stacy J. Suskauer
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Physical Medicine and RehabilitationJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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12
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Cosgrave C, Fuller C, Kung S, Cosgrave M, McFadden C, Franklyn-Miller A. A comparison of clinical assessment with common diagnostic tools for monitoring concussion recovery in adolescent rugby union players. Phys Ther Sport 2023; 61:165-171. [PMID: 37068386 DOI: 10.1016/j.ptsp.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES To characterise the incidence, severity and recovery of sport-related concussion (SRC) in schoolboy rugby players and explore whether the Sports Concussion Assessment Tool (SCAT), Cogstate Brief Battery (CBB) and the King-Devick test (K-D test) can be used to monitor concussion status through to full recovery. DESIGN Prospective cohort study. SETTING Rugby union has a high rate of SRC; however, there is little research investigating how concussion affects adolescent rugby players. PARTICIPANTS Schoolboy rugby players. MAIN OUTCOME MEASURES Participants completed baseline tests in the preseason. Participants diagnosed with SRC during the season attended for post-concussion testing on a weekly basis until recovered. RESULTS 135 schoolboy rugby players (16.7 ± 0.82y) participated in the study. There were 18 SRCs in 16 participants. Concussion incidence was 9/1000 player hours. CBB and K-D tests were poorly associated with clinical assessment and produced high false negative rates (0.58 and 0.52 respectively). CONCLUSIONS This study reports a relatively high match SRC incidence for an adolescent population. Analysis of clinical recovery with CBB and K-D test revealed a relatively poor ability to accurately monitor concussion status compared to clinical assessment suggesting that these tools should not be used in isolation for monitoring SRC recovery in adolescents.
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Affiliation(s)
| | - Colm Fuller
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland.
| | - Stacey Kung
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland.
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13
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Group Differences in Postconcussion Cognitive, Physical, Sleep-Arousal, and Affective Symptom Subscales in High School and Collegiate Athletes by Race, Gender, and Competitive Level. J Head Trauma Rehabil 2023; 38:E136-E145. [PMID: 36883899 DOI: 10.1097/htr.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE Prior psychometric research has identified symptom subscales for the Post-Concussion Symptom Scale (PCSS) based on confirmatory factor analysis (CFA), including cognitive, physical, sleep-arousal, and affective symptom factors. Study objectives included: (1) replicate the 4-factor PCSS model in a diverse sample of athletes with concussion, (2) test the model for invariance across race, gender, and competitive level, and (3) compare symptom subscale and total symptom scores across concussed groups with established invariance. SETTING Three regional concussion care centers. PARTICIPANTS A total of 400 athletes who completed the PCSS within 21 days of concussion (64% boys/men, 35% Black, and 69.5% collegiate athletes). DESIGN Cross-sectional. MAIN MEASURES A CFA tested the 4-factor model and measurement invariance testing was performed across racial, competitive level, and gender groups. Symptom subscales and total symptom severity scores were compared based on demographic groupings with established invariance. RESULTS The 4-factor model fit well and strong invariance was established across all demographic categories, indicating symptom subscales could be meaningfully compared across groups. Black and White athletes differed on total symptoms (U = 15 714.5, P = .021, r = 0.12), sleep-arousal symptoms (U = 15 953.5, P = .026, r = 0.11), and physical symptoms (U = 16 140, P = .051, r = 0.10), with Black athletes reporting slightly more symptoms. Collegiate athletes reported greater total symptom severity (U = 10 748.5, P < .001, r = 0.30), with greater symptom reporting on the cognitive (U = 12 985, P < .001, r = 0.21), sleep-arousal (U = 12 594, P < .001, r = 0.22), physical (U = 10 959, P < .001, r = 0.29), and emotional (U = 14 727.5, P = .005, r = 0.14) symptom subscales. There were no significant differences by gender in the total symptom score or subscale scores. After controlling for time since injury, no racial differences persisted, but a significant difference by competitive level in physical symptom reporting (F = 7.39, P = .00, η2 = 0.02) and total symptom reporting (F = 9.16, P = .003, η2 = 0.02) remained. CONCLUSION These results provide external validation for the PCSS 4-factor model and demonstrate that symptom subscale measurements are comparable across race, genders, and competitive levels. These findings support the continued use of the PCSS and 4-factor model for assessing a diverse population of concussed athletes.
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Wait TJ, Eck AG, Loose T, Drumm A, Kolaczko JG, Stevanovic O, Boublik M. Median Time to Return to Sports After Concussion Is Within 21 Days in 80% of Published Studies. Arthroscopy 2023; 39:887-901. [PMID: 36574536 DOI: 10.1016/j.arthro.2022.11.029] [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: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To perform a systematic review of the literature and evaluate the return to play (RTP) time frame after a concussion diagnosis. Our secondary purpose was to analyze and compare different prognostic variables affecting concussions, time to return to school, time to symptom resolution of concussive symptoms, and time each patient spent in the RTP protocol. METHODS A PubMed, Scopus, Medline, Embase, and Cochrane Library database literature review was performed in August 2022. The studies needed to report, in days, the length of time a patient/athlete was removed from play due to concussion management. The Risk of Bias in Non-Randomized Studies of Interventions tool was used for risk of bias for each study, and Methodological Index for Non-Randomized Studies criteria were used for quality assessment. RESULTS There were 65 studies included in the systematic review and a total of 21,966 patients evaluated. The RTP time intervals ranged from 1 to 1,820 days, with 80.7% of the median RTP time frames for each study within 21 days. Preconcussion risk factors for prolonged RTP included female sex, younger age, presence of psychiatric disorders, and history of previous concussion. Postconcussion risk factors included severe symptom scores at initial clinic visit, loss of consciousness, nonelite athletes, and delayed removal from competition. The most common sports resulting in concussion were contact sports, most commonly football and soccer. Median time to return to school was 3 to 23 days. Median time to symptom resolution ranged from 2 to 11 days. Median time in RTP protocol was 1 to 6 days. CONCLUSIONS Median time to return to sports after concussion is within 21 days in 80% of published studies. LEVEL OF EVIDENCE IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Trevor J Wait
- University of Colorado - Steadman Hawkins Clinic of Denver, Englewood, Colorado, U.S.A..
| | - Andrew G Eck
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas, U.S.A
| | - Tyler Loose
- University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Amelia Drumm
- University of Colorado School of Medicine, Englewood, Colorado, U.S.A
| | - Jensen G Kolaczko
- University of Colorado - Steadman Hawkins Clinic of Denver, Englewood, Colorado, U.S.A
| | - Ognjen Stevanovic
- University of Colorado - Steadman Hawkins Clinic of Denver, Englewood, Colorado, U.S.A
| | - Martin Boublik
- University of Colorado - Steadman Hawkins Clinic of Denver, Englewood, Colorado, U.S.A
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15
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Fish AM, Vanni J, Mohammed FN, Fedonni D, Metzger KB, Shoop J, Master CL, Arbogast KB, McDonald CC. Comparison of Anxiety and Depression Symptoms in Concussed and Nonconcussed Adolescents. Sports Health 2023; 15:185-191. [PMID: 35919017 PMCID: PMC9950990 DOI: 10.1177/19417381221113840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Few studies have examined psychiatric symptoms during the acute phase following a concussion in adolescents. Thus, this study compares anxiety and depression in acutely concussed and nonconcussed adolescents. HYPOTHESIS Acutely concussed adolescents will report greater anxiety and depressive symptoms compared with nonconcussed adolescents. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS Data were collected from 282 adolescents (111 concussed within 28 days of injury, 171 nonconcussed), 13 to 18 years of age, who completed Patient-Reported Outcome Measurement Information System (PROMIS) Anxiety and Depressive Symptoms measures. We calculated average T-scores for anxiety and depression across both groups and compared the proportion of those who scored above normal limits. Finally, we calculated risk ratios for anxiety and depression scores above normal limits. RESULTS Average T-scores for anxiety did not differ in concussed versus nonconcussed adolescents (mean: 45.9 [SD 10.84] vs 45.2 [8.1], respectively, P = 0.54), whereas average T-scores for depression were significantly higher in concussed versus nonconcussed adolescents (46.0 [10.88] vs 42.8 [8.48], respectively, P < 0.01). The proportion of concussed adolescents above normal limits for depression was greater than nonconcussed adolescents (32.4% vs 20.5%, respectively, P = 0.02). Post hoc sensitivity analyses excluding those with a history of anxiety or depression demonstrated a 1.45 (95% CI, 0.97, 2.01) and 1.56 (95% CI, 0.95, 2.56) increased risk of an above-normal anxiety and depression score for concussed compared with nonconcussed adolescents, respectively, although both were nonsignificant. CONCLUSION Although we found few significant differences between the 2 groups, the results highlight that many concussed adolescents met the threshold for above-average symptoms on the depression and anxiety PROMIS measures. CLINICAL RELEVANCE In adolescents, there is increased risk for psychiatric sequalae in the acute period after a concussion. As such, we suggest that clinicians consider incorporating depression screening when caring for adolescents after a concussion.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Catherine C. McDonald
- Catherine C. McDonald, PhD,
RN, FAAN, University of Pennsylvania, School of Nursing, Claire Fagin Hall, Rm
414, 418 Curie Boulevard, Philadelphia, PA 19104 (
) (Twitter: @KateMcD_PhDRN)
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16
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Stephenson K, Womble MN, Eagle S, Collins MW, Kontos AP, Elbin RJ. Symptom Provocation Following Post-concussion Computerized Neurocognitive Testing and Its Relationship to Other Clinical Measures of Concussion. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2022; 38:548-556. [PMID: 36566500 DOI: 10.1093/arclin/acac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study was to document the prevalence of post-computerized neurocognitive test (post-CNT) increases in symptoms in athletes with sport-related concussion, and to examine the effect of post-CNT symptom increases on concussion neurocognitive and vestibular/ocular motor clinical outcomes. METHODS This was a retrospective analysis of medical records from a concussion specialty clinic. Two hundred and three athletes (M = 16.48 ± 1.97 years; 44% [90/203] female) completed a clinical visit for concussion within 30 days of injury (M = 7.73 ± 5.54 days). Computerized neurocognitive testing (the Immediate Post-concussion Assessment and Cognitive Testing: ImPACT), the Post-Concussion Symptom Scale (PCSS), and the Vestibular Ocular Motor Screening (VOMS) were the main outcome measures for the current study. RESULTS Sixty-nine percent (141/203) of the sample did not report significant increases in PCSS scores following post-concussion CNT and were classified into a No Provocation (NO PROV) group. Thirty-one percent (62/203) of participants did report a significant increase in symptoms following post-concussion CNT and were classified into a Provocation (PROV) group. Neurocognitive performance was similar between groups. However, the PROV group reported significantly higher scores on the VOMS symptom items than the NO PROV group. CONCLUSIONS The majority of adolescent athletes can complete a post-concussion CNT without experiencing significant increases in concussion symptoms. Individuals that report symptom increases from completing a post-concussion CNT are more likely to exhibit increased vestibular/ocular motor symptoms. These findings underscore the relationship between the clinical findings from both CNT and vestibular/ocular motor measures following concussion.
