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Twohey E, Velasco G, Neidecker J, Giovane R. Knockout rates across the states as a way of predicting injury and knockout based on fighter sex, weight, or experience. PHYSICIAN SPORTSMED 2024; 52:395-399. [PMID: 37990916 DOI: 10.1080/00913847.2023.2285716] [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: 08/27/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Abstract
Combat sports, such as boxing and mixed martial arts [MMA], have the unique objective to finish a bout by way of knockout [KO] or technical knockout [TKO]. There are potentially both short- and long-term neurological injuries that can happen as a result of the repeated head trauma sustained in bouts, and thus it is imperative to identify the athletes that are at increased risk. Using an online database of professional boxing bouts [boxrec.com] over a 6-month period, KO/TKO rates were calculated across different states, weight classes, sex, and Fight Exposure Score [FES] categories. There was found to be a significant association between KO/TKO rates and weight class, sex, and FES category with heavyweights, males and FES 0 boxers having higher KO/TKO rates. KO/TKO rates were increased in winless boxers. KO/TKO rates across the states are documented in the study.
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Affiliation(s)
- Eric Twohey
- Mayo Clinic Department of Physical Medicine and Rehabilitation, Rochester, USA
| | - George Velasco
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - John Neidecker
- Sports Medicine, Orthopaedic Specialists of North Carolina, Raleigh, NC, USA
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Patterson Gentile C, Rosenthal S, Blume H, Rastogi RG, McVige J, Bicknese A, Ladak A, Zaveri H, Greene K, Barlow K. American Headache Society white paper on treatment of post-traumatic headache from concussion in youth. Headache 2024. [PMID: 39073141 DOI: 10.1111/head.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To provide healthcare professionals guidance on youth at risk for prolonged recovery and post-traumatic headache (PTH), and on pharmacologic and non-pharmacologic management of PTH due to concussion and mild traumatic brain injury. BACKGROUND Headache is the most common persistent post-concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines. METHODS This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society. RESULTS Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair-to-poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro-modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective. CONCLUSIONS This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth.
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Affiliation(s)
- Carlyn Patterson Gentile
- Division of Pediatric Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott Rosenthal
- Department of Pediatrics - Neurology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Heidi Blume
- Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Reena Gogia Rastogi
- Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Jennifer McVige
- Pediatric Neurology, Pediatric and Adult Headache, Dent Neurologic Institute, Amherst, New York, USA
| | - Alma Bicknese
- Division of Pediatric Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ali Ladak
- Division of Pediatric Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Harshul Zaveri
- Division of Child Neurology, Children's Hospital of Orange County, UC Irvine School of Medicine, Orange, California, USA
| | - Kaitlin Greene
- Division of Pediatric Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Karen Barlow
- Children's Hospital and Health Services, University of Queensland, Brisbane, Queensland, Australia
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Romeas T, Croteau F, Leclerc S. Where is the research on sport-related concussion in Olympic athletes? A descriptive report and assessment of the impact of access to multidisciplinary care on recovery. Br J Sports Med 2024:bjsports-2024-108211. [PMID: 39013617 DOI: 10.1136/bjsports-2024-108211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES This cohort study reported descriptive statistics in athletes engaged in Summer and Winter Olympic sports who sustained a sport-related concussion (SRC) and assessed the impact of access to multidisciplinary care and injury modifiers on recovery. METHODS 133 athletes formed two subgroups treated in a Canadian sport institute medical clinic: earlier (≤7 days) and late (≥8 days) access. Descriptive sample characteristics were reported and unrestricted return to sport (RTS) was evaluated based on access groups as well as injury modifiers. Correlations were assessed between time to RTS, history of concussions, the number of specialist consults and initial symptoms. RESULTS 160 SRC (median age 19.1 years; female=86 (54%); male=74 (46%)) were observed with a median (IQR) RTS duration of 34.0 (21.0-63.0) days. Median days to care access was different in the early (1; nSRC=77) and late (20; nSRC=83) groups, resulting in median (IQR) RTS duration of 26.0 (17.0-38.5) and 45.0 (27.5-84.5) days, respectively (p<0.001). Initial symptoms displayed a meaningful correlation with prognosis in this study (p<0.05), and female athletes (52 days (95% CI 42 to 101)) had longer recovery trajectories than male athletes (39 days (95% CI 31 to 65)) in the late access group (p<0.05). CONCLUSIONS Olympic athletes in this cohort experienced an RTS time frame of about a month, partly due to limited access to multidisciplinary care and resources. Earlier access to care shortened the RTS delay. Greater initial symptoms and female sex in the late access group were meaningful modifiers of a longer RTS.
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Affiliation(s)
- Thomas Romeas
- Sport Sciences, Institut national du sport du Québec, Montreal, Quebec, Canada
- School of Optometry, Université de Montréal, Montreal, Quebec, Canada
- IOC Research Centre for Injury Prevention and Protection of Athlete Health, Réseau Francophone Olympique de la Recherche en Médecine du Sport, Montreal, Quebec, Canada
| | - Félix Croteau
- IOC Research Centre for Injury Prevention and Protection of Athlete Health, Réseau Francophone Olympique de la Recherche en Médecine du Sport, Montreal, Quebec, Canada
- Sport Medicine, Institut national du sport du Québec, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Suzanne Leclerc
- IOC Research Centre for Injury Prevention and Protection of Athlete Health, Réseau Francophone Olympique de la Recherche en Médecine du Sport, Montreal, Quebec, Canada
- Sport Medicine, Institut national du sport du Québec, Montreal, Quebec, Canada
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Mavroudis I, Petridis F, Petroaie AD, Ciobica A, Kamal FZ, Honceriu C, Iordache A, Ionescu C, Novac B, Novac O. Exploring Symptom Overlaps: Post-COVID-19 Neurological Syndrome and Post-Concussion Syndrome in Athletes. Biomedicines 2024; 12:1587. [PMID: 39062160 PMCID: PMC11274969 DOI: 10.3390/biomedicines12071587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/06/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
The COVID-19 pandemic has introduced new challenges in managing neurological conditions, particularly among athletes. This paper explores the intersection of post-COVID-19 neurological syndrome (PCNS/PASC) and post-concussion syndrome (PCS), focusing on their implications in sports medicine. Our analysis covers the symptomatology, pathophysiology, and management strategies for PCNS/PASC and PPCS, with special attention paid to the unique challenges faced by athletes recovering from these conditions, including the risk of symptom exacerbation and prolonged recovery. Key findings reveal that both PCNS/PASC and PPCS present with overlapping symptoms such as cognitive difficulties, exercise intolerance, and mental health issues, but differ in specific manifestations like anosmia and ageusia, unique to COVID-19. Pathophysiological analysis reveals similarities in blood-brain barrier disruption (BBB) but differences in the extent of immune activation. Management strategies emphasize a gradual increase in physical activity, close symptom monitoring, and psychological support, with a tailored approach for athletes. Specific interventions include progressive aerobic exercises, resistance training, and cognitive rehabilitation. Furthermore, our study highlights the importance of integrating neurology, psychiatry, physical therapy, and sports medicine to develop comprehensive care strategies. Our findings underscore the dual challenge of COVID-19 and concussion in athletes, necessitating a nuanced, interdisciplinary approach to effective management. Future research should focus on the long-term neurological effects of both conditions and optimizing treatment protocols to improve patient outcomes. This comprehensive understanding is crucial for advancing the management of athletes affected by these overlapping conditions and ensuring their safe return to sports.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK;
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Antoneta Dacia Petroaie
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania; (A.C.); (C.I.)
- Centre of Biomedical Research, Romanian Academy, Bd. Carol I, no. 8, 700506 Iasi, Romania
- Academy of Romanian Scientists, Str. Splaiul Independentei no. 54, Sector 5, 050094 Bucharest, Romania
- “Ioan Haulica” Institute, Apollonia University, Pãcurari Street 11, 700511 Iasi, Romania
| | - Fatima Zahra Kamal
- Higher Institute of Nursing Professions and Health Techniques, Marrakesh 40000, Morocco
- Laboratory of Physical Chemistry of Processes and Materials, Faculty of Sciences and Techniques, Hassan First University, B.P. 539, Settat 26000, Morocco
| | - Cezar Honceriu
- Faculty of Physical Education, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania;
| | - Alin Iordache
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Cătălina Ionescu
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania; (A.C.); (C.I.)
- Clinical Department, Apollonia University, Păcurari Street 11, 700511 Iasi, Romania
| | - Bogdan Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Otilia Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
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Eagle SR, Henry RJ. Applying Dynamical Systems Theory to Improve Personalized Medicine Following Mild Traumatic Brain Injury. Neurotrauma Rep 2024; 5:671-679. [PMID: 39071984 PMCID: PMC11271149 DOI: 10.1089/neur.2024.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
A sizable proportion of patients with mild traumatic brain injury (mTBI) have persistent symptoms and functional impairments months to years following injury. This phenomenon is continually observed despite an explosion of research and interest in improving mTBI clinical outcomes over the last two decades. All pharmacological clinical trials to date have failed to demonstrate improved outcomes for mTBI. One possible explanation for these continued failures is an overly myopic approach to treating mTBI (i.e., testing the effect of a single drug with a specific mechanism on a group of people with highly heterogenous injuries). Clinical presentation and prognosis of mTBI vary considerably between patients, and yet we continue to assess group-level effects of a homogenized treatment. We need to utilize an equally complex treatment approach to match the extraordinary complexity of the human brain. Dynamical systems theory has been used to describe systems composed of multiple subsystems who function somewhat independently but are ultimately interconnected. This theory was popularized in the motor control literature as an overarching framework for how the mind and body connect to interact and move through the environment. However, the human body can be viewed as a dynamical system composed of multiple subsystems (i.e., organ systems) who have isolated functions, which are also codependent on the health and performance of other interconnected organ systems. In this perspective piece, we will use the example of mTBI in the obese patient to demonstrate how broadening our approach to treatment of the individual (and not necessarily the injury) may ultimately yield improved outcomes. Furthermore, we will explore clinical and pre-clinical evidence demonstrating multiple system interactions in the context of obesity and TBI and discuss how expanding our understanding of the mechanistic interplay between multiple organ systems may ultimately provide a more personalized treatment approach for this mTBI patient subpopulation.
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Affiliation(s)
- Shawn R. Eagle
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Cook NE, Kissinger-Knox A, Iverson IA, Stephenson K, Norman MA, Hunter AA, Saadi A, Iverson GL. Social Determinants of Health and Health Equity in the Treatment and Rehabilitation of Sport-Related Concussion: A Content Analysis of Intervention Research and Call-To-Action. J Neurotrauma 2024. [PMID: 38753708 DOI: 10.1089/neu.2023.0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
This review was designed to (1) determine the extent to which the clinical science on sport-related concussion treatment and rehabilitation has considered social determinants of health (SDoH) or health equity and (2) offer recommendations to enhance the incorporation of SDoH and health equity in concussion treatment research and clinical care. The Concussion in Sport Group consensus statement (2023) was informed by two systematic reviews examining prescribed rest or exercise following concussion and targeted interventions to facilitate concussion recovery. We examined 31 studies, including 2,698 participants, from those two reviews. Race (k = 6; 19.4%) and ethnicity (k = 4; 12.9%) of the study samples were usually not reported. Four studies examined ethnicity (i.e., Hispanic), exclusively as a demographic category. Five studies (16.1%) examined race as a demographic category. Three studies (9.7%) examined socioeconomic status (SES; measured as household income) as a demographic category/sample descriptor and one study (3.2%) examined SES in-depth, by testing whether the treatment and control groups differed by SES. Five studies examined an SDoH domain in a descriptive manner and four studies in an inferential/intentional manner. No study mentioned SDoH, health equity, or disparities by name. Many studies (61.3%) excluded participants based on demographic, sociocultural, or health factors, primarily due to language proficiency. The new consensus statement includes recommendations for concussion treatment and rehabilitation that rely on an evidence base that has not included SDoH or studies addressing health equity. Researchers are encouraged to design treatment and rehabilitation studies that focus specifically on underrepresented groups to determine if they have specific and unique treatment and rehabilitation needs, whether certain practical modifications to treatment protocols might be necessary, and whether completion rates and treatment adherence and response are similar.
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Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Concussion Research Program, Spaulding Hospital Cambridge, Cambridge, MA, USA
| | - Ila A Iverson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Katie Stephenson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Marc A Norman
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Amy A Hunter
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Injury Prevention Center, Connecticut Children's Medical Center and Hartford Hospital, Hartford, CT, USA
| | - Altaf Saadi
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Concussion Research Program, Spaulding Hospital Cambridge, Cambridge, MA, USA
- Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
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Smulligan KL, Magliato SN, Keeter CL, Wingerson MJ, Smith AC, Wilson JC, Howell DR. The Diagnostic Utility of Cervical Spine Proprioception for Adolescent Concussion. Clin J Sport Med 2024:00042752-990000000-00202. [PMID: 38953712 DOI: 10.1097/jsm.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE Cervical spine proprioception may be impaired after concussion. Our objective was to determine the diagnostic utility of cervical spine proprioception for adolescent concussion. DESIGN Cross-sectional. SETTING Research laboratory. PARTICIPANTS Adolescents ≤18 days of concussion and uninjured controls. INTERVENTIONS N/A. MAIN OUTCOMES Head repositioning accuracy (HRA) testing, a measure of cervical spine proprioception. The HRA test involved patients relocating their head back to a neutral starting position with eyes closed after maximal cervical spine flexion, extension, and right and left rotations. The overall HRA error score was the mean error (distance from the starting point to self-reported return to neutral) across 12 trials: 3 trials in each direction. We used t-tests to compare group means and logistic regression (outcome = group, predictor = HRA, covariates) to calculate odds ratios. We used a receiver operator characteristic curve to evaluate area under the curve (AUC) and calculate the optimal HRA cutpoint to distinguish concussion from controls. RESULTS We enrolled and tested 46 participants with concussion (age = 15.8 ± 1.3 years, 59% female, mean = 11.3 ± 3.3 days postconcussion) and 83 uninjured controls (age = 16.1 ± 1.4 years, 88% female). The concussion group had significantly worse HRA than controls (4.3 ± 1.6 vs 2.9 ± 0.7 degrees, P < 0.001, Cohen d = 1.19). The univariable HRA model AUC was 0.81 (95% CI = 0.73, 0.90). After adjusting for age, sex, and concussion history, the multivariable model AUC improved to 0.85 (95% CI = 0.77, 0.92). The model correctly classified 80% of participants as concussion/control at a 3.5-degree cutpoint. CONCLUSIONS Adolescents with concussion demonstrated worse cervical spine proprioception than uninjured controls. Head repositioning accuracy may offer diagnostic utility for subacute concussion.