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Affiliation(s)
- Katie Stephenson
- Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, AR 72703, USA
| | - Melissa N Womble
- Inova Sports Medicine Concussion Program, Inova Hospital, Fairfax, VA 22031, USA
| | - Shawn Eagle
- UPMC Sports Medicine Concussion Program - Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15203, USA
| | - Michael W Collins
- UPMC Sports Medicine Concussion Program - Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15203, USA
| | - Anthony P Kontos
- UPMC Sports Medicine Concussion Program - Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15203, USA
| | - R J Elbin
- Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, AR 72703, USA
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17
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Primary Headaches and Physical Performance: A Professional Youth Female Soccer Team Study. Brain Sci 2022; 12:brainsci12121702. [PMID: 36552162 PMCID: PMC9776109 DOI: 10.3390/brainsci12121702] [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: 11/23/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
The vast majority of the research on acute post-traumatic incidents in athletes focuses on migraines. Physical exercise might reduce the frequency of migraines as well as trigger a migraine attack. The objectives of the study were to evaluate primary headache prevalence in professional young female soccer players and to assess whether headaches are related to physical performance. To the best of our knowledge, this is the first study that has considered the relationship between primary headaches and physical performance assessment. The research was conducted in 19 females aged 12-17 from a professional youth soccer academy. Players completed a questionnaire about health status and then performed laboratory physical tests (e.g., cardiopulmonary tests, countermovement and squat jumps, handgrip, sit-and-reach tests). Subsequently, players were separated into a headache group and a headache-free control group. In the analysed group, eight female players (42%) suffered from primary headaches. Among the performance parameters, a significant result was found in terms of flexibility. Females from the headache group had higher results in the sit-and-reach test than females from the control group (p = 0.029). Flexibility as well as mobility in migraine patients is an area with significant potential for further investigation, as little research has been conducted to date.
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18
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Weil ZM, Ivey JT, Karelina K. Putting the Mind to Rest: A Historical Foundation for Rest as a Treatment for Traumatic Brain Injury. J Neurotrauma 2022. [DOI: 10.1089/neu.2022.0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Zachary M. Weil
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Julia T. Ivey
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Kate Karelina
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
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19
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Thomas DG, Erpenbach H, Hickey RW, Waltzman D, Haarbauer-Krupa J, Nelson LD, Patterson CG, McCrea MA, Collins MW, Kontos AP. Implementation of active injury management (AIM) in youth with acute concussion: A randomized controlled trial. Contemp Clin Trials 2022; 123:106965. [PMID: 36252936 PMCID: PMC10924688 DOI: 10.1016/j.cct.2022.106965] [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] [Received: 06/08/2022] [Revised: 09/10/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Nearly 2 million youth seek acute medical care following concussion in the U.S. each year. Current standard of care recommends rest for the first 48 h after a concussion. However, research suggests that prolonged rest may lengthen recovery time especially for patients with certain risk profiles. Research indicates that physical activity and behavioral management interventions (sleep, stress management) may enhance recovery. To date, there is limited empirical evidence to inform acute (<72 h) concussion recommendations for physical activity and behavioral management in adolescents. OBJECTIVE To determine the effectiveness of physical activity and behavioral management for acute concussion in adolescents and young adults, and to evaluate the role of patient characteristics on treatment response. METHODS This multicenter prospective randomized controlled trial will determine which combination of physical activity and behavioral management is most effective for patients 11-24 years old who present to the emergency department or concussion clinic within 72 h of injury. Participants are randomized into: 1) rest, 2) physical activity, 3) mobile health application (mHealth) behavioral management, or 4) physical activity and mHealth app conditions. Assessments at enrollment, 3-5 days, 14 days, 1 month, and 2 months include: concussion symptoms, balance, vestibular-ocular and cognitive assessments, quality of life, and recovery time. Somatic symptoms and other risk factors are evaluated at enrollment. Compliance with treatment and symptoms are assessed daily using actigraph and daily self-report. The primary study outcome is symptoms at 14 days. CONCLUSION Prescribed physical activity and behavioral management may improve outcomes in youth following acute concussion.
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Affiliation(s)
- D G Thomas
- Medical College of Wisconsin, Department of Pediatrics, United States of America.
| | - H Erpenbach
- Medical College of Wisconsin, Department of Pediatrics, United States of America
| | - R W Hickey
- University of Pittsburgh, Department of Pediatrics, United States of America
| | - D Waltzman
- Centers for Disease Control and Prevention, United States of America
| | - J Haarbauer-Krupa
- Centers for Disease Control and Prevention, United States of America
| | - L D Nelson
- Medical College of Wisconsin, Department of Neurosurgery, United States of America
| | - C G Patterson
- University of Pittsburgh, Department of Physical Therapy, United States of America
| | - M A McCrea
- Medical College of Wisconsin, Department of Neurosurgery, United States of America
| | - M W Collins
- University of Pittsburgh, Department of Orthopedic Surgery, United States of America
| | - A P Kontos
- University of Pittsburgh, Department of Orthopedic Surgery, United States of America
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20
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Hou BQ, Yengo-Kahn AM, Hajdu K, Tang AR, Grusky AZ, Zuckerman SL, Terry DP. Factors Associated With Additional Clinic Visits in the Treatment of Sports-Related Concussion. Clin J Sport Med 2022; 32:588-594. [PMID: 36194442 DOI: 10.1097/jsm.0000000000001057] [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: 12/27/2021] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the variables associated with additional concussion clinic visits before discharge to athletic trainer (AT). DESIGN Retrospective cohort study. SETTING Multidisciplinary Sports Concussion Center. PATIENTS Patients ages 12 to 23 years presenting with a sport-related concussion between January 11, 2017, and January 10, 2020, and were discharged to an AT. METHODOLOGY Our main outcome variable was being discharged to AT after the initial clinic visit versus those who attended additional clinic visits before AT discharge. We examined the influence of age, sex, initial visit symptom score, family and personal history of psychiatric disorders and migraines, history of prior concussions, and other variables on this outcome. RESULTS Of 524 patients, 236 were discharged to AT after the initial clinic visit, while 288 patients required additional clinic visits. The additional visit group had higher initial visit symptom scores ( P = 0.002), head imaging performed more frequently ( P < 0.02), a family history of psychiatric disorders and/or migraines ( P < 0.001, P < 0.001), more often reported a prior concussion ( P = 0.02), and was younger ( P = 0.014) compared with the one visit group. In a multiple variable model, the family history of psychiatric disorders [odds ratio (OR), 3.12 (95% CI, 1.531-6.343), P = 0.002], prior concussions [OR, 1.39 (95% CI, 1.020-1.892), P = 0.037], greater initial symptom score [OR, 1.05 (95% CI, 1.031-1.058), P < 0.001], and younger age [OR, 0.87 (95% CI, 0.773-0.979), P = 0.021] were strongly associated with additional visits. CONCLUSIONS Among athletes treated at a regional sports concussion center, family history of psychiatric disorders, increased symptom score at initial visit, prior concussions, and younger age were each uniquely associated with needing additional clinic visits at the time of initial assessment. Understanding these variables may guide treatment protocols for optimal care.