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Affiliation(s)
- Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
| | - Samantha N Magliato
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
| | - Carson L Keeter
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Mathew J Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
| | - Andrew C Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado
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Memmini AK, Snedden TR, Boltz AJ, Benson BA, Margolin E, Pasquina PF, McAllister TW, McCrea MA, Broglio SP. Factors Influencing Time to Return to Learn Among NCAA Student-Athletes Enrolled in the Concussion Assessment, Research, and Education (CARE) Study. Sports Med 2024; 54:1965-1977. [PMID: 38407750 DOI: 10.1007/s40279-024-01999-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The aim was to describe the demographic and post-injury factors that influence time to return to learn (RTL) among student-athletes enrolled in the Concussion Assessment, Research and Education (CARE) Consortium. METHODS A total of 47,860 student-athletes enrolled in the National Collegiate Athletic Association-Department of Defense (NCAA-DoD) CARE Consortium study from 2014 to 2020, with 1485 sport-related concussions (SRCs) analyzed in the present dataset. Demographic and post-injury characteristics were calculated using descriptive statistics, followed by Kaplan-Meier estimates to examine median time to return to normal academic performance (i.e., RTL) by sex (male, female), baseline psychiatric conditions (depression, anxiety) and/or learning disorder, NCAA division (I, II, III), SRC history (0, 1, 2, 3+), NCAA sport category (contact, limited contact, non-contact sport), and median difference in baseline/post-injury symptom severity scores (< 21, ≥ 21). Further, a multivariable zero-inflated negative binomial (ZINB) regression model was used to examine their association with RTL. RESULTS Overall, time to RTL (mean = 4.96 ± 8.24 days, median = 3.0 [interquartile range = 0.0, 6.0] days) was found to be influenced by several factors resulting in earlier trajectories. Notably, nearly 25% of the sample demonstrated immediate RTL (i.e., 0 days). Among student-athletes who did not immediately RTL, males demonstrated a decreased rate in RTL (rate = 0.79; 95% CI 0.66-0.96) compared to females. Further, student-athletes with a ≥ 21 change in symptom severity score (post-injury baseline) demonstrated a higher rate of RTL (rate = 1.47; 95% CI 1.21-1.79) compared to student-athletes with a symptom severity change score < 21. Lastly, male student-athletes demonstrated two times higher odds (odds ratio = 1.95; 95% CI 1.02-3.73) of immediate RTL compared to female student-athletes. No other covariates were associated with time to RTL. CONCLUSION Collectively, the present findings suggest a rapid return to the classroom following concussion. Specifically, males demonstrated higher odds of time to RTL, whereas those with greater differences in symptom severity resulted in a higher rate of time to RTL among those who did not immediately RTL. Ultimately, these findings support prior work emphasizing an individualized approach to SRC management.
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Affiliation(s)
- Allyssa K Memmini
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, 87131-0001, USA.
| | - Traci R Snedden
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Adrian J Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin A Benson
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Eric Margolin
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, ML, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael A McCrea
- Departments of Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
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Didner N, Boltz AJ, Robison HJ, Chandran A, Quinsey C. Concussion Symptomatology by Symptom Resolution Time in US High School Athletes: Findings From the National Athletic Treatment, Injury and Outcomes Network High School Surveillance Program (NATION-SP). J Athl Train 2024; 59:745-750. [PMID: 38014801 PMCID: PMC11277275 DOI: 10.4085/1062-6050-0201.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
CONTEXT Concussions incurred during high school athletics are a significant health concern, and studies examining concussions with a symptom resolution time (SRT) of 15 to 28 days have been limited. OBJECTIVE To compare concussions that had an SRT of 15 to 28 days with concussions that had an SRT of greater than 28 days among US high school athletes. DESIGN Descriptive epidemiology study. SETTING Secondary school athletic training clinics. PATIENTS OR OTHER PARTICIPANTS Secondary school athletes. MAIN OUTCOME MEASURE(S) Concussion frequency, symptom number, and symptom prevalence. RESULTS Among all 917 reported concussions (of which 50.8% had missing SRT), 88 had an SRT recorded as 15 to 28 days, and 29 had an SRT recorded as greater than 28 days. Greater frequencies of concussions with an SRT of 15 days or more were reported in boys' sports (n = 78) than girls' sports (n = 39). Boys' football (51.7%) and girls' basketball (11.5%) accounted for the largest proportions of all reported concussions with an SRT of 15 to 28 days; boys' football (58.6%) accounted for the greatest proportion of concussions reported with an SRT greater than 28 days. The average number of symptoms was 6.3 ± 3.4 for concussions with an SRT of 15 to 28 days and 7.2 ± 3.8 for those with an SRT greater than 28 days. The most frequently reported symptoms in concussions with both SRT of 15 to 28 days and greater than 28 days were headache, dizziness, sensitivity to light, and difficulty concentrating. The prevalence of irritability was higher in concussions with an SRT of 15 to 28 days as compared with concussions with an SRT greater than 28 days (26.1% versus 13.8%); visual problems (48.3% versus 35.2%) and hyperexcitability (24.1% versus 15.9%) were more prevalent in concussions with an SRT greater than 28 days, although differences were not statistically significant. CONCLUSIONS Symptom prevalence and total count were comparable between concussions with an SRT of 15 to 28 days and those with an SRT of greater than 28 days with no statistically significant difference, suggesting that symptom burdens within these groups are more similar than they are different.
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Affiliation(s)
- Nina Didner
- University of North Carolina School of Medicine, Chapel Hill
| | - Adrian J. Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Hannah J. Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill
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Ransom DM, Ahumada L, Amankwah EK, Katzenstein JM, Goldenberg NA, Bauer TA, Mularoni PP. Effects of Cumulative Head Impact Exposure in Adolescent Male Contact and Collision Sport Student Athletes. J Head Trauma Rehabil 2024; 39:284-292. [PMID: 37862133 DOI: 10.1097/htr.0000000000000915] [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: 10/22/2023]
Abstract
OBJECTIVE This prospective cohort study aimed to investigate the association between head impact exposure (HIE) and neuropsychological sequelae in high school football and ice hockey players over 1 year. SETTING Community sample. PARTICIPANTS A cohort of 52 adolescent American football and ice hockey players were enrolled in the study, with a final study sample of 35 included in analyses. DESIGN The study followed a prospective cohort design, with participants undergoing neuropsychological screening and accelerometer-based measurement of HIE over 1 season. MAIN MEASURES Changes in cognition, emotions, behavior, and reported symptoms were assessed using standardized neuropsychological tests and self-reported questionnaires. RESULTS Cumulative HIE was not consistently associated with changes in cognition, emotions, behavior, or reported symptoms. However, it was linked to an isolated measure of processing speed, showing inconsistent results based on the type of HIE. History of previous concussion was associated with worsened verbal memory recognition (ImPACT Verbal Memory) but not on a more robust measure of verbal memory (California Verbal Learning Test [CVLT]). Reported attention-deficit/hyperactivity disorder history predicted improved neurocognitive change scores. No associations were found between reported history of anxiety/depression or headaches/migraines and neuropsychological change scores. CONCLUSION Overall, our findings do not support the hypothesis that greater HIE is associated with an increase in neuropsychological sequelae over time in adolescent football and ice hockey players. The results align with the existing literature, indicating that HIE over 1 season of youth sports is not consistently associated with significant neuropsychological changes. However, the study is limited by a small sample size, attrition over time, and the absence of performance validity testing for neurocognitive measures. Future studies with larger and more diverse samples, longer follow-up, and integration of advanced imaging and biomarkers are needed to comprehensively understand the relationship between HIE and neurobehavioral outcomes. Findings can inform guidelines for safe youth participation in contact sports while promoting the associated health and psychosocial benefits.
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Affiliation(s)
- Danielle M Ransom
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, Florida (Drs Ransom, Katzenstein, and Mularoni); School of Medicine, Johns Hopkins University, Baltimore, Maryland (Drs Ransom, Ahumada, Amankwah, Katzenstein, Goldenberg, and Mularoni); Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children's Hospital, St Petersburg, Florida (Dr Ahumada); Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, Florida (Drs Amankwah and Goldenberg); and SenseTech, LLC, Denver, Colorado (Dr Bauer)
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11
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Howell DR, Wingerson MJ, Smulligan KL, Magliato S, Simon S, Wilson JC. Exercising More Than 150 min/wk After Concussion Is Associated With Sleep Quality Improvements. J Head Trauma Rehabil 2024; 39:E216-E224. [PMID: 38032838 PMCID: PMC11070449 DOI: 10.1097/htr.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To examine whether a high volume of aerobic exercise after concussion (>150 min/wk) is associated with improved sleep quality over a 1-month period. We hypothesized that more than 150 min/wk of exercise would be associated with improved sleep quality across concussion recovery. DESIGN Prospective cohort observational study. SETTING Sports medicine clinic. PARTICIPANTS Adolescents initially tested 8.4 ± 3.5 (range, 2-18) days postconcussion who returned for a follow-up assessment 34.3 ± 7.7 (range: 20-49) days postconcussion. MAIN OUTCOME MEASURES Participants completed the Pittsburgh Sleep Quality Index and the Post-Concussion Symptom Inventory. No specific exercise or sleep recommendations were given beyond what their treating physician provided. Between study visits, participants recorded exercise performed via wrist-worn actigraphy. We calculated average exercise minutes per week and grouped participants as those who exercised more than 150 min/wk versus those who exercised 150 min/wk or less. RESULTS Thirty-six adolescents participated. Fifteen (42%) recorded more than 150 min/wk of aerobic exercise (age = 14.0 ± 1.7 years; 47% female; mean = 5.6 ± 1.2 d/wk of exercise; mean = 49.2 ± 17.5 min/session), and 21 recorded 150 min/wk or less of aerobic exercise (age = 15.0 ± 1.9 years; 76% female; mean = 2.7 ± 1.6 d/wk of exercise; mean = 30.2 ± 7.8 min/session). There were no significant group differences in the proportion of those who self-reported beginning physical activity prior to enrollment (47% vs 33%; P = .42) or for initial sleep quality rating (8.0 ± 3.7 vs 8.6 ± 4.1; P = .67) or initial concussion symptom severity rating (34.9 ± 28.0 vs 42.6 ± 25.9; P = .40). The group that exercised more than 150 min/wk between visits demonstrated significantly greater median PSQI rating improvements than those who exercised 150 min/wk or less, with a large effect size noted (median change [interquartile range] = 5 [3, 7] vs 1 [0, 4]; P = .008; Cohen d = 0.96). CONCLUSION Current recommendations suggest that subsymptom aerobic exercise can be beneficial after concussion. Our findings indicate that an exercise volume of more than 150 min/wk led to greater sleep quality improvements than those who exercised below this level.
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Affiliation(s)
- David R. Howell
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mathew J. Wingerson
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Samantha Magliato
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stacey Simon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Pediatric Sleep Center, Children’s Hospital of Colorado, Aurora, CO, USA
| | - Julie C. Wilson
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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12
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Elias J, Sutherland E, Kennedy E. Concussion Management in Older People: A Scoping Review. J Head Trauma Rehabil 2024; 39:293-303. [PMID: 38453625 DOI: 10.1097/htr.0000000000000933] [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: 03/09/2024]
Abstract
OBJECTIVE To map existing literature about concussion management in older people, identifying and analyzing gaps in our understanding. CONTEXT Concussion injuries affect older people, yet little guidance is available about how to approach concussion management with older people. Research does not always include older populations, and it is unclear to what extent standard concussion management is appropriate for older people. DESIGN Scoping review. METHOD A structured literature search was conducted using 4 databases to identify existing literature relating to concussion management in older people. Studies that assessed outcomes relating to the management of concussion/mild traumatic brain injury in those 65 years or older were included and mapped according to the main themes addressed. RESULTS The search yielded a total of 18 articles. Three themes related to early management (use of anticoagulants n = 6, intracranial lesions n = 3, and service delivery for older people n = 5), and 1 theme related to general management (cognitive issues n = 4). A lack of articles exploring general management in older people was observed. CONCLUSION Existing literature indicates that specific management strategies are needed for older people with concussion, especially in early management. This review highlights that good evidence is available about early management and this is reflected in some guidelines, yet little evidence about general management is available and this gap is not acknowledged in guidelines. Distinct approaches to early management in older people are clearly recommended to mitigate the risk of poor outcomes. In contrast, general concussion management for older people is poorly understood, with older people poorly represented in research. A better understanding is needed because-as observed in early management-older people have distinct characteristics that may render standard management approaches unsuitable.
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Affiliation(s)
- Josh Elias
- Author Affiliations: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand (Mr Elias and Dr Kennedy); and Department of Physiology, University of Otago, Dunedin, New Zealand (Ms Sutherland)
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13
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Memmini AK, Bos LN, Maluski K, Ellsworth-Kopkowski A, Savvidou P, Schuyten KH. Evaluating Post-concussion Clinical Management of University-Aged Performing Artists: A Systematic Review. J Dance Med Sci 2024:1089313X241255443. [PMID: 38859678 DOI: 10.1177/1089313x241255443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Contemporary concussion literature has yet to establish appropriate clinical management guidelines to address the unique needs of performing arts populations, especially at the collegiate level. Therefore, the purpose of this investigation was to collate current evidence regarding post-concussion return to performance management among university-aged performing artists to generate broad clinical implications. METHODS The research team was comprised of two faculty members in the performing arts, one concussion researcher, and athletic trainer, two university librarians, and one physical therapy graduate student with expertise in post-concussion management among performing arts patients. Two librarians searched the literature using PubMed, Cochrane, SPORTdiscus, and Education Research Complete. Studies were eligible for preliminary inclusion if they were written in English, conducted in the United States, as well as published in a peer-reviewed journal. There were no restrictions on publication date due to the limited literature on this topic. The most recent search was conducted in July 2023. RESULTS Of the 18 studies identified during the search process, only 2 met the inclusion criteria. Broadly, this investigation identified common mechanisms of injury among stage crew/technicians and dancers who are of university-age. Furthermore, both studies identified several patients who opted to return to performing arts on their own volition. However, there were no studies that solely focused on the collegiate performing arts population and their return to performance procedures. CONCLUSIONS Overall, these findings highlight a momentous gap in concussion literature regarding how to guide clinicians and academic teams when returning collegiate performing artists back to their performance environment(s). Thus, additional research is strongly warranted to understand the lived experiences of performing artists with concussion, as well as how to address specific coursework-related demands to support their recovery.
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Affiliation(s)
| | - Lauren N Bos
- Columbia University Programs in Physical Therapy, New York, NY, USA
| | | | | | | | - Kristen H Schuyten
- University of Michigan, Ann Arbor, MI, USA
- Michigan MedSport Clinic, Michigan Medicine, Ann Arbor, MI, USA
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Marusic S, Vyas N, Chinn RN, O'Brien MJ, Roberts TL, Raghuram A. Vergence and accommodation deficits in paediatric and adolescent patients during sub-acute and chronic phases of concussion recovery. Ophthalmic Physiol Opt 2024. [PMID: 38853693 DOI: 10.1111/opo.13346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/22/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Visual function deficits have been reported in adolescents following concussion. We compared vergence and accommodation deficits in paediatric and adolescent patients at a tertiary medical centre in the sub-acute (15 days to 12 weeks) and chronic (12 weeks to 1 year) phases of concussion recovery. METHODS The study included patients aged 7 to <18 years seen between 2014 and 2021, who had a binocular vision (BV) examination conducted within 15 days and 1 year of their concussion injury. Included patients had to have 0.10 logMAR monocular best-corrected vision or better in both eyes and be wearing a habitual refractive correction. BV examinations at near included measurements of near point of convergence, convergence and divergence amplitudes, vergence facility, monocular accommodative amplitude and monocular accommodative facility. Vergence and accommodation deficits were diagnosed using established clinical criteria. Group differences were assessed using nonparametric statistics and ANCOVA modelling. RESULTS A total of 259 patients were included with 111 in the sub-acute phase and 148 in the chronic phase of concussion recovery. There was no significant difference in the rates of vergence deficits between the two phases of concussion recovery (sub-acute = 48.6%; chronic = 49.3%). There was also no significant difference in the rates of accommodation deficits between the two phases of concussion recovery (sub-acute = 82.0%; chronic = 77.0%). CONCLUSION Patients in both the sub-acute and chronic phases of concussion recovery exhibited a high frequency of vergence and accommodation deficits, with no significant differences between groups. Results indicate that patients exhibiting vision deficits in the sub-acute phase may not resolve without intervention, though a prospective, longitudinal study is required to test the hypothesis.
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Affiliation(s)
- Sophia Marusic
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Neerali Vyas
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ryan N Chinn
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael J O'Brien
- Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Aparna Raghuram
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Wingerson MJ, Schmitz B, Smulligan KL, Walker GA, Magliato S, Wilson JC, Howell DR. Concussion symptom presentation and clinical recovery among pediatric athletes: comparing concussions sustained during school and summer months. Brain Inj 2024; 38:574-582. [PMID: 38511887 DOI: 10.1080/02699052.2024.2332770] [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: 05/24/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE We examined post-concussion symptom presentation, exercise, and sleep among pediatric athletes who sustained concussion during the school year vs. summer months. METHODS We evaluated athletes 6-18 years old within 21-days of concussion. They reported symptoms (Health and Behavior Inventory), with cognitive/somatic domain sub-scores calculated, and indicated if they had exercised or experienced sleep problems since injury. We grouped patients by injury season: summer months (June-August) vs. school year (September-May). RESULTS 350 patients (14.4 ± 2.4 years old; 37% female; initial visit 8.8 ± 5.3 days post-concussion) were seen for care: 24% sustained a concussion during summer months, 76% during the school year. Lower cognitive (median = 7 [IQR = 1, 15] vs. 9.5 [4, 17]; p = 0.01), but not somatic (7 [2.5, 11] vs. 8 [4, 13]; p = 0.06), HBI scores were observed for patients injured during the summer. Groups were similar in proportion exercising (16% vs 17%) and endorsing sleep problems (29% vs 31%). After adjustments, sustaining a concussion during the summer predicted total (β=-3.43; 95%CI = -6.50, -0.36; p = 0.029) and cognitive (β = -2.29; 95%CI = -4.22, -0.36; p = 0.02), but not somatic (β=-1.46; 95%CI = -2.84, -0.08; p = 0.04), symptom severity. CONCLUSION Pediatric patients with concussion may present with greater cognitive symptoms during the school year, compared to summer months.
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Affiliation(s)
- Mathew J Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
| | - Baylie Schmitz
- Doctor of Occupational Therapy Program, Northern Arizona University, Phoenix, Arizona, USA
| | - Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
| | - Gregory A Walker
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
| | - Samantha Magliato
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine Denver, Colorado, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
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Harmon KG, Whelan BM, Aukerman DF, Hwang CE, Poddar SK, DeLeo A, Elkington HA, Garruppo G, Holliday M, Bruce JM. Diagnosis of Sports-Related Concussion Using Symptom Report or Standardized Assessment of Concussion. JAMA Netw Open 2024; 7:e2416223. [PMID: 38861257 PMCID: PMC11167498 DOI: 10.1001/jamanetworkopen.2024.16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/10/2024] [Indexed: 06/12/2024] Open
Abstract
Importance The Sports Concussion Assessment Tool-5 (SCAT5) has been recommended for concussion evaluation and utilizes both a subjective reported symptom grading scale and objective measures of concussion including a cognitive evaluation: the Standardized Assessment of Concussion (SAC). The SAC includes testing for orientation, immediate memory, concentration, and delayed recall; a 10-word list is used to assess immediate memory and delayed recall. Objective To determine the diagnostic accuracy of components of the SCAT5 and to provide a framework for clinical interpretation. Design, Setting, and Participants This prospective case-control study of National Collegiate Athletic Association Division I athletes from any sport was conducted from July 2020 to December 2022 at 4 universities. Athletes completed baseline SCAT5 testing using the 10-word list. When an athlete presented acutely with suspected concussion (sideline or within 2 days), the tests were repeated. If a concussion was diagnosed, a control athlete underwent the same tests. Controls were identified and matched on comorbid conditions, sex and gender, sport, season, and baseline scores. Data analysis was conducted from August to October 2023. Main Outcomes and Measures The primary outcomes were area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive value, and test-retest reliability of the symptom score; symptom severity score; the total SAC score; and the orientation, immediate memory, concentration, and delayed memory subcomponent scores on the SCAT5 compared with clinical diagnosis of concussion. Results Baseline and postinjury data were collected on 92 athletes with concussion and 92 matched control athletes (96 men [52%] and 88 women [48%]; 110 who played a sport other than football [59%]). Diagnostic utility was considered excellent for symptom score (AUC, 0.93; 95% CI, 0.89-0.96) and symptom severity score (AUC, 0.94; 95% CI, 0.90-0.97). An increase of 2 points on the symptom score was associated with a sensitivity of 86% (95% CI, 78%-92%), specificity of 80% (95% CI, 70%-87I%), and positive predictive value of 81% (95% CI, 72%-88%). The total SAC score had poor to fair diagnostic utility (AUC, 0.70; 95% CI, 0.63-0.77); however, 41 athletes with concussion (45%) had a total SAC score at or above their baseline score (ie, within normal limits). The diagnostic utility was poor to fair for immediate memory (AUC, 0.68, 95%CI, 0.61-0.75) and delayed recall (AUC, 0.69; 95% CI, 0.62-0.77) and not useful for orientation (AUC, 0.49; 95% CI, 0.43-0.56) and concentration (AUC, 0.52 95% CI, 0.44-0.61). Test-retest reliability was fair for total SAC and poor for immediate memory and delayed recall, orientation, and concentration. Conclusions and Relevance In this case-control study of the diagnostic accuracy of reported symptoms and the SAC, reported symptoms were the most accurate indicator of concussion while the 10-word SAC had limited sensitivity. These findings suggest that understanding the properties of the SAC is important when making the diagnosis of concussion.
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Affiliation(s)
| | | | | | - Calvin E. Hwang
- Department of Orthopedic Surgery, Stanford University, Stanford, California
| | | | | | | | - Gabrielle Garruppo
- Department of Orthopedic Surgery, Stanford University, Stanford, California
| | | | - Jared M. Bruce
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City School of Medicine, Kansas City
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Roberts M, Popovich M, Almeida A. The Evaluation and Management of Concussion to Optimize Safe Recovery. Prim Care 2024; 51:269-282. [PMID: 38692774 DOI: 10.1016/j.pop.2024.02.009] [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: 05/03/2024]
Abstract
Concussion is a mild traumatic brain injury causing temporary neurologic dysfunction. Symptoms following concussion are variable and generally are expected to resolve within about 1 month, but some patients experience persistent and prolonged symptoms. An early return to safe, symptom-limited activity is now favored, using targeted rehabilitation and treatments. Accommodations may be needed to facilitate return-to-school and work following concussion. Athletes should not be cleared for a full return to sport until they have recovered from a concussion and completed a return-to-play progression, in addition to returning to work/school fully.
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Affiliation(s)
- Mark Roberts
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA
| | - Michael Popovich
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA.
| | - Andrea Almeida
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA
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18
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Oesterschlink J, Reinsberger C. [Head injuries: What the team physician needs to know]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:415-419. [PMID: 38740669 DOI: 10.1007/s00132-024-04507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
A concussion is the mildest form of a mild traumatic brain injury (tbi) and resembles the most prevalent type of sports associated tbi. Diffuse axonal injuries, the main pathophysiological mechanism of concussion, leads to disruption of communication between different brain areas. The resulting clinical symptoms may relate to several clinical domains (cognition, fatigue, anxiety disorders, headaches/migraines or vestibulo-ocular problems), all of which need to be assessed in a clinical screening during an evaluation for possible concussion. Appropriate and consensus-based protocols to conduct clinical exams are provided by the Concussion in Sport Group (Sport Concussion Assessment Tool (SCAT), Sport Concussion Office Assessment Tool (SCOAT)) and should be used in the most up-to-date version. Therapeutically, slowly and incrementally increasing sub symptomatic activation consisting of daily routine activities, aerobic and cognitive exercises should be introduced early after the trauma. Education about concussion should be geared towards target audiences and will then greatly contribute to adherence and acceptance of medical management.
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Affiliation(s)
- Julian Oesterschlink
- Department Sport und Gesundheit, Sportmedizinisches Institut, Universität Paderborn, Warburger Straße 100, 33098, Paderborn, Deutschland
| | - Claus Reinsberger
- Department Sport und Gesundheit, Sportmedizinisches Institut, Universität Paderborn, Warburger Straße 100, 33098, Paderborn, Deutschland.
- Division of Sports Neurology and Neurosciences, Mass General Brigham, Harvard Medical School, Boston, USA.
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King JA, Nelson LD, Cheever K, Brett B, Gliedt J, Szabo A, Dong H, Huber DL, Broglio SP, McAllister TW, McCrea M, Pasquina P, Feigenbaum LA, Hoy A, Mihalik JP, Duma SM, Buckley T, Kelly LA, Miles C, Goldman JT, Benjamin HJ, Master CL, Ortega J, Kontos A, Clugston JR, Cameron KL, Kaminski TW, Chrisman SP, Eckner JT, Port N, McGinty G. The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium. Am J Sports Med 2024; 52:1845-1854. [PMID: 38742422 DOI: 10.1177/03635465241247212] [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] [Indexed: 05/16/2024]
Abstract
BACKGROUND Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes. HYPOTHESIS New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018. RESULTS A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without (P < .001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days (P < .001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) (P = .592). CONCLUSION This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery.