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Affiliation(s)
- Brian Q Hou
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Aaron M Yengo-Kahn
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee; and.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine Hajdu
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Alan R Tang
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Alan Z Grusky
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Scott L Zuckerman
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee; and.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas P Terry
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee; and.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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21
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International perspectives on trends in paediatric sports-related concussion: knowledge, management, unanswered questions. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-01014-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
Purpose
In the last 20 years, concussion has received increased attention in the media, with distinct recognition of sports-related concussion (SRC). Much of this attention has centred on the paediatric population, due to concerns over adolescent brain development and the high numbers of teenagers playing contact sport. This qualitative study explored (1) what experts in the field of concussion perceive regarding trends in paediatric concussion awareness and management, and (2) how responses to these questions differ by country (US vs. NZ) and by discipline (research vs. sports coaching vs. sports medicine).
Methods
After the development of a semi-structured interview template, questions were coded for interviews of six (N = 6) experts in academia, medicine, and coaching: three in the United States (N = 3) and three in New Zealand (N = 3). Interviews were then transcribed and qualitatively analysed using a thematic narrative analysis. Emergent themes included concussion knowledge, management, and unanswered questions.
Results
Findings showed general commonalities on the importance of concussion education, the improvement of concussion awareness, compliance to concussion protocols, and the need to research long-term outcomes. Fewer commonalities were found regarding the level of concussion reporting, the impact of multiple concussions, whether paediatric and adult concussion should be treated similarly, and the utility of concussion tests.
Conclusions
Concussion experts agree on many areas; however, divergent opinions were apparent. Further original research is required within the paediatric population to analyse the efficacy of current concussion guidelines.
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22
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Cuff S, Maki A, Feiss R, Young J, Shi J, Hautmann A, Yang J. Risk factors for prolonged recovery from concussion in young patients. Br J Sports Med 2022; 56:1345-1352. [DOI: 10.1136/bjsports-2022-105598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
ObjectivesFor young patients sustaining concussion, assessing recovery is vital in determining safe return to play. Identifying risk factors may aid clinicians in recognising patients at risk for prolonged recovery. The study objective is to identify risk factors for prolonged (>28 days) and extended (>90 days) recovery (defined as symptom duration) and analyse how these risk factors differ between the two groups.MethodsWe retrospectively analysed electronic health record data (n=4937) among patients aged 10–18 years collected at Nationwide Children’s Hospital Sports Medicine concussion clinics between 1 July 2012 and 30 June 2019. Data collected included patient demographics, comorbidities (eg, prior psychiatric diagnoses, prior concussions) and injury characteristics (eg, loss of consciousness, injury setting). We examined patient risk factors for prolonged (>28 days) and/or extended (>90 days) recovery using modified Poisson regression models.ResultsFactors associated with increased risk of prolonged recovery from concussion included prior concussions (adjusted risk ratio (ARR) 1.19, 95% CI 1.02 to 1.38) for two concussions (ARR 1.36, 95% CI 1.14 to 1.61), for >3, and higher initial symptom score (ARR 2.57, 95% CI 2.34 to 2.83) for postconcussion symptom (PCS) scores 21–60 (ARR 2.89, 95% CI 2.54 to 3.29), for PCS>60. Risk factors for extended recovery included history of concussion (ARR 1.50, 95% CI 1.09 to 2.06) for two concussions (ARR 1.75, 95% CI 1.17 to 2.62), for >3 and older age (15–18 years, ARR 1.11, 95% CI 1.05 to 1.18). Additionally, comorbid attention deficit hyperactivity disorder increased risk of prolonged recovery (ARR 1.14, 95% CI 1.01 to 1.29) while anxiety increased risk for extended recovery (ARR 1.47, 95% CI 1.10 to 1.95).ConclusionOverall, risk factors for prolonged recovery differ somewhat from risk factors for extended recovery. For patients who present to clinic with concussion, mental health is an important consideration which may impact the timeline for symptom recovery.
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O'Brien KH, Lundine JP, Pei Y, Kemp AM. The School-Based Speech-Language Pathologist and Students With Concussion: An Examination of Evolving Knowledge and Confidence. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1992-2003. [PMID: 35881877 DOI: 10.1044/2022_ajslp-21-00315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This study examines school-based speech-language pathologists' (SLPs') experience, knowledge, and confidence in supporting students as they return to the classroom following concussion, with a particular focus on knowledge of new management guidelines over the last decade. METHOD Participants were 74 school-based SLPs who completed an electronic survey about their knowledge and experiences serving students with concussion. We examined participants' accuracy and confidence across knowledge questions using Kruskal-Wallis tests. We also conducted linear regression to explore the relationships between training, work experiences, knowledge, and confidence. RESULTS Nearly half of participants who are currently working with students with concussion reported having no clinical or training experiences related to concussion. Participants who had more concussion-related training or working experiences reported higher confidence. Participants were confident about general concussion knowledge but less confident about providing assessment and supporting students with concussion as they returned to school. Participants had the lowest confidence and accuracy for the most recent guidelines around rest and activity, as well as the differential impact of concussion on children as compared to adults. CONCLUSIONS Many school-based SLPs have limited training around concussion management and are often not specifically consulted to work with students following concussion. Despite this, SLPs have good awareness of their knowledge about concussion, but show gaps in knowledge surrounding more recent evidence-based guidelines. Additional investigation is needed to determine better ways to move research into clinical practice and to increase the involvement of SLPs in school-based concussion teams. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20361969.
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Affiliation(s)
- Katy H O'Brien
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| | - Jennifer P Lundine
- Department of Speech and Hearing Science, The Ohio State University, Columbus
- Division of Clinical Therapies and Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
| | - Yalian Pei
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| | - Amy M Kemp
- Department of Communication Sciences and Special Education, University of Georgia, Athens
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Manzhurtsev AV, Yakovlev AN, Bulanov PA, Menshchikov PE, Ublinskiy MV, Melnikov IA, Akhadov TA, Semenova NA. Macromolecular-Suppressed GABA-Edited MR Spectroscopy in the Posterior Cingulate Cortex of Patients With Acute Mild Traumatic Brain Injury. J Magn Reson Imaging 2022; 57:1433-1442. [PMID: 36053885 DOI: 10.1002/jmri.28410] [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: 05/27/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) causes a number of molecular and cellular alterations. There is evidence of an imbalance between the main excitatory (glutamate, Glu) and the main inhibitory (gamma-aminobutyric acid [GABA]) neurotransmitters following mTBI. In vivo human GABA-Glu balance studies following mTBI are sparse. PURPOSE To investigate the effect of acute mTBI on the GABA concentration measured in the posterior cingulate cortex (PCC) of pediatric patients by using the macromolecular (MM)-suppressed GABA J-editing technique. STUDY TYPE Prospective patient and phantom. PARTICIPANTS A total of 14 pediatric patients (mean age 16.0 ± 1.7) with acute mTBI (<3 days after trauma; Glasgow Coma Scale 15) and 16 healthy volunteers (mean age 16.9 ± 2.8). Phantom: 524 cm3 sphere containing 10 mM glycine, 10 mM GABA. FIELD STRENGTH/SEQUENCE A 3 T, MEGA-PRESS pulse sequence. ASSESSMENT GABA spectra were processed in Gannet software. MM-suppressed GABA editing efficiency was derived from the phantom study. Absolute GABA and glutamate + glutamine (Glx) concentrations were quantified using different types of correction and compared between groups. N-acetyl aspartate (NAA) and choline (Cho) levels relative to tCr were also compared. STATISTICAL TESTS Shapiro-Wilk test, Mann-Whitney U test, Student t-test, Pearson or Spearman correlations. P < 0.01 was considered statistically significant. RESULTS The MM-suppressed GABA editing efficiency was 0.63. GABA signal fit error was <16% for all participants. The GABA concentration in the PCC of the mTBI group was significantly different from that in healthy controls: GABA/tCr was higher by 27%, absolute GABA concentration with different types of correction was higher by ≈17%. No significant differences were observed in Glx concentrations (P ≥ 0.32) or in Glx/tCr (P ≥ 0.1), NAA/tCr (P = 0.55), and Cho/tCr levels (P = 0.85). DATA CONCLUSION We report an increase in the GABA concentration in the PCC region in acute mTBI pediatric patients. This may suggest activation of GABA synthesis and impairment of the GABAergic system after acute mTBI. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Andrei V Manzhurtsev
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russian Federation.,Emanuel Institute of Biochemical Physics of the Russian Academy of Sciences, Moscow, Russian Federation.,Moscow State University, Moscow, Russian Federation
| | - Alexey N Yakovlev
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russian Federation.,Emanuel Institute of Biochemical Physics of the Russian Academy of Sciences, Moscow, Russian Federation.,N.N. Semenov Federal Research Center for Chemical Physics Russian Academy of Sciences, Moscow, Russian Federation
| | - Petr A Bulanov
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russian Federation.,Moscow State University, Moscow, Russian Federation.,Philips Healthcare, Moscow, Russian Federation
| | - Petr E Menshchikov
- Emanuel Institute of Biochemical Physics of the Russian Academy of Sciences, Moscow, Russian Federation.,Philips Healthcare, Moscow, Russian Federation
| | - Maxim V Ublinskiy
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russian Federation.,Emanuel Institute of Biochemical Physics of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Ilya A Melnikov
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russian Federation
| | - Tolib A Akhadov
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russian Federation.,Moscow State University, Moscow, Russian Federation
| | - Natalia A Semenova
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russian Federation.,Emanuel Institute of Biochemical Physics of the Russian Academy of Sciences, Moscow, Russian Federation.,Moscow State University, Moscow, Russian Federation.,N.N. Semenov Federal Research Center for Chemical Physics Russian Academy of Sciences, Moscow, Russian Federation
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25
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Jenkins AS, Pollock JR, Moore ML, Makovicka JL, Brinkman JC, Chhabra A. The 100 Most-Cited and Influential Articles in Collegiate Athletics. Orthop J Sports Med 2022; 10:23259671221108401. [PMID: 35837444 PMCID: PMC9274432 DOI: 10.1177/23259671221108401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 12/26/2022] Open
Abstract
Background Bibliometric citation analyses have been widely used in medicine to help researchers gain foundational knowledge about a topic and identify subtopics of popular interest for further investigations. There is a lack of similar research in collegiate athletics. Purpose To identify the 100 most-cited research publications related to collegiate athletics. Study Design Cross-sectional study. Methods The Clarivate Analytics Web of Knowledge database was used to generate a list of articles relating to collegiate athletics on January 24, 2022. Articles were filtered by the total number of citations, and the 100 most-cited articles were selected. For each article, we identified and analyzed the following: author name, publication year, country of origin, journal name, article type, main research topic area, competitive level, sex of study population, and level of evidence. Results Of the top 100 most-cited articles, 63 were related to medicine. In total, 96% of articles were published in the United States, and 80% were published in the year 2000 or later. Of the top 100 articles, 85 were observational; only 5 were experimental. The sport most represented was soccer, followed by football, baseball, and basketball. Of the top 100 articles, 21 were published in a single journal, the American Journal of Sports Medicine. Ten authors published ≥5 of the top 100 most-cited studies. Conclusion The majority of top 100 articles were published in the United States after 1999 and primarily focused on medicine-related topics. Soccer was studied by more articles than football, baseball, and basketball. An author's prestige may have influenced the likelihood of citation. The top 100 most-cited studies provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions to the literature on collegiate athletics.