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Affiliation(s)
- Jeffrey A King
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA Lindsay
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kelly Cheever
- Applied Biomechanics Research Laboratory, Department of Kinesiology, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Benjamin Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jordan Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Huaying Dong
- Division of Biostatistics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel L Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven P Broglio
- University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paul Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Luis A Feigenbaum
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - April Hoy
- Department of Athletics, School of Behavioral and Applied Sciences, Azusa Pacific University, Azusa, California, USA
| | - Jason P Mihalik
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stefan M Duma
- Institute for Critical Technology and Applied Science, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Thomas Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Louise A Kelly
- Department of Exercise Science, California Lutheran University, Thousand Oaks, California, USA
| | - Chris Miles
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Joshua T Goldman
- Departments of Family Medicine and Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Holly J Benjamin
- Departments of Orthopaedic Surgery and Rehabilitation Medicine and Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Christina L Master
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justus Ortega
- School of Applied Health, California State Polytechnic University, Humboldt, Arcata, California, USA
| | - Anthony Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James R Clugston
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | - Kenneth L Cameron
- Orthopaedic and Sports Medicine Research, United States Military Academy, West Point, New York, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Sara P Chrisman
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - James T Eckner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas Port
- School of Optometry, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Gerald McGinty
- Department of Athletics, United States Air Force Academy, Air Force Academy, Colorado, USA
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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20
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Caccese JB, Master CL, Buckley TA, Chrisman SPD, Clugston JR, Eckner JT, Ermer E, Harcum S, Hunt TN, Jain D, Kelly LA, Langford TD, Lempke LB, McDevitt J, Memmini AK, Mozel AE, Perkins SM, Putukian M, Roby PR, Susmarski A, Broglio SP, McAllister TW, McCrea M, Pasquina PF, Esopenko C. Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study. Sports Med 2024; 54:1707-1721. [PMID: 38133787 DOI: 10.1007/s40279-023-01982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. METHODS National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24-48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King-Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale. RESULTS Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24-48 h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5-70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6-49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1-2.9; male athletes, mean = 4.1, 95% CI 1.5-10.9). CONCLUSIONS Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48 h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W. 10th Avenue, Columbus, OH, 43210, USA.
| | | | | | | | | | | | - Elsa Ermer
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stacey Harcum
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Divya Jain
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Anne E Mozel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan M Perkins
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | | | | | - Paul F Pasquina
- Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, USA
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21
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Mochizuki G, Dang N, Inness EL, Chandra T, Foster E, Comper P, Bayley MT, Danells C. Measurement Properties of the Activities-Specific Balance Confidence Scale in Adults From the General Population With Concussion: A Report From the Toronto Concussion Study. Arch Phys Med Rehabil 2024:S0003-9993(24)00991-2. [PMID: 38719165 DOI: 10.1016/j.apmr.2024.05.003] [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: 10/03/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE The aim of this study was to establish the internal consistency and construct validity of the Activities-specific Balance Confidence (ABC) Scale and ABC-6 in adults from the general population with concussion. DESIGN Prospective analysis. SETTING Outpatient concussion care clinic. PARTICIPANTS Adults from the general population with concussion referred to a concussion care clinic within 7 days of injury (N=511). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Balance confidence was assessed with the Activities-specific Balance Confidence (ABC) Scale and the ABC-6. Concussion symptoms were characterized using the Sport Concussion Assessment Tool version 5 (SCAT5) symptom checklist. Instrumented measures of balance and gait included center of pressure velocity and double support time, respectively. Balance was also assessed using the mBESS. RESULTS The ABC and ABC-6 were strongly correlated (ρ=0.980, P<.001). Cronbach α for ABC and ABC-6 was 0.966 and 0.940, respectively. Factor analysis verified the existence of 2 components of the ABC, 1 including all items of the ABC-6 as well as 3 additional items. ABC and ABC-6 were moderately significantly correlated with SCAT5 symptom number, severity, and symptom domain (ρ=-0.350 to -0.604). However, correlations between ABC and ABC-6 with instrumented measures of balance and gait were not statistically significant, except for double support time during dual-task gait with ABC-6 (ρ=-0.218). CONCLUSIONS In community-dwelling adults with concussion, the ABC and ABC-6 have good internal consistency. Convergent validity is stronger for symptom endorsement measures within SCAT5 domains, which has a similar construct (subjectivity) to balance confidence. Both the ABC and ABC-6 are valid measures of balance self-efficacy in adults from the general population with concussion. The ABC-6 may be a useful tool for characterizing the effect of concussion on perceptions of the ability to perform functional tasks that challenge balance and mobility.
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Affiliation(s)
- George Mochizuki
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada; UHN-Toronto Rehabilitation Institute, Toronto, Canada.
| | - Norman Dang
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Elizabeth L Inness
- UHN-Toronto Rehabilitation Institute, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Evan Foster
- UHN-Toronto Rehabilitation Institute, Toronto, Canada
| | - Paul Comper
- UHN-Toronto Rehabilitation Institute, Toronto, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Mark T Bayley
- UHN-Toronto Rehabilitation Institute, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cynthia Danells
- UHN-Toronto Rehabilitation Institute, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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22
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Al Attar WSA, Mahmoud H, Alfadel A, Faude O. Does Headgear Prevent Sport-Related Concussion? A Systematic Review and Meta-Analysis of Randomized Controlled Trials Including 6311 Players and 173,383 Exposure Hours. Sports Health 2024; 16:473-480. [PMID: 37204092 PMCID: PMC11025511 DOI: 10.1177/19417381231174461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
CONTEXT A sport-related concussion (SRC) is a traumatic brain injury that is caused by biomechanical stresses and results in a complex pathophysiological process in the brain. Some in the sporting community believe that headgear (HG) can prevent SRC, and several professional Australian sports organizations, including rugby, football, and soccer clubs, recommend its use. OBJECTIVE The purpose of this study is to determine whether HG is effective in lowering the prevalence of SRC in sports. DATA SOURCES A systematic search for related studies published between 1985 and 2023 was conducted using the following databases: Cochrane Library, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION Only randomized controlled trials (RCTs) that investigated the effectiveness of HG in reducing SRC rate were included. STUDY DESIGN Systematic review and meta-analysis of RCTs. LEVEL OF EVIDENCE Level 1a. DATA EXTRACTION Two researchers independently completed the title and abstract search and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. The PEDro scale was used to evaluate the quality of the included RCTs. Data recorded from each study included authors, year of publication, type and number of players, study design, duration of the study, injury rate, compliance (%), sports/level, and exposure hours. RESULTS The pooled results of 6311 players and 173,383 exposure hours showed 0% SRC reduction per 1000 hours of exposure in the experimental group compared with the control group, with an injury risk ratio of 1.03 (95% CI, 0.82-1.30; P = 0.79). CONCLUSION This systematic review and meta-analysis demonstrates that HG does not prevent SRC among soccer and rugby players, and therefore the findings from this meta-analysis do not currently support the use of HG to prevent SRC in soccer or rugby.
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Affiliation(s)
- Wesam Saleh A. Al Attar
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
| | - Hayam Mahmoud
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy for Neurology, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Abdulaziz Alfadel
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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23
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Wingerson MJ, Hunt DL, Wilson JC, Mannix RC, Meehan WP, Howell DR. Factors Associated with Symptom Resolution after Aerobic Exercise Intervention in Adolescent and Young Adults with Concussion. Med Sci Sports Exerc 2024; 56:783-789. [PMID: 38109187 PMCID: PMC11018463 DOI: 10.1249/mss.0000000000003358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Aerobic exercise facilitates postconcussion symptom resolution at the group level, but patient-level characteristics may affect the likelihood of treatment efficacy. PURPOSE This study aimed to investigate demographic and clinical characteristics, which differentiate postconcussion aerobic exercise treatment efficacy from nonefficacy in the intervention arm of a randomized clinical trial. METHODS Adolescent and young adult participants initiated a standardized aerobic exercise intervention within 14 d of concussion, consisting of self-selected exercise for 100 min·wk -1 at an individualized heart rate (80% of heart rate induced symptom exacerbation during graded exercise testing). Treatment efficacy was defined as symptom resolution within 28-d postconcussion. Treatment efficacy and nonefficacy groups were compared on demographics, clinical characteristics, intervention adherence, and persistent symptom risk using the Predicting Persistent Postconcussive Problems in Pediatrics (5P) clinical risk score. RESULTS A total of 27 participants (16.1 ± 2.3 yr old; range, 11-21 yr; 52% female) began the intervention, with a mean of 9.5 ± 3.7 d after concussion; half ( n = 13; 48%) demonstrated treatment efficacy (symptom resolution within 28 d postconcussion). Those whose symptoms resolved within 28 d had significantly lower preintervention postconcussion symptom inventory scores (21.2 ± 13.2 vs 41.4 ± 22.2; P < 0.01), greater adherence to the intervention (77% vs 36%; P = 0.05), and longer average exercise duration (median [interquartile range], 49.7 [36.8-68.6] vs 30.4 [20.7-34.7] min; P < 0.01) than those whose symptoms lasted more than 28 d. Groups were similar in age, sex, timing of intervention, and preintervention 5P risk score. CONCLUSIONS A standardized aerobic exercise intervention initiated within 14 d of concussion demonstrated efficacy for approximately half of participants, according to our definition of treatment efficacy. This multisite aerobic exercise intervention suggests that lower symptom severity, higher intervention adherence, and greater exercise duration are factors that increase the likelihood of symptoms resolving within 28 d of concussion.
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Affiliation(s)
- Mathew J. Wingerson
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO
- Children’s Hospital Colorado, Sports Medicine Center, Aurora, CO
| | - Danielle L. Hunt
- Boston Children’s Hospital, Micheli Center for Sports Injury Prevention, Boston, MA
| | - Julie C. Wilson
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO
- Children’s Hospital Colorado, Sports Medicine Center, Aurora, CO
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
| | - Rebekah C. Mannix
- Boston Children’s Hospital, Micheli Center for Sports Injury Prevention, Boston, MA
| | - William P. Meehan
- Boston Children’s Hospital, Micheli Center for Sports Injury Prevention, Boston, MA
| | - David R. Howell
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO
- Children’s Hospital Colorado, Sports Medicine Center, Aurora, CO
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24
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Ernst W, Kneavel M. Barriers to concussion reporting in collegiate athletes: an analysis of a peer-led worksheet activity. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1215-1223. [PMID: 35549828 DOI: 10.1080/07448481.2022.2071621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/25/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Objective: To determine if a peer-led concussion reporting worksheet activity could elucidate barriers to reporting in collegiate athletes. Participants: Five hundred and three athletes from 7 universities across all three NCAA divisions. Methods: A supplementary qualitative analysis of responses to a concussion reporting worksheet completed during an RCT of a novel peer concussion education program. The first column of the worksheet required participants to list thoughts that prevent reporting and the second column required replacement thoughts that facilitate reporting. Results: A qualitative phenomenological thematic analysis of responses to the first column of the worksheets identified themes that coalesced into three areas: 1) missing out on athletic and social events, 2) losing one's competitive edge, and 3) negative interpersonal interaction/self-perception. Conclusions: Barriers to concussion reporting from several areas central to the collegiate athlete experience were identified. These barriers should be considered during clinical assessment and when developing concussion education programs.
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Affiliation(s)
- William Ernst
- Department of Professional Psychology, Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - Meredith Kneavel
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA
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25
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Roberts J, Wilson JC, Halstead ME, Miller SM, Santana JA, Valovich McLeod TC, Zaslow TL, Master CL, Grady MF, Snedden TR, Fazekas ML, Coel RA, Howell DR. Variables associated with days of school missed following concussion: results from the Sport Concussion Outcomes in PEdiatrics (SCOPE) study. PHYSICIAN SPORTSMED 2024:1-9. [PMID: 38648009 DOI: 10.1080/00913847.2024.2344435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To understand factors associated with missed academic time after concussion to improve support for patients. Our goal was to assess patient-specific predictors of total school time lost after pediatric/adolescent concussion. STUDY DESIGN We performed a prospective cohort study of children and adolescents (8-18 years of age) seen within 14 days of concussion from seven pediatric medical centers across the United States. We collected outcomes via the Concussion Learning Assessment & School Survey (CLASS) and constructed a multivariable predictive model evaluating patient factors associated with school time loss. RESULTS 167 patients participated (mean age = 14.5 ± 2.2 years; 46% female). Patients were assessed initially at 5.0 ± 3.0 days post-injury and had a final follow-up assessment 24.5 ± 20.0 days post-concussion. Participants missed a median of 2 days of school (IQR = 0.5-4), and 21% reported their grades dropped after concussion. Higher initial symptom severity rating (β = 0.06, 95% CI = 0.03-0.08, p < 0.001) and perception of grades dropping after concussion (β = 1.37, 95% CI = 0.28-2.45, p = 0.01) were significantly associated with more days of school time missed after concussion. Those who reported their grades dropping reported missing significantly more school (mean = 5.0, SD = 4.7 days missed of school) than those who reported their grades did not drop (mean = 2.2, SD = 2.6 days missed of school; p < 0.001; Cohen's d = 0.87). CONCLUSIONS Children and adolescents reported missing a median of 2 days of school following concussion, and more missed school time after a concussion was associated with more severe concussion symptoms and perception of grades dropping. These findings may support recommendations for minimal delays in return-to-learn after concussion.
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Affiliation(s)
- Jeremy Roberts
- Sports Medicine Center, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark E Halstead
- School of Medicine, Departments of Orthopedics and Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Shane M Miller
- Scottish Rite for Children and UT Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan A Santana
- Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Tracy L Zaslow
- Cedars Sinai Kerlan Jobe Institute, Los Angeles, CA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew F Grady
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Traci R Snedden
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | | | - Rachel A Coel
- Kapi'olani Medical Center for Women and Children, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
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26
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Konstantinides NA, Murphy SM, Whelan BM, Harmon KG, Poddar SK, Hernández TD, Rowe RK. Nominal Differences in Acute Symptom Presentation and Recovery Duration of Sport-Related Concussion Between Male and Female Collegiate Athletes in the PAC-12. SPORTS MEDICINE - OPEN 2024; 10:31. [PMID: 38564117 PMCID: PMC10987417 DOI: 10.1186/s40798-024-00699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Sport-related concussion (SRC) is a heterogenous injury that often presents with varied symptoms and impairment. Recently, research has focused on identifying subtypes, or clinical profiles of concussion to be used in assessing and treating athletes with SRC. The purpose of this study was to investigate sex differences in clinical profiles, recovery duration, and initial symptom severity after SRC in a cohort of collegiate athletes in the Pacific-12 Conference (Pac-12). METHODS This prospective cohort study examined post-SRC symptoms, recovery, and return-to-play times using data from the Pac-12 CARE Affiliated Program and Pac-12 Health Analytics Program. Clinical profiles reported by student-athletes were defined by the number (> 50%) of specific symptoms frequently reported for each profile. Generalized linear mixed models were used to examine associations among sex, clinical profiles, time-to-recovery, and return-to-play times. RESULTS 479 concussion incidents met inclusion criteria. The probabilities of initial presentation of each clinical profile, initial injury severity scores, and recovery times within a profile did not differ between sexes (p = 0.33-0.98). However, both males and females had > 0.75 probabilities of exhibiting cognitive and ocular profiles. Initial injury severity score was a strong nonlinear predictor of initial number of clinical profiles (p < 0.0001), which did not differ between sexes. The number of clinical profiles was also a nonlinear predictor of time-to-recovery (p = 0.03) and return-to-play times (p < 0.0001). CONCLUSIONS Initial symptom severity was strongly predictive of the number of acute clinical profiles experienced post-SRC. As the number of clinical profiles increased, time-to-recovery and time to return-to-play also increased. Factors other than sex may be better associated with acute symptom presentation post-concussion as no sex differences were found in reported clinical profiles or recovery. Understanding the number and type of clinical profiles experienced post-SRC may help inform concussion diagnostics and management.
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Affiliation(s)
- Niki A Konstantinides
- Department of Integrative Physiology, University of Colorado Boulder, UCB 354, Boulder, CO, 80309, USA.
| | - Sean M Murphy
- Cumberland Biological and Ecological Researchers, Longmont, CO, USA
| | | | | | - Sourav K Poddar
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Theresa D Hernández
- Psychology and Neuroscience (CU Boulder), Physical Medicine and Rehabilitation (CU Anschutz School of Medicine), Aurora, CO, USA
| | - Rachel K Rowe
- Department of Integrative Physiology, University of Colorado Boulder, UCB 354, Boulder, CO, 80309, USA
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27
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Glaser J, Jaeckle S, Beblo T, Mueller G, Eidenmueller AM, Schulz P, Schmehl I, Rogge W, Hollander K, Toepper M, Gonschorek AS. The effect of repeated concussions on clinical and neurocognitive symptom severity in different contact sports. Scand J Med Sci Sports 2024; 34:e14626. [PMID: 38610121 DOI: 10.1111/sms.14626] [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: 12/08/2023] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The potential consequences of repeated concussions in sport are well documented. However, it remains unclear whether the cumulative impact of sports-related concussions differs between different contact sports. Therefore, the aim of the current study was to investigate the cumulative effects of sports-related concussions on clinical and neurocognitive health in different contact sports. MATERIALS AND METHODS In a prospective multicenter study, we examined 507 (74 females) active professional athletes between 18 and 40 years of age from five different contact sports (soccer, handball, American football, basketball, and ice hockey). Data collection involved concussion history, clinical symptom evaluation, neurocognitive assessment, and the collection of other sports-related information. Composite scores were built for clinical symptoms (such as neck pain and balance disturbances) and for neurocognitive symptoms (such as memory and attention impairments). RESULTS Athletes having suffered 3+ concussions in the past showed disproportionally higher clinical symptom severity than athletes with less than three concussions across all sports. The level of clinical symptom burden in athletes with 3+ concussions indicated mild impairment. The number of past concussions did not affect neurocognitive performance. DISCUSSION Repeated sports-related concussions appear to have a cumulative impact on clinical-but not cognitive-symptom severity. Although clinical symptom burden in athletes with 3+ concussions in the past was not alarmingly high yet in our sample, increased caution should be advised at this point. Despite few exceptions, results are similar for different contact sports, suggesting a similar multidisciplinary concussion management across all types of sport.
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Affiliation(s)
- Jennifer Glaser
- Concussion Center Hamburg, Neurozentrum, BG Klinikum Hamburg, Hamburg, Germany
| | - Sarah Jaeckle
- Concussion Center Würzburg, Praxis für Sport-Neuropsychologie Würzburg, Wuerzburg, Germany
| | - Thomas Beblo
- Evangelisches Klinikum Bethel gGmbH, University Hospital of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Gerhard Mueller
- Concussion Center Würzburg, Praxis für Sport-Neuropsychologie Würzburg, Wuerzburg, Germany
| | - Andreas M Eidenmueller
- Concussion Center Würzburg, Praxis für Sport-Neuropsychologie Würzburg, Wuerzburg, Germany
| | - Philipp Schulz
- Evangelisches Klinikum Bethel gGmbH, University Hospital of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Ingo Schmehl
- Concussion Center Berlin, Klinik für Neurologie, BG Klinikum Unfallkrankenhaus Berlin GmbH, Berlin, Germany
| | - Witold Rogge
- Concussion Center Berlin, Klinik für Neurologie, BG Klinikum Unfallkrankenhaus Berlin GmbH, Berlin, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Max Toepper
- Evangelisches Klinikum Bethel gGmbH, University Hospital of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Licciardi L, Olver J, Lalor A, Callaway L. Occupational therapy scope of practice in the rehabilitation of adults experiencing persistent post-concussion symptoms following traumatic brain injury: a scoping review protocol. JBI Evid Synth 2024; 22:727-736. [PMID: 38018871 PMCID: PMC10986781 DOI: 10.11124/jbies-23-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The objective of the review is to identify, categorize, and examine literature describing occupational therapy scope of practice in the rehabilitation of adults experiencing persistent post-concussion symptoms (PPCS). INTRODUCTION PPCS are symptoms experienced by adults a minimum of 2 to 4 weeks after a traumatic brain injury (TBI), and include vestibular, neuropsychiatric, visual, and cognitive issues. Enduring PPCS may result in disability, affecting a person's independence and/or participation in daily activities. Despite growing recognition of the role occupational therapy can offer in TBI rehabilitation, evidence is limited regarding the scope of practice occupational therapists have in the rehabilitation of adults experiencing PPCS. INCLUSION CRITERIA Literature that includes adults (aged 18 to 65 years) experiencing PPCS that describes the occupational therapy scope of practice in concussion programs will be considered for inclusion in this review. Sources reporting on participants aged under 18 years, classified with non-persistent symptoms, and receiving care in acute health care settings will be excluded. Non-English publications or gray literature from civil society or disabled persons organizations or other representative bodies in the field of brain injury will also be excluded. METHODS The scoping review will follow the JBI methodology for scoping reviews. Five electronic databases will be searched for literature published between 2013 and the present: MEDLINE, Embase, Emcare, PsycINFO, and CINAHL. Two reviewers will independently conduct title and abstract screening of the results and, upon consensus, independently screen full texts to confirm final sources for inclusion. Any disagreements will be resolved by discussion with a third reviewer. Data will be extracted from included sources and we will then map occupational therapy scope of practice (inclusive of assessments and interventions) against the World Health Organization's International Classification of Functioning One-Level Classification. Results will be presented in tabular or narrative format. REVIEW REGISTRATION Open Science Framework osf.io/qxgzj.
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Affiliation(s)
- Lisa Licciardi
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - John Olver
- Rehabilitation Services, Epworth HealthCare, Melbourne, Vic, Australia
- Victor Smorgon Epworth Institute of Education and Research, Monash University, Melbourne, Vic, Australia
| | - Aislinn Lalor
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Vic, Australia
| | - Libby Callaway
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Vic, Australia
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29
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Sanclemente D, Belair JA, Talekar KS, Roedl JB, Stache S. Return to Play Following Concussion: Role for Imaging? Semin Musculoskelet Radiol 2024; 28:193-202. [PMID: 38484771 DOI: 10.1055/s-0043-1778031] [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: 03/19/2024]
Abstract
This review surveys concussion management, focusing on the use of neuroimaging techniques in return to play (RTP) decisions. Clinical assessments traditionally were the foundation of concussion diagnoses. However, their subjective nature prompted an exploration of neuroimaging modalities to enhance diagnosis and management. Magnetic resonance spectroscopy provides information about metabolic changes and alterations in the absence of structural abnormalities. Diffusion tensor imaging uncovers microstructural changes in white matter. Functional magnetic resonance imaging assesses neuronal activity to reveal changes in cognitive and sensorimotor functions. Positron emission tomography can assess metabolic disturbances using radiotracers, offering insight into the long-term effects of concussions. Vestibulo-ocular dysfunction screening and eye tracking assess vestibular and oculomotor function. Although these neuroimaging techniques demonstrate promise, continued research and standardization are needed before they can be integrated into the clinical setting. This review emphasizes the potential for neuroimaging in enhancing the accuracy of concussion diagnosis and guiding RTP decisions.
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Affiliation(s)
- Drew Sanclemente
- Medical Student, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kiran S Talekar
- Department of Radiology, Brain Mapping (fMRI and DTI) in Neuroradiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Johannes B Roedl
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephen Stache
- Division of Non-Operative Sports Medicine, Department of Orthopaedics and Family and Community Medicine, Rothman Orthopaedic Institute, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Department of Orthopaedics and Pediatrics, University Athletics, Drexel University and Drexel College of Medicine, Philadelphia, Pennsylvania
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Katsigiannis S, Maai N, Patsalis P, Groppa S, Gousias K, Pintea B. FIFA Initiatives Improved Survival After Loss of Consciousness During Football Games. Sports Med Int Open 2024; 8:a21969348. [PMID: 38812956 PMCID: PMC11135400 DOI: 10.1055/a-2196-9348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/12/2023] [Indexed: 05/31/2024] Open
Abstract
Loss of consciousness (LOC) during football games is associated with very high mortality rates. In order to address football medical emergencies, in 2013 FIFA implemented the "FIFA 11 steps to prevent sudden cardiac death" program and distributed the FIFA Medical Emergency Bag. The purpose of this work was to identify independent survival factors after LOC on the pitch and to investigate the effectiveness of the FIFA initiatives. An internet search was performed to identify football players suffering LOC on the pitch between 1990 and 2021. A total of 268 cases could be identified and were dichotomized according to the implementation date of the FIFA medical emergency bag. There was 55% mortality after LOC, while cardiogenic LOC was more often (82% vs. 20%) fatal than traumatic LOC. Mortality in developing countries was higher than in developed countries. From the year 2013 survival improved significantly for both traumatic and cardiogenic cases. The location of the LOC significantly influenced survival (OR: 0.20 and p<0.001). LOC on the football field is associated with increased mortality and requires separate monitoring based on a traumatic vs. non-traumatic cause. FIFA initiatives significantly reduced mortality after LOC but significant differences were identified between developed and developing countries.
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Affiliation(s)
- Sotirios Katsigiannis
- Neurosurgery, Knappschaftskrankenhaus University Hospital, Ruhr
University of Bochum, Bochum, Germany
| | - Nader Maai
- Department of Orthopedics and Traumatology, Bergmannsheil University
Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Internal Medicine, Cardiology, Knappschaftskrankenhaus
University Hospital, Ruhr University of Bochum, Bochum, Germany
- Department of Cardiology and Angiology, Bergmannsheil University
Hospital, Ruhr University of Bochum, Bochum, Germany, Bochum,
Germany
| | - Sergiu Groppa
- Department of Neurology, University Medical Center of the Johannes
Gutenberg University Mainz, Mainz, Germany
| | | | - Bogdan Pintea
- Department of Neurosurgery, Bergmannsheil University Hospital, Ruhr
University of Bochum, Bochum, Germany
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Helm TC, Bowman TG, Kelshaw PM, Beidler E, Cifu DX, Resch JE. Academic adjustments and concussion recoveries in NCAA student-athletes: a LIMBIC MATARS investigation. Brain Inj 2024; 38:282-287. [PMID: 38345018 DOI: 10.1080/02699052.2024.2310786] [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: 03/02/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the association between academic adjustments and recovery from sport-related concussions (SRCs) in collegiate athletes. MATERIALS AND METHODS A retrospective medical chart review was performed between the 2015-2016 and 2019-2020 sport seasons at 11 Long-term Impact of Military-relevant Brain Injury Consortium Military and Tactical Athlete Research Study (LIMBIC MATARS) sites. Days between injury and symptom resolution, and injury and return to sport (dependent variables) for collegiate athletes who did or did not receive academic adjustments (independent variable) were analyzed using Mann-Whitney U tests. RESULTS The number of days between date of injury and symptom-resolution between those who did (median = 9 [interquartile range = 5,16]) and did not have (7[3,12]) academic adjustments were statistically different (z=-2.76, p < 0.01, r=-0.17). However, no differences were observed between days to return to sport among those who did (14[10,22]) and did not (13[8,20]) receive assigned academic adjustments (z= -1.66, p = 0.10, r= -.10). CONCLUSIONS Recovery trajectories were similar between athletes diagnosed with a SRC who did or did not receive academic adjustments.. Our findings suggest academic adjustments supported recovery for those who needed academic adjustments. Clinicians and healthcare professionals should assist and support collegiate athletes after SRCs on an individual basis, including academic adjustments when appropriate based on patient presentation.
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Affiliation(s)
- Tenesha C Helm
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Patricia M Kelshaw
- Department of Kinesiology, Brain Research and Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham, New Hampshire, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Gomes D, Eagle S, Mehmel B, Albrecht T, Versace A, Lima Santos JP, Trbovich A, Stiffler R, Martinez L, Holland CL, Zynda AJ, Collins MW, Kontos AP. Impact of Sex and Pubertal Development on Anxiety in Adolescents After Concussion. J Neurotrauma 2024. [PMID: 38407975 DOI: 10.1089/neu.2023.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Concussion often results in psychological symptoms, including anxiety. Post-concussion anxiety has been well documented, although much of this research has focused on collegiate athletes. The purpose of this study was to compare (1) anxiety symptoms in concussed and healthy controls over time and (2) to explore sex differences in post-concussion anxiety within the context of pubertal development. Participants (N = 126, mean age = 15.1 years old), including concussed (n = 86) and healthy adolescents (n = 40), completed the Pubertal Development Scale (PDS) and the Screen for Child Anxiety and Related Disorders (SCARED-C). The concussed groups completed SCARED-C at three visits (<10 days, 4 weeks, 3 months). Results of an analysis of covariance (ANCOVA) and multi-variate analysis of covariance (MANCOVA) found concussed adolescents reported higher SCARED-C total, generalized, and panic anxiety scores than healthy controls, after controlling for sex, age, and PDS score (PDSS). A three-way mixed ANCOVA examined the effects of sex, PDSS, time, and their interaction on SCARED-C total score in concussed adolescents while controlling for age. There was a significant three-way interaction between sex, age, and PDSS on SCARED-C total score while controlling for age. Overall, we observed increased anxiety in concussed adolescents, compared with controls, as well as greater post-concussion anxiety reported by females compared with males, including within PDSS groups. Concussion providers should be prepared to receive training to administer well-validated measures of psychopathology and should consider that female adolescents, compared with males, regardless of pubertal development, may be at greater risk for post-concussion anxiety.