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Affiliation(s)
- Anna S Jenkins
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - M Lane Moore
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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26
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Exploring Vestibular/Ocular and Cognitive Dysfunction as Prognostic Factors for Protracted Recovery in Sports-Related Concussion Patients Aged 8 to 12 Years. Clin J Sport Med 2022; 32:408-414. [PMID: 34516435 DOI: 10.1097/jsm.0000000000000975] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore the prognostic ability of the vestibular/ocular motor screening (VOMS), King-Devick (K-D) Test, and C3 Logix Trails A and B to identify protracted recovery from sports-related concussion (SRC) in patients aged 8 to 12 years. DESIGN Retrospective cohort analysis. SETTING Specialty pediatric sports concussion clinic. PARTICIPANTS A total of 114 youth athletes aged 8 to 12 years who were diagnosed with an SRC within 7 days of injury. INDEPENDENT VARIABLES A positive screen on the VOMS, K-D, and C3 Logix Trails A and Trails B. Combined positive screens on multiple tests (ie, 2, 3, or all 4 positive screens of 4 possible). MAIN OUTCOME MEASURES Recovery time in days and protracted recovery (recovery time ≥30-days) were the primary outcomes of interest. RESULTS A positive VOMS screen was associated with 1.31 greater days to SRC recovery ( P = 0.02) than a negative VOMS screen. The K-D and C3 Logix tests were not significantly associated with recovery time, nor were any combinations of tests ( P > 0.05). The VOMS demonstrated moderate prognostic ability to predict normal recovery (negative predictive value = 80.78% [95% CI = 63.73-90.95]). Overall predictive accuracy of normal versus protracted recovery was strongest when a participant screened positive on all 4 tests (Accuracy = 76.32% [95% CI = 67.45-83.78]). CONCLUSIONS The VOMS was associated with overall recovery time and proved to be a useful test to identify those who would experience a normal recovery time. Combining the 4 tests improved the prognostic accuracy of the protocol in predicting protracted versus normal recovery. These findings suggest that combining multiple, varied assessments of cognition and vestibular/ocular functions may better explain factors contributing to protracted recovery.
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Congeni J, Murray T, Kline P, Bouhenni R, Morgan D, Liebig C, Lesak A, McNinch NL. Preliminary Safety and Efficacy of Head and Neck Cooling Therapy After Concussion in Adolescent Athletes: A Randomized Pilot Trial. Clin J Sport Med 2022; 32:341-347. [PMID: 34009790 PMCID: PMC9223510 DOI: 10.1097/jsm.0000000000000916] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the safety and efficacy of head and neck cooling when applied up to 8 days after concussion among adolescent athletes. DESIGN A randomized nonblinded pilot trial. SETTING Sports Medicine Clinic in a tertiary hospital. PATIENTS Adolescent athletes aged 12 to 17 years diagnosed with a concussion within 1 week of injury. INTERVENTIONS AND MAIN OUTCOME MEASURES The control group (n = 27) received standard treatment (short term brain rest), whereas the treatment group (n = 28) received standard treatment and head and neck cooling. Head and neck cooling treatment was applied to patients at the postinjury assessment visit and at 72 hours post-injury. The SCAT5 (Sport Concussion Assessment Tool) total symptom severity score was collected at postinjury assessment visit, pre- and post-treatment at 72 hours, and at 10 days, and 4 weeks post-treatment. RESULTS Athletes who received head and neck cooling had a faster symptom recovery ( P = 0.003) and experienced significant reduction in symptom severity scores after treatment ( P < 0.001). Sport type and gender did not influence the treatment outcome ( P = 0.447 and 0.940, respectively). CONCLUSIONS This pilot study demonstrates feasibility of head and neck cooling for the management of acute concussion in adolescent athletes.
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Affiliation(s)
- Joseph Congeni
- Department of Sports Medicine, Akron Children's Hospital, Akron, Ohio; and
| | - Tamara Murray
- Department of Sports Medicine, Akron Children's Hospital, Akron, Ohio; and
| | - Peyton Kline
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Rachida Bouhenni
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Danielle Morgan
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Christopher Liebig
- Department of Sports Medicine, Akron Children's Hospital, Akron, Ohio; and
| | - Alexandria Lesak
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Neil L. McNinch
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
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Proton MR Spectroscopy of Pediatric Brain Disorders. Diagnostics (Basel) 2022; 12:diagnostics12061462. [PMID: 35741272 PMCID: PMC9222059 DOI: 10.3390/diagnostics12061462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
In vivo MR spectroscopy is a non -invasive methodology that provides information about the biochemistry of tissues. It is available as a “push-button” application on state-of-the-art clinical MR scanners. MR spectroscopy has been used to study various brain diseases including tumors, stroke, trauma, degenerative disorders, epilepsy/seizures, inborn errors, neuropsychiatric disorders, and others. The purpose of this review is to provide an overview of MR spectroscopy findings in the pediatric population and its clinical use.
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Repeated Sub-Concussive Impacts and the Negative Effects of Contact Sports on Cognition and Brain Integrity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127098. [PMID: 35742344 PMCID: PMC9222631 DOI: 10.3390/ijerph19127098] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/29/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
Sports are yielding a wealth of benefits for cardiovascular fitness, for psychological resilience, and for cognition. The amount of practice, and the type of practiced sports, are of importance to obtain these benefits and avoid any side effects. This is especially important in the context of contact sports. Contact sports are not only known to be a major source of injuries of the musculoskeletal apparatus, they are also significantly related to concussion and sub-concussion. Sub-concussive head impacts accumulate throughout the active sports career, and thus can cause measurable deficits and changes to brain health. Emerging research in the area of cumulative sub-concussions in contact sports has revealed several associated markers of brain injury. For example, recent studies discovered that repeated headers in soccer not only cause measurable signs of cognitive impairment but are also related to a prolonged cortical silent period in transcranial magnetic stimulation measurements. Other cognitive and neuroimaging biomarkers are also pointing to adverse effects of heading. A range of fluid biomarkers completes the picture of cumulating effects of sub-concussive impacts. Those accumulating effects can cause significant cognitive impairment later in life of active contact sportswomen and men. The aim of this review is to highlight the current scientific evidence on the effects of repeated sub-concussive head impacts on contact sports athletes’ brains, identify the areas in need of further investigation, highlight the potential of advanced neuroscientific methods, and comment on the steps governing bodies have made to address this issue. We conclude that there are indeed neural and biofluid markers that can help better understand the effects of repeated sub-concussive head impacts and that some aspects of contact sports should be redefined, especially in situations where sub-concussive impacts and concussions can be minimized.
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30
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Socioeconomic and demographic considerations of pediatric concussion recovery. J Clin Neurosci 2022; 100:94-99. [DOI: 10.1016/j.jocn.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/21/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022]
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Current Attitudes and Beliefs in Interdisciplinary Return to Play Management for Pediatric Concussion: A Survey. J Sport Rehabil 2022; 31:856-868. [PMID: 35483703 DOI: 10.1123/jsr.2021-0368] [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: 10/12/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT The pediatric population is more susceptible to sustaining concussion and experiencing more severe and prolonged symptoms as compared with adults. Current evidence indicates conflicting beliefs within the interdisciplinary team in terms of best practices for managing pediatric concussion. OBJECTIVES (1) To describe current practices on interdisciplinary coordination among physical therapists (PTs) and athletic trainers (ATs) during management and return to play (RTP) of children and adolescents with concussion and (2) to describe their confidence in implementing RTP protocols, their comprehension of concussion legislation, and scope of practice of their profession regarding returning pediatric athletes to sport postconcussion. DESIGN AND METHODS A 34-item anonymous survey containing questions regarding demographics, confidence with concussion management, knowledge of sports-related concussion state legislation, beliefs of interdisciplinary concussion management team, and referral/communication patterns was electronically distributed through alumni networks. PARTICIPANTS 141 respondents (80 ATs and 61 PTs). RESULTS Only 12.5% of ATs believed that PTs had any role in the initial concussion management, whereas 65% of PTs regarded the role of ATs in initial management as important. In terms of legislation, 44% of PTs and 12.5% of ATs were unsure of state laws pertaining to concussion management or health care professions responsible for RTP. There was consensus among PTs and ATs (61%) in the lack of interdisciplinary coordination of care and lack of awareness among physician groups regarding RTP protocols. Within their respective disciplines, a greater proportion of PTs (63%) agreed that the process of care lacked standardization as compared with ATs (21%). CONCLUSION Lack of interdisciplinary communication and collaboration during management of pediatric concussion may cause premature RTP that may lead to catastrophic effects on the developing pediatric brain. Barriers regarding education, time management, knowledge of state laws, and understanding other professions' scope of practice need to be further addressed to ensure safe RTP.
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Resting State Functional Connectivity between Dorsal Attentional Network and Right Inferior Frontal Gyrus in Concussed and Control Adolescents. J Clin Med 2022; 11:jcm11092293. [PMID: 35566427 PMCID: PMC9100070 DOI: 10.3390/jcm11092293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022] Open
Abstract
Concussion among adolescents continues to be a public health concern. Yet, the differences in brain function between adolescents with a recent concussion and adolescents with no history of concussion are not well understood. Although resting state functional magnetic resonance imaging (fMRI) can be a useful tool in examining these differences, few studies have used this technique to examine concussion in adolescents. Here, we investigate the differences in the resting state functional connectivity of 52 adolescents, 38 with a concussion in the previous 10 days (mean age = 15.6; female = 36.8%), and 14 controls with no concussion history (mean age = 15.1; female = 57.1%). Independent component analysis and dual regression revealed that control adolescents had significantly greater functional connectivity between the dorsal attention network (DAN) and right inferior frontal gyrus (RIFG) compared to concussed adolescents (p-corrected < 0.001). Specifically, there was a positive DAN-RIFG connectivity in control, but not concussed, adolescents. Our findings indicate that concussion is associated with disrupted DAN-RIFG connectivity, which may reflect a general, nonspecific response to injury.
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Glendon K, Desai A, Blenkinsop G, Belli A, Pain M. Recovery of symptoms, neurocognitive and vestibular-ocular-motor function and academic ability after sports-related concussion (SRC) in university-aged student-athletes: a systematic review. Brain Inj 2022; 36:455-468. [PMID: 35377822 DOI: 10.1080/02699052.2022.2051740] [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: 12/29/2022]
Abstract
BACKGROUND Physiological differences between a maturing and matured brain alters how Sports-Related Concussion (SRC) affects different age groups; therefore, a review specific to university-aged student-athletes is needed. OBJECTIVES Determine time to recovery for symptom burden, neurocognitive and Vestibular-Ocular-Motor (VOM) function and academic impact in university-aged student-athletes. METHODS Searches were conducted in PubMed, SpringerLink, PsycINFO, Science Direct, Scopus, Cochrane, Web of Science and EMBASE. Articles were included if they contained original data collected within 30 days in university-aged student-athletes, analysed SRC associated symptoms, neurocognitive or VOM function or academic ability and published in English. Two reviewers independently reviewed sources, using the Oxford Classification of Evidence-Based Medicine (CEBM) and the Downs and Black checklist, and independently extracting data before achieving consensus. RESULTS 58 articles met the inclusion criteria. Recovery of symptoms occurred by 7 and 3-5.3 days for neurocognition. The evidence base did not allow for a conclusion on recovery time for VOM function or academic ability. Few papers investigated recovery times at specified re-assessment time-points and have used vastly differing methodologies. CONCLUSIONS To fully understand the implication of SRC on the university-aged student-athlete' studies using a multi-faceted approach at specific re-assessments time points are required.Systematic review registration number: CRD42019130685.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Desai
- 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, College of Medical and Dental Sciences, University of Birmingham, UK
| | - M Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Male Youth Ice Hockey Concussion Incidence in a USA Hockey Membership-Adjusted Population: A Peak in 2011 and the Impact of Major Rule Changes. Clin J Sport Med 2022; 32:122-127. [PMID: 34009791 DOI: 10.1097/jsm.0000000000000893] [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: 02/10/2020] [Accepted: 08/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the incidence of youth ice hockey-related concussions preceding and following the implementation of new body-checking and head contact rules by USA hockey in 2011. We hypothesized a decrease in concussions after the rule change. DESIGN Retrospective analysis. SETTING United States emergency department (ED) data queried in the National Electronic InjurySurveillance System (NEISS). PATIENTS National Electronic Injury Surveillance System reported male youth (≤18 years) ice hockey concussion cases from January 1, 2002, to December 31, 2016. In total, 848 players were diagnosed with concussion, representing a national estimate of 17 374 cases. INDEPENDENT VARIABLES Time, specifically years. MAIN OUTCOME MEASURES Incidences and incidence rates (measured per 10 000 person-years) of male youth ice hockey concussions. Annual trends were analyzed using descriptive and linear or polynomial regression analysis. RESULTS The national estimate of youth ice hockey-related concussions seen in US emergency departments (EDs) increased significantly from 656 in 2007 to 2042 in 2011 (P < 0.01). During the same period, their respective incidence increased significantly from 21.8 to 66.8 per 10 000, before dropping through 2016 (P < 0.05). After 2011, concussions decreased from 1965 in 2012 to 1292 in 2016 (P = 0.055). The gap in concussion incidence between the 11 to 12 and 13 to 14 divisions widened after 2011 (before 2011: 41 vs 49 per 10 000 person-years [P = 0.80]; after 2011: 45 and 89, respectively [P < 0.01]). CONCLUSIONS US EDs experienced a significant increase in youth ice hockey concussion visits from 2007 to 2011. After the 2011 rule changes, concussion visits decreased significantly from 2012 to 2016.
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Kelshaw PM, Cook NE, Terry DP, Iverson GL, Caswell SV. Child Sport Concussion Assessment Tool 5th Edition: Normative Reference Values in Demographically Diverse Youth. Clin J Sport Med 2022; 32:e126-e133. [PMID: 34009797 DOI: 10.1097/jsm.0000000000000921] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Examine sociodemographic differences (gender, age, and language spoken at home) on baseline Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) scores and establish normative reference data for the Child SCAT5 among middle school student athletes. DESIGN Cross-sectional study. SETTING Nine middle schools in Virginia. PARTICIPANTS A sample of 1355 athletes playing competitive school-sponsored sports (ages 11-13, M = 12.3 ± 0.8; 40.1% girls, 59.9% boys) during the 2017 and 2018 school year. Certified athletic trainers administered the Child SCAT5 within the first 2 weeks of the sport season. INDEPENDENT VARIABLES Self-reported gender, age, and language spoken at home. MAIN OUTCOME MEASURES All Child SCAT5 outcome measures. RESULTS Gender, age, and language spoken at home were associated with Child SCAT5 scores, but the magnitude of differences was generally small. Specifically, girls endorsed more symptoms (girls: M = 8.4 ± 5.7, boys: M = 7.5 ± 5.7; P = 0.003) and greater symptom severity (girls: M = 11.6 ± 9.4, boys: M = 10.4 ± 9.3; P = 0.006) than boys and performed slightly better than boys on cognitive and balance tasks. Older students performed slightly better than younger students on tests of cognition (eg, SAC-C: 11-year-olds: M = 21.3 ± 2.1, 13-year-olds: M = 21.7 ± 2.1; P = 0.02). Total symptoms (P = 0.01), symptom severity (P = 0.01), immediate memory (P < 0.001), delayed recall (P = 0.001), and SAC-C total scores (P = 0.002) differed across language groups. CONCLUSIONS Gender, age, and language spoken in the home are associated with baseline scores on multiple components of the Child SCAT5 among middle school students, although the magnitudes of observed differences are small. Normative reference values are provided for clinicians when interpreting Child SCAT5 scores.