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Affiliation(s)
- Dean Gomes
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn Eagle
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bindal Mehmel
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ted Albrecht
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Alicia Trbovich
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richelle Stiffler
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laramie Martinez
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cyndi L Holland
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aaron J Zynda
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael W Collins
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony P Kontos
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Charleston L, Posas J. Categorizing Sports-Related Concussion Disparities by Key Domains of Social Determinants of Health. Curr Pain Headache Rep 2024; 28:125-132. [PMID: 38227210 DOI: 10.1007/s11916-023-01187-2] [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] [Accepted: 11/01/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW To explore recently published data on disparities in concussion and best categorize these data into domains of social determinants of health (SDOH). RECENT FINDINGS Disparities in concussion cover a range of SDOH domains. Questions on disparities in concussion remain. Interventions to reduce these disparities and inequities are needed. Social determinants of health may play a significant role in disparities and inequities in sports related concussion. There is interplay and overlap in SDOH domains that affect concussion outcomes. It is possible that an increase in SDOH may affect concussion disparities by moderated mediation; however, further data is needed to validate this potential effect. Moreover, attention to SDOH domains in sports related concussion may provide insight on intervention targets to ameliorate disparities in sports related concussion.
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Affiliation(s)
- Larry Charleston
- Department of Neurology, Michigan State University College of Human Medicine, East Lansing, MI, USA.
| | - Jose Posas
- Oschner Health Neuroscience Institute, New Orleans, LA, USA
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Bretzin AC, Zynda AJ, Pollard-McGrandy AM, Wiebe DJ, Covassin T. Acute Sport-Related Concussion Management and Return to Sport Time in High School Athletes. Am J Sports Med 2024; 52:791-800. [PMID: 38279802 DOI: 10.1177/03635465231219263] [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] [Indexed: 01/29/2024]
Abstract
BACKGROUND The current evidence for acute management practices of sport-related concussion (SRC) is often limited to in-clinic visits, with limited studies identifying professionals in early SRC care and the association with prolonged recovery outcomes. PURPOSE To describe acute SRC management practices (ie, the personnel in the initial evaluations, removal from activity) and test the association with prolonged return to sport (RTS) time. STUDY DESIGN Descriptive epidemiology study. METHODS We conducted a retrospective cohort study of 17,081 high school SRCs accrued between the 2015-2016 and 2020-2021 academic years. We reported acute management practices and RTS time as frequencies stratified by sex, sport, and event type and compared athletic trainer (AT) access in initial evaluation with chi-square tests (P < .05). Separate logistic regressions estimated odds ratios (ORs) and 95% CIs for removal from activity and prolonged RTS >21 days by acute management practices. RESULTS Most SRCs (n = 12,311 [72.1%]) had complete initial evaluation by an AT. Boys had an AT evaluation in 75.5% (n = 2860/3787) of practice-related and 74.8% (n = 5551/7423) of competition-related events. Girls had an AT evaluation in 61.3% (n = 1294/2110) of practice-related and 69.3% (n = 2606/3761) of competition-related events. In sex-comparable sports (n = 6501), there was no difference between boys (n = 1654/2455 [67.4%]) and girls (n = 2779/4046 [68.7%]) having an AT involved in the first evaluation (χ2 = 1.21; P = .27). Notably, 25.3% of girls' SRCs were evaluated by a coach alone, and we observed differences in personnel in initial evaluations by sport. The odds of immediate removal were higher when an AT made the initial evaluation (OR, 2.8 [95% CI, 2.54-3.08]). The odds of prolonged RTS >21 days was lower for those with an AT in the initial evaluation (OR, 0.74 [95% CI, 0.65-0.84]) adjusting for significant factors from univariate analyses, boys relative to girls (OR, 0.85 [95% CI, 0.76-0.96]), specialty care relative to PCP (OR, 2.16 [95% CI, 1.90-2.46]), specialty care relative to urgent or ready care (OR, 0.99 [95% CI, 0.82-1.22]) concussion history (OR, 1.41 [95% CI, 1.22-1.63]), and removal from activity (OR, 0.90 [95% CI, 0.78-1.05]). CONCLUSION This study found variability in personnel involved in initial SRC evaluations, with higher percentages of athletes with SRCs having ATs make the initial evaluation during competitive events. There was no association between sex and AT involvement in comparable sports. There was an association between prolonged RTS and AT involvement, sex, concussion history, and location of follow-up care.
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Affiliation(s)
- Abigail C Bretzin
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron J Zynda
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | | | - Douglas J Wiebe
- Department of Epidemiology, Injury Prevention Center, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
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Broglio SP, Register-Mihalik JK, Guskiewicz KM, Leddy JJ, Merriman A, Valovich McLeod TC. National Athletic Trainers' Association Bridge Statement: Management of Sport-Related Concussion. J Athl Train 2024; 59:225-242. [PMID: 38530653 DOI: 10.4085/1062-6050-0046.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To provide athletic trainers and team physicians with updated recommendations to the 2014 National Athletic Trainers' Association (NATA) concussion position statement regarding concussion management, specifically in the areas of education, assessment, prognostic factors, mental health, return to academics, physical activity, rest, treatment, and return to sport. BACKGROUND Athletic trainers have benefited from the 2 previous NATA position statements on concussion management, and although the most recent NATA position statement is a decade old, knowledge gains in the medical literature warrant updating several (but not all) recommendations. Furthermore, in various areas of the body of literature, current evidence now exists to address items not adequately addressed in the 2014 statement, necessitating the new recommendations. This document therefore serves as a bridge from the 2014 position statement to the current state of concussion evidence, recommendations from other organizations, and discrepancies between policy and practice. RECOMMENDATIONS These recommendations are intended to update the state of the evidence concerning the management of patients with sport-related concussion, specifically in the areas of education; assessment advances; prognostic recovery indicators; mental health considerations; academic considerations; and exercise, activity, and rehabilitation management strategies.
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Affiliation(s)
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Kevin M Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
| | | | - Tamara C Valovich McLeod
- Athletic Training Program, A.T. Still University, Mesa, AZ. Dr Guskiewicz is now at the Department of Kinesiology, Michigan State University, East Lansing
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36
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Liston M, Fuller C, Dahly D, Falla D, McLoughlin R, Yeomans C, van Dyk N, Falvey E. A Profile of Isometric Cervical Strength in Elite Professional Male Rugby Players. J Orthop Sports Phys Ther 2024; 54:201-208. [PMID: 38284387 DOI: 10.2519/jospt.2024.11830] [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] [Indexed: 01/30/2024]
Abstract
OBJECTIVES: To (1) provide position-specific normative data for isometric cervical muscle strength and endurance in professional, male rugby players and (2) assess the relationship between age, height, weight, and playing position with cervical muscle strength and endurance. DESIGN: Cross-sectional study. METHODS: Professional rugby players completed peak isometric cervical strength testing followed by a test of cervical muscle endurance. Descriptive statistics for continuous variables with strength normalized to body weight were performed. Multiple linear regression was used to estimate associations between strength measurements. RESULTS: In total, 136 players participated including front-row forwards (27%), other forwards (28%), and backs (45%). Front-row forwards had significantly greater peak isometric cervical muscle strength than other position groups, with backs having the lowest strength. Extension produced the highest force for all 3 position groups (429 N ± 104 N), whereas flexion produced the least (275 N ± 65 N). Age was associated with increased isometric cervical muscle strength. There was a statistically significant relationship between peak flexion strength and flexion endurance (P = .003). The average time for the endurance tests were 55.7 (±17.1) seconds and 52.9 (±20.1) seconds for extension and flexion, respectively. Other forwards had lower cervical extension muscle endurance than backs and front-row forwards. CONCLUSIONS: Normative values for peak and endurance isometric strength in professional rugby players illustrate significant differences between playing position. Consider age, body weight, and intraindividual variability when interpreting cervical strength and endurance results. J Orthop Sports Phys Ther 2024;54(3):1-8. Epub 29 January 2024. doi:10.2519/jospt.2024.11830.
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Bowman TG, Lininger MR, Oldham JR, Smetana RM, Kelshaw PM, Beidler E, Campbell TR, Walton SR, Munce TA, Larson MJ, Didehbani N, Cullum CM, Rosenblum DJ, Cifu DX, Resch JE. Physical activity and recovery following concussion in collegiate athletes: a LIMBIC MATARS Consortium Investigation. Brain Inj 2024:1-8. [PMID: 38324635 DOI: 10.1080/02699052.2024.2310791] [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: 03/02/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To investigate whether routine daily activities (RDA), non-prescribed exercise (Non-ERx), or prescribed exercise (ERx) were associated with recovery from sport-related concussion (SRC) in collegiate athletes. MATERIALS AND METHODS Data for this cross-sectional, retrospective chart review of collegiate athletes diagnosed with SRC (n = 285[39.6% female], age = 19.5 ± 1.4 years) were collected during the 2015-16 to 2019-20 athletic seasons. The independent variable was group (RDA, Non-ERx, ERx). Dependent variables included days from date of diagnosis to symptom resolution (Dx-SR) and SR to return to sport (SR-RTS). RESULTS Those in the Non-ERx group took nearly 1.3 times longer to achieve SR (IRR = 1.28, 95% CI: 1.11, 1.46) and, 1.8 times longer for RTS (IRR = 1.82, 95% CI: 1.11, 2.71) when compared to those in the RDA group. No other comparisons were significant. CONCLUSION Collegiate athletes in the Non-ERx group took approximately 1 week longer to achieve SR as compared to the RDA and ERx groups. Our findings suggest that if exercise is recommended following SRC, it must be clearly and specifically prescribed. If exercise parameters cannot be prescribed, or monitored, RDA appear to be similarly beneficial during recovery for collegiate athletes with concussion.
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Affiliation(s)
- Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Monica R Lininger
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Racheal M Smetana
- Neuropsychology Assessment Clinic, University of Virginia Health, Charlottesville, Virginia, USA
| | - Patricia M Kelshaw
- Department of Kinesiology, Brain Research and Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham, NH, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas R Campbell
- School of Rehabilitation Sciences, College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Thayne A Munce
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - Michael J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Nyaz Didehbani
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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McPherson JI, Marsh AC, Cunningham A, Leddy JJ, Corrado C, Cheema ZD, Nazir MSZ, Nowak AS, Farooq O, Willer BS, Haider MN. An Exploratory Analysis of Physical Examination Subtypes in Pediatric Athletes With Concussion. Clin J Sport Med 2024:00042752-990000000-00173. [PMID: 38329287 DOI: 10.1097/jsm.0000000000001207] [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: 07/27/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Pediatric athletes with concussion present with a variety of impairments on clinical assessment and require individualized treatment. The Buffalo Concussion Physical Examination is a brief, pertinent clinical assessment for individuals with concussion. The purpose of this study was to identify physical examination subtypes in pediatric athletes with concussion within 2 weeks of injury that are relevant to diagnosis and treatment. DESIGN Secondary analysis of a published cohort study and clinician consensus. SETTING Three university-affiliated sports medicine centers. PARTICIPANTS Two hundred seventy children (14.9 ± 1.9 years). INDEPENDENT VARIABLES Orthostatic intolerance, horizontal and vertical saccades, smooth pursuits, vestibulo-ocular reflex, near-point convergence, complex tandem gait, neck range of motion, neck tenderness, and neck spasm. MAIN OUTCOME MEASURES Correlations between independent variables were calculated, and network graphs were made. k-means and hierarchical clustering were used to identify clusters of impairments. Optimal number of clusters was assessed. Results were reviewed by experienced clinicians and consensus was reached on proposed subtypes. RESULTS Physical examination clusters overlapped with each other, and no optimal number of clusters was identified. Clinician consensus suggested 3 possible subtypes: (1) visio-vestibular (horizontal and vertical saccades, smooth pursuits, and vestibulo-ocular reflex), (2) cervicogenic (neck range of motion and spasm), and (3) autonomic/balance (orthostatic intolerance and complex tandem gait). CONCLUSIONS Although we identified 3 physical examination subtypes, it seemed that physical examination findings alone are not enough to define subtypes that are both statistically supported and clinically relevant, likely because they do not include symptoms, assessment of mood or cognitive problems, or graded exertion testing.