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Affiliation(s)
- Patricia M Kelshaw
- Athletic Training Program, Department of Kinesiology, University of New Hampshire, Durham, New Hampshire
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Advancing Healthcare Initiatives for Underserved Students (ACHIEVES), Institute for BioHealth Innovation, George Mason University, Manassas, Virginia
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Charlestown, Massachusetts
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Charlestown, Massachusetts
- Neuropsychology Outcome Assessment Laboratory, Center for Health and Rehabilitation Research, Charlestown, Massachusetts
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Charlestown, Massachusetts
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, Massachusetts; and
| | - Shane V Caswell
- Athletic Training Education Program, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, School of Kinesiology, Advancing Healthcare Initiatives for Underserved Students (ACHIEVES) Project, George Mason University, Manassas, Virginia
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Sullivan L, Wysong M, Yang J. Concussion Recovery in Children and Adolescents: A Qualitative Study of Parents' Experiences. THE JOURNAL OF SCHOOL HEALTH 2022; 92:132-139. [PMID: 34806778 PMCID: PMC8792299 DOI: 10.1111/josh.13114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/08/2021] [Accepted: 05/20/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Although parents play an instrumental role in youth concussion management, few studies have qualitatively explored youth concussion recovery from the parents' perspective. This study explored parents' experiences with and perceptions of their child's recovery from concussion, particularly with regards to the return-to-school process. METHODS We conducted 11 face-to-face semi-structured interviews with the parents of concussed youth aged 11 to 17 years between October 2018 and April 2019. We used the methods of open coding, axial coding, and selective coding to analyze the data. RESULTS We identified 7 themes during data analysis, which we divided into 2 categories: at home (prior to school re-entry) and at school (during the school reintegration process). The at-home category included 4 themes: (1) physical and cognitive rest; (2) child-led decision-making; (3) the role of parent-child communication in recovery; and (4) feelings about returning to school following concussion. The at-school category included 3 themes: (1) availability and utilization of academic accommodations; (2) return-to-school policies and procedures; and (3) support from school officials and teachers. CONCLUSIONS Parents' experiences of their child's return-to-school post-concussion underscore the need for evidence-based guidelines for cognitive rest post-concussion and a collaborative, team-based approach to concussion management.
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Affiliation(s)
- Lindsay Sullivan
- Discipline of Children's Studies, School of Education, College of Arts, Social Sciences, & Celtic Studies, National University of Ireland, Galway, University Road, Arts Millenium Building, Room 342, Galway, Ireland
| | - Matthew Wysong
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43205
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, 43205
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43205
- The Ohio State University, College of Medicine, Columbus, OH, 43205
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Jildeh TR, Castle JP, Buckley PJ, Abbas MJ, Hegde Y, Okoroha KR. Lower Extremity Injury After Return to Sports From Concussion: A Systematic Review. Orthop J Sports Med 2022; 10:23259671211068438. [PMID: 35111864 PMCID: PMC8801663 DOI: 10.1177/23259671211068438] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Recent studies have suggested increased rates of lower extremity (LE) musculoskeletal injury after a diagnosed concussion, although significant heterogeneity exists. Purpose: To examine the current body of research and determine whether there is an increased risk for LE musculoskeletal injury after a concussion and to identify populations at an increased risk. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of current literature using MEDLINE and PubMed databases was performed. Keywords included concussion, athlete, lower extremity injury, and return to sport. Inclusion criteria required original research articles written in the English language examining the rate of LE injuries after a diagnosed concussion. Results: A total of 13 studies involving 4349 athletes (88.1% male and 11.9% female; mean age, 19.8 years) met inclusion criteria. Athletes were classified as high school (46.1%), collegiate (17.0%), or professional (36.9%). Of the 13 studies, 4 demonstrated an increased risk of LE injury within 90 days of a diagnosed concussion (odds ratio [OR], 3.44; 95% CI, 2.99-4.42), and 6 revealed an elevated risk of injury within 1 year of concussion (OR, 1.85; 95% CI, 1.73-2.84). Increased risk was seen in professional (OR, 2.49; 95% CI, 2.40-2.72) and collegiate (OR, 2.00; 95% CI, 1.96-2.16) athletes compared with high school athletes (OR, 0.97; 95% CI, 0.89-1.05). A stepwise increase in risk of sustaining an LE injury was observed with multiple concussions, with increasing risk observed from ≥2 (OR, 2.29; 95% CI, 1.85-2.83) to ≥3 (OR, 2.86; 95% CI, 2.36-3.48) career concussions. Conclusion: An increased incidence of LE injuries was observed at 90 days and 1 year after the diagnosis of a concussion. Higher levels of competition, such as at the collegiate and professional levels, resulted in an increased risk of sustaining a subsequent LE injury after a diagnosed concussion. These results suggest an at-risk population who may benefit from injury prevention methods after a concussion. Future studies should focus on identifying which injuries are most common, during what time period athletes are most vulnerable, and methods to prevent injury after return to sports.
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Affiliation(s)
- Toufic R. Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joshua P. Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Patrick J. Buckley
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muhammad J. Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Yash Hegde
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Kelechi R. Okoroha
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Brady M, Hume PA, Mahon S, Theadom A. What Is the Evidence on Natural Recovery Over the Year Following Sports-Related and Non-sports-Related Mild Traumatic Brain Injury: A Scoping Review. Front Neurol 2022; 12:756700. [PMID: 35069407 PMCID: PMC8766792 DOI: 10.3389/fneur.2021.756700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Treatment approaches often differ dependent upon whether a person experiences a sports-related or a non-sports-related mild traumatic brain injury. It remains unclear if recovery from these injuries is comparable or unique to context of the injury. Objective: To identify knowledge gaps on self-reported outcomes and trajectories between sports- and non-sports-related mild traumatic brain injuries and how they are assessed in adults. Methods: This scoping review used a systematic search of key electronic databases, including PubMed, SPORTDiscus, Embase, MEDLINE, and CINAHL for articles published in 1937 until March 10, 2021. Articles were included if they were available in English; full text published in a peer-reviewed journal; had a prospective or retrospective study design; reported data on mild TBI cases >16 years of age, and included data from at least two time points on self-reported outcomes within 12 months post-injury. A standardized data extraction spreadsheet was used to determine the participant characteristics, definitions, assessment methods, outcomes, and recovery time frames. Results: Following removal of duplicates, the search strategy elicited 6,974 abstracts. Following abstract review, 174 were retained for full text review. Of the 42 articles that met inclusion criteria, 18 were sports related (15 in the USA and three in Canada) and 24 were general population studies (six in USA, three in Canada, three in Australasia, nine in Europe, two in Taiwan, and one in Morocco). Direct comparison in recovery trajectories between the sport and general population studies was difficult, given notable differences in methodology, definitions, types of outcome measures, and timing of follow-up assessments. Only one article reported on both sports-related and non-sports-related traumatic brain injuries separately at comparable timepoints. This study revealed no differences in recovery time frames or overall symptom burden. Discussion: Whilst there is a clear benefit in researching specific subpopulations in detail, standardized outcome measures and follow-up time frames are needed across contexts to facilitate understanding of similarities and differences between sports- and non-sports-related mild traumatic brain injuries to inform clinical treatment.
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Affiliation(s)
- Morgan Brady
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Patria A Hume
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Susan Mahon
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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A Scoping Review of Concussion Guidelines in Amateur Sports in the United Kingdom. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031072. [PMID: 35162096 PMCID: PMC8834413 DOI: 10.3390/ijerph19031072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 12/02/2022]
Abstract
Objectives To investigate which United Kingdom (UK) amateur sporting organisations have published sports-related concussion (SRC) guidelines, their accessibility and the extent to which they follow the Berlin statement recommendations. This article is targeted at those involved with designing and implementing SRC guidelines in amateur sport. Design Scoping Review. Data Sources The SRC guidelines of 15 sporting organisations were accessed through public materials available from the official organisation website. Eligibility Criteria: To be included in this review, sports must enjoy broad participation by UK amateur athletes with a high risk of athletes sustaining an SRC. Results: 15 sporting organisations were included in this review with two, British Cycling and British Eventing, found not to have published SRC guidelines. There was found to be a large discrepancy between the extent to which the sport-specific guides followed the Berlin statement recommendations. Conclusions: The large discrepancy between the contents of the SRC guidelines may be putting the health of athletes at risk. We recommend the UK government publish standardised concussion guidelines based on the latest scientific research that must be used by all UK amateur sport groups.
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Kerschner AE, Huber DL, Brett BL, Meier TB, Nelson LD, McCrea MA. Age-Group Differences and Annual Variation in Return-To-Play Practices After Sport-Related Concussion. Clin J Sport Med 2022; 32:e52-e60. [PMID: 32941381 PMCID: PMC7956921 DOI: 10.1097/jsm.0000000000000871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine return-to-play (RTP) practice differences between high school and collegiate athletes, as well as the stability (ie, year-by-year) in these practices over a 5-year period. We hypothesized that similar protocols for treatment will be comparable across competition levels and that these practices will vary year-to-year. DESIGN Prospective cohort study. SETTING Nine high schools and 4 National Collegiate Athletic Association Division III colleges in Southeastern Wisconsin. PARTICIPANTS AND INDEPENDENT VARIABLES Two-hundred seventy-three (N = 273) athletes with sport-related concussions (SRCs). Independent predictors included competition level (high school, n = 88 vs collegiate, n = 185) and year-of-injury. OUTCOME MEASURES Athletes were evaluated prospectively for differences in symptom duration, symptom free waiting period (SFWP), and time to RTP, as well as longitudinal changes in management. RESULTS High school and collegiate athletes experienced comparable median symptom duration (high school, 6.0 days, interquartile range (IQR) = 3.5-11.0; college, 6.0 days, IQR = 4.0-9.0, P = 0.95), SFWP (high school, 5.0 days, IQR = 3.0-8.0; college, 5.0 days, IQR = 3.0-7.0, P = 0.12), and total time to RTP (high school, 10.5 days, IQR = 7.0-16.0; college, 11.0 days, IQR = 8.0-14.0 days, P = 0.94). A Cox regression analysis revealed a nonsignificant trend toward longer SFWPs in high school athletes (P = 0.055; hazard ratio = 1.347, confidence interval = 0.99-1.83). Among football players, SFWPs in 2017 (Median = 3.5 days, IQR = 1.5-5.0 days) were significantly longer than those in 2014 (Median = 5.0 days, IQR = 4.0-8.5 days, P = 0.029) after correction for multiple comparisons. CONCLUSION Similar postinjury and RTP management practices were observed at the high school and collegiate levels after SRCs. Symptom duration and time from injury to unrestricted RTP were comparable, although high school athletes may have longer SFWPs.
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Affiliation(s)
- Anna E Kerschner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Daniel L Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; and
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Schoenfeld R, Drendel A, Ahamed SI, Thomas D. Longitudinal Assessment of Acute Concussion Outcomes Through SMS Text (ConText Study). Pediatr Emerg Care 2022; 38:e37-e42. [PMID: 34986585 DOI: 10.1097/pec.0000000000002596] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI), or concussion, is a common health problem that has seen a recent increase in US adolescents. This study uses SMS text messaging (a mobile health [mHealth] tool) to report patient symptoms. We aim to better characterize mTBI recovery and hypothesize that this mHealth tool will have high retention rates and correlate with a conventional means of assessing symptoms, the Post-Concussion Symptom Inventory (PCSI). METHODS A prospective observational cohort pilot study. Thirty-one pediatric patients with acute mTBI were recruited to characterize their injury and report their symptoms via text messaging. Patients reported symptoms once every 3 days for the first 21 days, then once a week for 6 weeks. RESULTS There was a strong and positive correlation between the PCSI and the mHealth tool (rs = 0.875, P < 0.000, n = 22). Retention was 74% until symptom resolution and 42% until study completion. Patients with balance deficits had a significantly higher somatization score than those with normal balance (6.53 ± 3.25 vs 2.56 ± 2.30, t(22) = 3.211, P < 0.01). CONCLUSIONS This pilot study demonstrates that this tool is a valid and easy-to-use method of reporting pediatric mTBI symptoms-it replicates and identifies novel findings. Our results suggest that there may be a relationship between balance and the manifestation of somatic symptoms. Retention rates were lower than predicted, indicating that text messaging may not be the ideal format in this population. Text messaging may still have other applications for short-term communication/symptom measurement.
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Affiliation(s)
| | - Amy Drendel
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Sheikh Iqbal Ahamed
- Department of Mathematics Statistics and Computer Science, Marquette University
| | - Danny Thomas
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
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McQuivey KS, Moore ML, Pollock JR, Hassebrock JD, Patel KA, Chhabra A. Top-100 Most-Cited Sports-Related Concussion Articles Focus on Symptomatology, Epidemiology, and Demographics. Arthrosc Sports Med Rehabil 2021; 3:e1585-e1597. [PMID: 34977610 PMCID: PMC8689224 DOI: 10.1016/j.asmr.2021.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To analyze the top-100 cited articles on sports-related concussions together with a bibliometric analysis to determine citations by year, level of evidence, study design, and several other factors related to the top referenced articles in sports concussions. Methods The Clarivate Analytics Web of Knowledge database was used to gather data using Boolean queries to capture all possible iterations of sports-related concussion research. Articles were organized in descending order based on the number of citations and included or excluded based on relevance to concussion. Collected information included author name, publication year, country of origin, journal name, article type, study focus, and the level of evidence. Results The top-100 articles were cited 31,197 times with an average of 312.0 citations per publication. More than one half were published in 2006 or later (52). Cohort studies and descriptive articles were the most prevalent study types (22 each). Studies with Level V evidence were the most common (33). The most common areas of study were symptomatology (short term, long term) with 17 articles, followed by epidemiology/demographics with 16 articles. The least common area of study was concussion prevention (2 articles), followed by management/treatment, diagnostics (labs, imaging) with 4 articles each. Conclusions We identified the most influential studies in sports-related concussion based on number of citations and citation density. A majority of these articles were published in the United States after 2006 and are most commonly cohort studies (Level IV evidence) and descriptive articles (Level V evidence). Current research focuses most heavily on the symptomatology and epidemiology/demographics of sports concussion. Clinical Relevance This study serves to identify the most influential articles in sports-related concussion and identify research topics with general deficiencies within the field of sports-related concussion research.
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Affiliation(s)
| | - M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | | | | | - Karan A Patel
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix
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DeMatteo CA, Lin CYA, Foster G, Giglia L, Thabane L, Claridge E, Noseworthy MD, Hall GB, Connolly JF. Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion. Clin J Sport Med 2021; 31:e406-e413. [PMID: 31876794 DOI: 10.1097/jsm.0000000000000800] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 02/13/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The need to have a pediatric-specific concussion management protocol on Return to School (RTS) and Return to Activity (RTA) after concussion has been recognized internationally. The first step to evaluate the protocol effectiveness is to establish whether children and youth are adhering to these recommendations. The objective of this study was to explore the prevalence and predictors of adherence to RTS and RTA concussion management protocols for children/youth. DESIGN A prospective cohort of children/youth with concussion. SETTING Childhood Disability Research Centre. PARTICIPANTS One hundred thirty-nine children/youth aged 5 to 18 years, diagnosed with concussion and symptomatic upon enrollment, were followed for up to 6 months. Primary recruitment occurred from a Children's Hospital Emergency Department. INTERVENTION Provision of RTS/RTA guidelines. MAIN OUTCOME MEASURES Measurement of adherence came from multiple sources, including the child's and parent's knowledge of protocols, research personnel evaluations, and self-reported stages of RTS/RTA and Post-Concussion Symptom Scale (PCSS) scores. RESULTS Spearman correlations and logistic regression were used, investigating the relationship between PCSS and progression of protocols and determining predictors of adherence. Significant negative associations between total PCSS score and stage of RTS/RTA protocols were found. Fifty-three percent and 56% of the participants adhered to the RTS and RTA protocols, respectively. CONCLUSIONS Children's knowledge of protocols and total PCSS scores significantly predicted adherence to RTS/RTA and may be the most important factors in predicting adherence during recovery from concussion.
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Affiliation(s)
- Carol A DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Chia-Yu A Lin
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- ARiEAL, Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, Ontario, Canada
| | - Gary Foster
- Biostatistics Unit, The Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; and
| | - Lucia Giglia
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Biostatistics Unit, The Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; and
| | - Everett Claridge
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Michael D Noseworthy
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Geoffrey B Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; and
| | - John F Connolly
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
- ARiEAL, Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; and
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Using a Likelihood Heuristic to Summarize Conflicting Literature on Predictors of Clinical Outcome Following Sport-Related Concussion. Clin J Sport Med 2021; 31:e476-e483. [PMID: 32941376 DOI: 10.1097/jsm.0000000000000825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce a new methodology for summarizing the results from systematic reviews-a likelihood heuristic-to the field of sport-related concussion. DATA SOURCES We applied the likelihood heuristic to the results of a systematic review published by Iverson et al (2017), containing 101 studies, on the predictors of worse clinical outcome following sport-related concussion. STUDY SELECTION We re-examined 5 individual prognostic factors that are of clinical interest and for which there is conflicting literature (female sex = 44 studies, prior concussion history = 41 studies, loss of consciousness = 31 studies, post-traumatic amnesia = 25 studies, and retrograde amnesia = 10 studies). DATA EXTRACTION For each prognostic factor, likelihood ratios were generated using the (1) number of significant and nonsignificant studies, (2) study power, (3) alpha level, and (4) prior probability that the alternative hypothesis was true. DATA SYNTHESIS Assuming each study had 80% power and an alpha level of 5%, observing the reported number of conflicting studies for female sex, prior concussion history, and retrograde amnesia is substantially more likely if each prognostic factor is associated with worse clinical outcome following sport-related concussion. For loss of consciousness, the observed number of conflicting studies is more likely if loss of consciousness is not associated with worse clinical outcome following sport-related concussion. A secondary analysis incorporating potentially more realistic study parameters of statistical power (45%) and alpha level (25%) generates weaker likelihood evidence that the observed numbers of studies for each prognostic factor are associated with worse clinical outcome following sport-related concussion than they are not. CONCLUSIONS Using a likelihood heuristic with 80% power and 5% alpha level, there is very strong likelihood evidence that female sex, prior concussion history, and retrograde amnesia are associated with worse clinical outcome following sport-related concussion. The strength of likelihood evidence that prognostic factors are associated with worse clinical outcome reduces when statistical power is lower and alpha level is inflated.