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Affiliation(s)
- Jacob I McPherson
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York
| | | | - Adam Cunningham
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
| | - John J Leddy
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Cathlyn Corrado
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
| | - Zaheerud D Cheema
- Department of Neurology, Division of Pediatric Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Muhammad S Z Nazir
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
| | - Andrew S Nowak
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
- Central Michigan University College of Medicine, Mt. Pleasant, Michigan; and
| | - Osman Farooq
- Department of Neurology, Division of Pediatric Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Barry S Willer
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Mohammad N Haider
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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Trbovich AM, Mucha A, Zynda AJ, Farley T, Kegel N, Fazio V, Collins MW, Kontos AP. Multidomain Predictors of Protracted Recovery following Concussion among 5- to 9-Year-Old Patients: A Preliminary Study. J Pediatr 2024; 268:113927. [PMID: 38309522 DOI: 10.1016/j.jpeds.2024.113927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/09/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To determine which components from a multidomain assessment best predict protracted recovery in pediatric patients with a concussion. STUDY DESIGN A prospective cohort of patients aged 5-9 years who presented within 21 days of concussion to a specialty clinic were categorized into normal (≤30 days) and protracted (>30 days) recovery. Participants provided demographic and medical history information, and completed the Child Sport Concussion Assessment Tool-5 symptom report and balance assessment, the Vestibular/Ocular Motor Screen-Child (VOMS-C), and the Pediatric Immediate Post-concussion Assessment and Cognitive Testing. Univariate logistic regressions (LR) were used to inform a follow-up forward stepwise LR to identify the best predictors of protracted recovery. Receiver operating characteristic analysis of the area under the curve (AUC) was used to identify which predictors retained from the LR model best discriminated recovery. RESULTS The final sample included 68 patients (7.52 ± 2.3 years; 56% male), 36 (52.9%) with normal and 32 (47.1%) with protracted recovery. Results of the LR to identify protracted recovery were significant (P < .001) and accounted for 39% of the variance. The model accurately classified 78% of patients, with days to first clinic visit (OR, 1.2; 95% CI, 1.1-1.4; P = .003) and positive VOMS-C findings (OR, 8.32; 95% CI, 2.4-28.8; P < .001) as significant predictors. A receiver operating characteristic analysis of the AUC of this 2-factor model discriminated protracted from normal recovery (AUC, 0.82; 95% CI, 0.71-0.92; P < .001). CONCLUSIONS Days to first clinic visit and positive findings on the VOMS-C were the most robust predictors of protracted recovery after concussion in young pediatric patients.
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Affiliation(s)
- Alicia M Trbovich
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA.
| | - Anne Mucha
- University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA
| | - Aaron J Zynda
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Taylor Farley
- University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA
| | - Nathan Kegel
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Vanessa Fazio
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Michael W Collins
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Anthony P Kontos
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
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Barnes A, Smulligan K, Wingerson MJ, Little C, Lugade V, Wilson JC, Howell DR. A Multifaceted Approach to Interpreting Reaction Time Deficits After Adolescent Concussion. J Athl Train 2024; 59:145-152. [PMID: 36701688 PMCID: PMC10895397 DOI: 10.4085/1062-6050-0566.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
CONTEXT Reaction time (RT) is a critical element of return to participation (RTP), and impairments have been linked to subsequent injury after a concussion. Current RT assessments have limitations in clinical feasibility and in the identification of subtle deficits after concussion symptom resolution. OBJECTIVES To examine the utility of RT measurements (clinical drop stick, simple stimulus-response, single-task Stroop, and dual-task Stroop) to differentiate between adolescents with concussion and uninjured control individuals at initial assessment and RTP. DESIGN Prospective cohort study. SETTING A pediatric sports medicine center associated with a regional tertiary care hospital. PATIENTS OR OTHER PARTICIPANTS Twenty-seven adolescents with a concussion (mean age = 14.8 ± 2.1 years; 52% female; tested 7.0 ± 3.3 days postconcussion) and 21 uninjured control individuals (mean age = 15.5 ± 1.6 years; 48% female). MAIN OUTCOME MEASURE(S) Participants completed the Post-Concussion Symptoms Inventory (PCSI) and a battery of RT tests: clinical drop stick, simple stimulus-response, single-task Stroop, and dual-task Stroop. RESULTS The concussion group demonstrated slower clinical drop stick (β = 58.8; 95% CI = 29.2, 88.3; P < .001) and dual-task Stroop (β = 464.2; 95% CI = 318.4, 610.0; P < .001) RT measures at the initial assessment than the uninjured control group. At 1-month follow up, the concussion group displayed slower clinical drop stick (238.9 ± 25.9 versus 188.1 ± 21.7 milliseconds; P < .001; d = 2.10), single-task Stroop (1527.8 ± 204.5 versus 1319.8 ± 133.5 milliseconds; P = .001; d = 1.20), and dual-task Stroop (1549.9 ± 264.7 versus 1341.5 ± 114.7 milliseconds; P = .002; d = 1.04) RT than the control group, respectively, while symptom severity was similar between groups (7.4 ± 11.2 versus 5.3 ± 6.5; P = .44; d = 0.24). Classification accuracy and area under the curve (AUC) values were highest for the clinical drop stick (85.1% accuracy, AUC = 0.86, P < .001) and dual-task Stroop (87.2% accuracy, AUC = 0.92, P < .002) RT variables at initial evaluation. CONCLUSIONS Adolescents recovering from concussion may have initial RT deficits that persist despite symptom recovery. The clinical drop stick and dual-task Stroop RT measures demonstrated high clinical utility given high classification accuracy, sensitivity, and specificity to detect postconcussion RT deficits and may be considered for initial and RTP assessment.
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Affiliation(s)
- Alice Barnes
- Sports Medicine Center, Children's Hospital Colorado, Aurora
| | - Katherine Smulligan
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
| | - Mathew J Wingerson
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
| | - Casey Little
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
| | - Vipul Lugade
- Division of Physical Therapy, Binghamton University, NY
- Control One LLC, Atlanta, GA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
- Departments of Pediatrics, University of Colorado School of Medicine, Aurora
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora
- Departments of Orthopedics, University of Colorado School of Medicine, Aurora
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Stewart SL, Withers A, Graham AA, Poss JW, Donnelly N. Examining the Biopsychosocial Factors Related to Lifetime History of Concussion in Children and Youth. Child Psychiatry Hum Dev 2024; 55:36-47. [PMID: 35729361 DOI: 10.1007/s10578-022-01384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Abstract
This study investigated the prevalence of lifetime concussions, related psychosocial problems, and post-concussion recovery rates in a clinical sample of children and youth. Participants were 24,186 children and youth (M = 11.9 years, SD = 3.5) who completed an interRAI Child and Youth Mental Health Assessment at mental health agencies across Ontario, Canada. In addition to the expected physiological correlates, results found concussions to be more prevalent in children and youth with attention deficit hyperactivity disorders, anxiety disorders, disruptive behaviour disorders, mood disorders, and those involved in self-harm, harm to others, destructive aggression, and internalizing and externalizing symptoms. The results of this study add to our understanding of children and youth's experiences with concussions. Clinical implications and recommendations are discussed to maximize the effectiveness of evidence-based interventions related to concussion recovery.
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Affiliation(s)
- Shannon L Stewart
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada
| | - Abigail Withers
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada.
| | - Alana A Graham
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G5, Canada
| | - Nicholas Donnelly
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada
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Kureshi S, Mendizabal M, Francis J, Djalilian HR. Conservative Management of Acute Sports-Related Concussions: A Narrative Review. Healthcare (Basel) 2024; 12:289. [PMID: 38338173 PMCID: PMC10855441 DOI: 10.3390/healthcare12030289] [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: 12/11/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
This review explores the application of the conservative management model for pain to sports-related concussions (SRCs), framing concussions as a distinct form of pain syndrome with a pathophysiological foundation in central sensitization. Drawing parallels with proven pain management models, we underscore the significance of a proactive approach to concussion management. Recognizing concussions as a pain syndrome allows for the tailoring of interventions in alignment with conservative principles. This review first covers the epidemiology and controversies surrounding prolonged concussion recovery and persistent post-concussion symptoms (PPCS). Next, the pathophysiology of concussions is presented within the central sensitization framework, emphasizing the need for early intervention to mitigate the neuroplastic changes that lead to heightened pain sensitivity. Five components of the central sensitization process specific to concussion injuries are highlighted as targets for conservative interventions in the acute period: peripheral sensitization, cerebral metabolic dysfunction, neuroinflammation, glymphatic system dysfunction, and pain catastrophizing. These proactive interventions are emphasized as pivotal in accelerating concussion recovery and reducing the risk of prolonged symptoms and PPCS, in line with the philosophy of conservative management.
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Affiliation(s)
- Sohaib Kureshi
- Neurosurgical Medical Clinic, San Diego, CA 92111, USA
- TBI Virtual, San Diego, CA 92111, USA
| | | | | | - Hamid R. Djalilian
- TBI Virtual, San Diego, CA 92111, USA
- Departments of Otolaryngology, Neurological Surgery, and Biomedical Engineering, University of California, Irvine, CA 92697, USA
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Verma R, DeMaio E, Render A, Wild J, Hunt D, Cato S, Shenvi N, LaBella C, Stracciolini A, Jayanthi N. The Effects of Injury Type on Health-Related Quality of Life in Youth Athletes: A Cross-Sectional Analysis. Clin J Sport Med 2024; 34:52-60. [PMID: 38147630 DOI: 10.1097/jsm.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/09/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE The relationship between health-related quality of life (HRQoL) and injury type has not been analyzed for young athletes. We hypothesized that there would be no difference in HRQoL between injured athletes, injured nonathletes, and normative data for healthy youth (NDHY) or among athletes with acute, overuse, or concussion injuries. DESIGN Cross-sectional clinical cohort. SETTING Primary care sports medicine clinics at 3 academic institutions. PARTICIPANTS Patients aged 8 to 18 years presenting with injury. INDEPENDENT VARIABLES Injury type and athletic participation. MAIN OUTCOME MEASURES Health-related quality of life measured 1 month after injury through the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 v2.0 assessed pain interference, peer relationships, depression, fatigue, anxiety, and mobility. One-way analysis of variance was performed with P values of <0.05 considered significant. Concussion Learning Assessment and School Survey (CLASS) evaluated academic performance. RESULTS Three hundred fifty-seven patients (36% male), with average age of 14.2 years, completed HRQoL and CLASS surveys following injury. There were 196 overuse injuries (55%), 119 acute injuries (33%), and 42 concussions (12%). Ninety-four percent were athletes. Six percent were nonathletes; 90.5% of concussed patients reported grades worsening. Concussed athletes reported more fatigue (P = 0.008) compared with other injury types but no worse than NDHY. Athletes with overuse injuries had lower mobility (P = 0.005) than other injury types and NDHY. Patients with lower HRQoL were female, older age, or required surgery. No other domains had significant differences by injury type nor did HRQoL differ between the athletes, nonathletes, and NDHY. CONCLUSIONS With the exception of injuries requiring surgery, HRQoL of injured young athletes was similar to NDHY in most domains.
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Affiliation(s)
- Rajiv Verma
- NorthShore University HealthSystem, Skokie, Illinois
| | - Emily DeMaio
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandria Render
- Emory Sports Medicine Center, Johns Creek, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Jacob Wild
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Danielle Hunt
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts; and
| | - Sarah Cato
- Emory Sports Medicine Center, Johns Creek, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Neeta Shenvi
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cynthia LaBella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Andrea Stracciolini
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts; and
| | - Neeru Jayanthi
- Emory Sports Medicine Center, Johns Creek, Georgia
- Emory University School of Medicine, Atlanta, Georgia
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Bowman TG, Thibault R, Radack BM, Davis A, Elam P. Clinical outcomes for various benign paroxysmal positional vertigo (BPPV) diagnoses in adolescents and young adults with recent concussions. Phys Ther Sport 2024; 65:90-94. [PMID: 38096715 DOI: 10.1016/j.ptsp.2023.12.004] [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: 09/04/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Determine how positive BPPV findings in adolescents and young adults following concussion impacted the total number of treatments required and time until discharge. SETTING Outpatient physical therapy clinic. PARTICIPANTS 167 individuals who were diagnosed with concussion or brain injury. DESIGN Retrospective chart review. MAIN MEASURES Total number of treatments and days until discharge were compared for various BPPV diagnoses (anterior canal, posterior canal, horizontal canal, and combination) and for individuals with and without BPPV. RESULTS Fifty-one out of 167 cases (30.54%) were diagnosed with BPPV. The total number of treatments provided was statistically different across BPPV diagnoses (P = .004). However, days until discharge were not statistically different between BPPV diagnoses (P = .28). There was no significant difference between time to discharge between those with BPPV (median = 21 days, range = 7-126) and those without (median = 28 days, range = 7-84 days; P = .23, r = 0.09). CONCLUSION To optimize outcomes, including symptom resolution and return to sport and/or work, early identification of BPPV and subsequent intervention should be prioritized for individuals who have concussion symptoms that suggest vestibular dysfunction.
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Affiliation(s)
- Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, 1501 Lakeside Dr, Lynchburg VA, 24501, USA.
| | - Rachel Thibault
- Rehab Associates of Central Virginia, 3211 Forest Brook Rd, Lynchburg, VA, 24501, USA
| | - Benjamin M Radack
- School of Physical Therapy, University of Lynchburg, 300 Monticello Ave, Ste A, Lynchburg, VA, 24501, USA
| | - Anissa Davis
- School of Physical Therapy, University of Lynchburg, 300 Monticello Avenue, Suite A, Lynchburg, VA, 24501, USA
| | - Penelope Elam
- School of Physical Therapy, University of Lynchburg, 300 Monticello Avenue, Suite A, Lynchburg, VA, 24501, USA
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Morris A, Petersell TL, Pelo R, Hill S, Cassidy B, Jameson T, Iriye T, Burke J, Dibble LE, Fino PC. Use of Reactive Balance Assessments With Clinical Baseline Concussion Assessments in Collegiate Athletes. J Athl Train 2024; 59:39-48. [PMID: 36583958 PMCID: PMC10783474 DOI: 10.4085/1062-6050-0231.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Current clinical concussion evaluations assess balance deficits using static or dynamic balance tasks while largely ignoring reactive balance. Including a reactive balance assessment might provide a more comprehensive concussion evaluation. OBJECTIVES To identify redundancy in current clinical baseline assessments of concussion and determine whether reactive balance adds unique information to these evaluations. DESIGN Cross-sectional study. SETTING Clinical assessment. PATIENTS OR OTHER PARTICIPANTS A total of 279 healthy National Collegiate Athletic Association Division I athletes. INTERVENTION(S) Two cohorts of data were collected at the beginning of the athletic season. For cohort 1 (n = 191), the Immediate Post-Concussion Assessment and Cognitive Tool, instrumented modified push and release (I-mP&R), and Balance Error Scoring System (BESS) were administered. For cohort 2 (n = 88), the I-mP&R, BESS, timed tandem gait, walking with eyes closed, and clinical reaction time were administered. MAIN OUTCOME MEASURE(S) The strengths of the relationships between the Immediate Post-Concussion Assessment and Cognitive Tool cognitive indices, mP&R clinical score, instrumented measures (BESS sway; I-mP&R time to stability, latency, and step length), BESS score, timed tandem gait, walking time to completion, and clinical reaction time were characterized. RESULTS The strongest interinstrument correlation value was between single-task time to stability from the I-mP&R and clinical reaction time but was considered weak (r = 0.35, P = .001). The mP&R and I-mP&R clinical scores were weakly associated with the other assessments. CONCLUSIONS Weak correlations between interassessment variables indicated that little redundancy was present in the current clinical evaluations. Furthermore, reactive balance represents a unique domain of function that may improve the comprehensiveness of clinical assessments.