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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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Carey L, Terry DP, McIntosh AS, Stanwell P, Iverson GL, Gardner AJ. Video Analysis and Verification of Direct Head Impacts Recorded by Wearable Sensors in Junior Rugby League Players. SPORTS MEDICINE - OPEN 2021; 7:66. [PMID: 34529180 PMCID: PMC8446122 DOI: 10.1186/s40798-021-00353-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Rugby league is a high-intensity collision sport that carries a risk of concussion. Youth athletes are considered to be more vulnerable and take longer to recover from concussion than adult athletes. PURPOSE To review head impact events in elite-level junior representative rugby league and to verify and describe characteristics of X-patchTM-recorded impacts via video analysis. STUDY DESIGN Observational case series. METHODS The X-patchTM was used on twenty-one adolescent players (thirteen forwards and eight backs) during a 2017 junior representative rugby league competition. Game-day footage, recorded by a trained videographer from a single camera, was synchronised with X-patchTM-recorded timestamped events. Impacts were double verified by video review. Impact rates, playing characteristics, and gameplay situations were described. RESULTS The X-patchTM-recorded 624 impacts ≥ 20g between game start and finish, of which 564 (90.4%) were verified on video. Upon video review, 413 (73.2%) of all verified impacts ≥ 20g where determined to be direct head impacts. Direct head impacts ≥ 20g occurred at a rate of 5.2 impacts per game hour; 7.6 for forwards and 3.0 for backs (range = 0-18.2). A defender's arm directly impacting the head of the ball carrier was the most common event, accounting for 21.3% (n = 120) of all impacts, and 46.7% of all "hit-up" impacts. There were no medically diagnosed concussions during the competition. CONCLUSION The majority (90.4%) of head impacts ≥ 20g recorded by the X-patchTM sensor were verified by video. Double verification of direct head impacts in addition to cross-verification of sensor-recorded impacts using a secondary source such as synchronised video review can be used to ensure accuracy and validation of data.
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Affiliation(s)
- Lauchlan Carey
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Andrew S McIntosh
- School of Engineering and Australian Collaboration for Research into Injury in Sport and its Prevention, Edith Cowan University, Perth, Australia
| | - Peter Stanwell
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia.
- Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia.
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambtom Height, NSW, Australia.
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Stitt D, Draper N, Alexander K, Kabaliuk N. Laboratory Validation of Instrumented Mouthguard for Use in Sport. SENSORS 2021; 21:s21186028. [PMID: 34577235 PMCID: PMC8472105 DOI: 10.3390/s21186028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
Concussion is an inherent risk of participating in contact, combat, or collision sports, within which head impacts are numerous. Kinematic parameters such as peak linear and rotational acceleration represent primary measures of concussive head impacts. The ability to accurately measure and categorise such impact parameters in real time is important in health and sports performance contexts. The purpose of this study was to assess the accuracy of the latest HitIQ Nexus A9 instrumented mouthguard (HitIQ Pty. Ltd. Melbourne Australia) against reference sensors in an aluminium headform. The headform underwent drop testing at various impact intensities across the NOCSAE-defined impact locations, comparing the peak linear and rotational acceleration (PLA and PRA) as well as the shapes of the acceleration time-series traces for each impact. Mouthguard PLA and PRA measurements strongly correlated with (R2 = 0.996 and 0.994 respectively), and strongly agreed with (LCCC = 0.997) the reference sensors. The root mean square error between the measurement devices was 1 ± 0.6g for linear acceleration and 47.4 ± 35 rad/s2 for rotational acceleration. A Bland-Altman analysis found a systematic bias of 1% for PRA, with no significant bias for PLA. The instrumented mouthguard displayed high accuracy when measuring head impact kinematics in a laboratory setting.
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Affiliation(s)
- Danyon Stitt
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand; (D.S.); (K.A.); (N.K.)
| | - Nick Draper
- School of Health Sciences, University of Canterbury Christchurch, Christchurch 8041, New Zealand
- Correspondence: ; Tel.: +64-3-369-3878
| | - Keith Alexander
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand; (D.S.); (K.A.); (N.K.)
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand; (D.S.); (K.A.); (N.K.)
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Sex Differences and Reporting of SCAT-5 Concussion Symptoms in Adolescent Athletes. Clin J Sport Med 2021; 31:e229-e234. [PMID: 31985537 DOI: 10.1097/jsm.0000000000000788] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/21/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To elucidate specific symptoms that may differ between adolescent female and male athletes after a sports-related concussion (SRC) and identify symptoms that may require greater clinical attention by medical and athletic staff. DESIGN Prospective. SETTING This study is part of a larger research project conducted at clinics in the North Texas Concussion Network (ConTex) Registry. PARTICIPANTS Subjects (N = 491) aged 12 to 18 years who sustained a diagnosed SRC within 30 days of clinic visit. INDEPENDENT VARIABLES Sex (female vs male). Covariates included age, race, current mood (anxiety and depression), learning disability/ADHD, and time to clinic. MAIN OUTCOME MEASURES Twenty-two individual postconcussion symptoms as measured by the Post-Concussion Symptom Scale from the Sport Concussion Assessment Tool-5 (SCAT-5). RESULTS Girls endorsed higher levels of anxiety and depression symptoms at initial clinic visit. analysis of covariance results revealed that girls had significantly greater symptom severity of headache, dizziness, sensitivity to light, sensitivity to noise, pressure in the head, feeling slowed down, fatigue, and drowsiness than boys. Ordinal logistic regression results also revealed that girls had significantly greater predicted odds of higher symptom severity on these 8 symptoms and in trouble concentrating than boys. CONCLUSIONS Closer examination of specific symptoms with attention to patients' current levels of anxiety and depression symptoms may better inform medical and athletic staff to anticipate and address symptoms that may present greater challenges for adolescent girls than boys.
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Smith A, Thomas J, Friedhoff C, Chin E. The Utility of the Test of Memory Malingering Trial 1 in Differentiating Neurocognitive, Emotional, and Behavioral Functioning in a Pediatric Concussion Population. Arch Clin Neuropsychol 2021; 37:322-337. [PMID: 34386811 DOI: 10.1093/arclin/acab065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/08/2021] [Accepted: 07/21/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In concussion populations, suboptimal task engagement detected by performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive symptoms (PCS). This study examined if Pass/Fail status on the Test of Memory Malingering-TOMM Trial 1-differentiated the neurocognitive, emotional, and behavioral profile of pediatric patients with concussion. METHOD This study utilized archival data from 93 patients (mean age = 14.56 and SD = 2.01) with a history of concussion who were assessed at ~5-6 weeks post-injury (mean days = 40.27 and SD = 35.41). Individuals were divided into "Pass" and "Fail" groups based on TOMM Trial 1 performance. The testing battery included ACT, CPT-II and III, HVLT-R, WJ-III and IV ACH, ImPACT, BASC-2, and BRIEF. RESULTS The overall pass rate on Trial 1 was 70% (mean = 46.04 and SD = 4.55). Findings suggested that a passing score on Trial 1 may be associated with adequate performance across the remaining two trials of the TOMM. The Fail group scored significantly lower across attention, memory, and processing speed measures when compared with the Pass group. On rating scales, significantly more concerns were endorsed with the Fail group for attention and executive functioning relative to the Pass group. Parents generally endorsed significantly more concerns for executive functioning when compared with their children's self-reported symptoms. There was a trend for the Fail group to report more PCS; however, they did not significantly differ from the Pass group for depression, anxiety, or somatization. CONCLUSIONS This study highlights the importance of utilizing PVTs when evaluating concussion recovery.
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Affiliation(s)
- Alphonso Smith
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
| | - Julia Thomas
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
| | - Claire Friedhoff
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
| | - Esther Chin
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
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Corwin DJ, Grady MF, Master CL, Joffe MD, Zonfrillo MR. Evaluation and Management of Pediatric Concussion in the Acute Setting. Pediatr Emerg Care 2021; 37:371-379. [PMID: 34180858 DOI: 10.1097/pec.0000000000002498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Concussion, a type of mild traumatic brain injury, is a common injury encountered by providers caring for pediatric patients in the emergency department (ED) setting. Our understanding of the pathophysiologic basis for symptom and recovery trajectories for pediatric concussion continues to rapidly evolve. As this understanding changes, so do recommendations for optimal management of concussed youth. As more and more children present to EDs across the country for concussion, it is imperative that providers caring for children in these settings remain up-to-date with diagnostic recommendations and management techniques. This article will review the definition, epidemiology, pathophysiology, diagnosis, and management of pediatric concussion in the ED setting.
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Affiliation(s)
- Daniel J Corwin
- From the Attending Physician, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Matthew F Grady
- Attending Physician, Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christina L Master
- Attending Physician, Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark D Joffe
- From the Attending Physician, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Mark R Zonfrillo
- Attending Physician, Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI
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