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Affiliation(s)
- Amanda Morris
- Department of Health & Kinesiology, University of Utah, Salt Lake City
| | - Tessa L Petersell
- Department of Health & Kinesiology, University of Utah, Salt Lake City
| | - Ryan Pelo
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City
| | - Sarah Hill
- Department of Health & Kinesiology, University of Utah, Salt Lake City
| | - Benjamin Cassidy
- Department of Health & Kinesiology, University of Utah, Salt Lake City
| | - Trevor Jameson
- Department of Athletics, University of Utah, Salt Lake City
| | - Tom Iriye
- Department of Athletics, University of Utah, Salt Lake City
| | - Jon Burke
- Department of Athletics, University of Utah, Salt Lake City
| | - Leland E Dibble
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City
| | - Peter C Fino
- Department of Health & Kinesiology, University of Utah, Salt Lake City
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46
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Pollard-McGrandy AM, Tracey AJ, Wallace J, Covassin T, Beidler E. Perceptions of personal control and treatment efficacy of sport-related concussions in collegiate athletes. Brain Inj 2023; 37:1362-1369. [PMID: 38111232 DOI: 10.1080/02699052.2023.2292998] [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: 09/07/2022] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE The purpose of this study was to examine healthy collegiate athletes' perceptions of personal control and beliefs regarding the treatment efficacy related to sport-related concussion (SRC) along with identifying factors that may be associated with these perceptions. METHODS This cross-sectional study included collegiate athletes (n = 956) between the age of 18-26 years. Participants completed a 10- to 15-min survey regarding their demographics, diagnosed SRC history, SRC knowledge, and Perceptions of Concussion Inventory for Athletes (PCI-A). Chi-squared analysis and multivariable logistic regressions were conducted to identify factors associated with the PCI-A outcomes of personal control and treatment efficacy perceptions. RESULTS 24.2% of respondents reported higher perceptions of personal control, while 77.3% reported higher perceptions of treatment efficacy. The multivariable logistic regression revealed males had higher odds of greater perceptions of personal control (OR = 1.50; 95% CI: 1.10-2.03), while those with a history of diagnosed SRC had lower odds of having favorable treatment efficacy beliefs (OR: 0.69; 95% CI: 0.50-0.96). CONCLUSIONS This study established that collegiate athletes generally have lower perceptions of personal control and higher perceptions of treatment efficacy related to SRC recovery. Comprehensive SRC education should be expanded for individuals to understand that they have power over their own health outcomes and that SRC is a treatable injury.
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Affiliation(s)
| | - Allie J Tracey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jessica Wallace
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
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Garcia GGP, Czerniak LL, Lavieri MS, Liebel SW, Van Pelt KL, Pasquina PF, McAllister TW, McCrea MA, Broglio SP. Estimating the Relationship Between the Symptom-Free Waiting Period and Injury Rates After Return-to-Play from Concussion: A Simulation Analysis Using CARE Consortium Data. Sports Med 2023; 53:2513-2528. [PMID: 37610654 DOI: 10.1007/s40279-023-01901-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND A key component of return-to-play (RTP) from sport-related concussion is the symptom-free waiting period (SFWP), i.e., the period during which athletes must remain symptom-free before permitting RTP. Yet, the exact relationship between SFWP and post-RTP injury rates is unclear. OBJECTIVE We design computational simulations to estimate the relationship between the SFWP and rates of repeat concussion and non-concussion time-loss injury up to 30 days post-RTP for male and female collegiate athletes across 13 sports. METHODS We leverage N = 735 female and N = 1,094 male post-injury trajectories from the National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research, and Education Consortium. RESULTS With a 6-day SFWP, the mean [95% CI] rate of repeat concussion per 1,000 simulations was greatest in ice hockey for females (20.31, [20.16, 20.46]) and American football for males (24.16, [24.05, 24.28]). Non-concussion time-loss injury rates were greatest in field hockey for females (153.66, [152.59, 154.74]) and wrestling for males (247.34, [246.20, 248.48]). Increasing to a 13-day SFWP, ice hockey for females (18.88, [18.79, 18.98]) and American football for males (23.16, [23.09, 24.22]) exhibit the greatest decrease in repeat concussion rates across all sports within their respective sexes. Field hockey for females (143.24, [142.53, 143.94]) and wrestling for males (237.73, [236.67, 237.90]) exhibit the greatest decrease in non-concussion time-loss injury rates. Males receive marginally smaller reductions in injury rates for increased SFWP compared to females (OR = 1.003, p ≤ 0.002). CONCLUSION Longer SFWPs lead to greater reductions in post-RTP injury rates for athletes in higher risk sports. Moreover, SFWPs should be tailored to sport-specific post-RTP injury risks.
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Affiliation(s)
- Gian-Gabriel P Garcia
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Lauren L Czerniak
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Mariel S Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Spencer W Liebel
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | | | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
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48
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Tadmor D, Till K, Phillips G, Brown J, Fairbank L, Hendricks S, Johnston RD, Longworth T, Stokes K, Jones B. I won't let you down; why 20% of Men's and Women's Super League players underreported suspected concussions. J Sci Med Sport 2023; 26:688-693. [PMID: 37813720 DOI: 10.1016/j.jsams.2023.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/27/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Quantify and identify factors associated with concussion underreporting in Super League rugby league players. DESIGN Cross sectional survey. METHODS During the 2022 season preseason, 422 Men's and Women's Super League players completed an online survey quantifying player demographics, rugby playing history, concussion history, prevalence of, and reasons for underreporting concussion, concussion knowledge and long-term implications and perceptions of concussion. RESULTS Overall, 20% of respondents stated they did not report concussion-related symptoms to medical staff during the 2020 and 2021 seasons. The two most common reasons for underreporting concussion were 'didn't want to be ruled out of a match' (35%) and 'didn't want to let down team' (24%). 65% of players reported an appropriate level of knowledge about concussion and potential long-term implications at the start of their senior rugby career, versus 89% now. In relation to concussion knowledge, symptoms were correctly identified on 74% of occasions. 57% of players surveyed were concerned about the potential long-term implications from concussion, and 11% of players would encourage their/family members' children to not play rugby league. CONCLUSIONS The proportion of Super League players who did not report concussion symptoms was similar to rugby league players in Australia. The main reasons for not reporting concussion appeared to be due to perceptions of what is beneficial for the team, suggesting both performance and medical staff should collectively encourage players to report concussion. A player's attitude towards concussion is potentially an individual modifiable risk factor and should be considered within the concussion management of players.
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Affiliation(s)
- Daniel Tadmor
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Leeds Rhinos Rugby League Club, United Kingdom; England Performance Unit, Rugby Football League, United Kingdom. https://twitter.com/danieltadmor
| | - Kevin Till
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Leeds Rhinos Rugby League Club, United Kingdom. https://twitter.com/ktconditioning
| | - Gemma Phillips
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; England Performance Unit, Rugby Football League, United Kingdom; Hull Kingston Rovers, United Kingdom
| | - James Brown
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Institute of Sport and Exercise Medicine (ISEM), Department of Exercise, Sport and Lifestyle Medicine and Health Sciences, Stellenbosch University, South Africa; Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre, Department of Human Biology, Faculty of Health Sciences, The University of Cape Town, South Africa. https://twitter.com/jamesbrown06
| | - Laura Fairbank
- England Performance Unit, Rugby Football League, United Kingdom
| | - Sharief Hendricks
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre, Department of Human Biology, Faculty of Health Sciences, The University of Cape Town, South Africa. https://twitter.com/sharief_h
| | - Rich D Johnston
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; School of Behavioural and Health Sciences, Australian Catholic University, Australia; Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Australia. https://twitter.com/richjohnston88
| | - Thomas Longworth
- Sports Medicine, Eastern Suburbs Sports Medicine Centre, Australia; Medical, New South Wales Institute of Sport, Australia
| | - Keith Stokes
- Centre for Health, and Injury & Illness Prevention in Sport, University of Bath, United Kingdom; UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, United Kingdom; Rugby Football Union, United Kingdom. https://twitter.com/drkeithstokes
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; England Performance Unit, Rugby Football League, United Kingdom; Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre, Department of Human Biology, Faculty of Health Sciences, The University of Cape Town, South Africa; School of Behavioural and Health Sciences, Australian Catholic University, Australia; Premiership Rugby, United Kingdom.
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49
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Kontos AP, Eagle SR, Braithwaite R, Preszler J, Manderino L, Turner RL, Jennings S, Trbovich A, Hickey RW, Collins MW, McCrea M, Nelson LD, Root J, Thomas DG. The Effects of Rest on Concussion Symptom Resolution and Recovery Time: A Meta-analytic Review and Subgroup Analysis of 4329 Patients. Am J Sports Med 2023; 51:3893-3903. [PMID: 36847271 DOI: 10.1177/03635465221150214] [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] [Indexed: 03/01/2023]
Abstract
BACKGROUND Numerous individual studies suggest that rest may have a negative effect on outcomes following concussion. PURPOSE To perform a systematic meta-analysis of the effects of prescribed rest compared with active interventions after concussion. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A meta-analysis (using the Hedges g) of randomized controlled trials and cohort studies was conducted to evaluate the effects of prescribed rest on symptoms and recovery time after concussion. Subgroup analyses were performed for methodological, study, and sample characteristics. Data sources were obtained from systematic search of key terms using Ovid Medline, Embase, Cochrane Database of Systematic Reviews, APA PsycINFO, Web of Science, SPORTDiscus, and ProQuest dissertations and theses through May 28, 2021. Eligible studies were those that (1) assessed concussion or mild traumatic brain injury; (2) included symptoms or days to recovery for ≥2 time points; (3) included 2 groups with 1 group assigned to rest; and (4) were written in the English language. RESULTS In total, 19 studies involving 4239 participants met criteria. Prescribed rest had a significant negative effect on symptoms (k = 15; g = -0.27; SE = 0.11; 95% CI, -0.48 to -0.05; P = .04) but not on recovery time (k = 8; g = -0.16; SE = 0.21; 95% CI, -0.57 to 0.26; P = .03). Subgroup analyses suggested that studies with shorter duration (<28 days) (g = -0.46; k = 5), studies involving youth (g = -0.33; k = 12), and studies focused on sport-related concussion (g = -0.38; k = 8) reported higher effect sizes. CONCLUSION The findings support a small negative effect for prescribed rest on symptoms after concussion. Younger age and sport-related mechanisms of injury were associated with a greater negative effect size. However, the lack of support for an effect for recovery time and the relatively small overall numbers of eligible studies highlight ongoing concerns regarding the quantity and rigor of clinical trials in concussion. REGISTRATION CRD42021253060 (PROSPERO).
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Affiliation(s)
- Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Shawn R Eagle
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rock Braithwaite
- Department of Kinesiology and Recreation Administration, Cal Poly Humboldt, Arcata, California, USA
| | - Jonathan Preszler
- UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Lisa Manderino
- UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Rose L Turner
- Health Science Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Alicia Trbovich
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Robert W Hickey
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Children's Hospital of Pittsburgh Division of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael W Collins
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeremy Root
- Pediatric Emergency Medicine, George Washington School of Medicine, Washington, DC, USA; Children's National Health System, Fairfax, Virginia, USA
| | - Danny G Thomas
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Pediatric Emergency Medicine, Children's Wisconsin, Wauwatosa, Wisconsin, USA)
- Investigation performed at University of Pittsburgh Medical Center Sports Concussion Program and University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, Pennsylvania, USA
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50
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Thomas GA, Bradson ML, Riegler KE, Arnett PA. Affective Disturbance and Neurocognitive Variability in College Athletes. Arch Clin Neuropsychol 2023; 38:1623-1634. [PMID: 37194439 DOI: 10.1093/arclin/acad037] [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: 12/13/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE Research on the neurocognitive effects of comorbid mood/anxiety disturbance in college athletes is limited. Previous research found that athletes with comorbid depression/anxiety performed worse on measures of attention/processing speed (A/PS) at baseline compared to healthy controls. However, this work solely examined mean performance. The current study expands upon this work by examining intraindividual variability (IIV) in relation to affective disturbance. METHOD 835 (M = 624, F = 211) collegiate athletes completed baseline neuropsychological testing. Athletes were separated into four groups (Healthy Mood [n = 582], Depression Alone [n = 137], Anxiety Alone [n = 54], and Co-Occurring Depression/Anxiety [n = 62]) based on self-reported anxiety and depression. IIV was examined globally and within composites of A/PS and memory via intraindividual standard deviation, with higher scores indicating greater variability. RESULTS Linear regression results revealed that the Co-Occurring Depression/Anxiety group exhibited greater variability within the memory composite compared to the Healthy Mood group, as well as the Depression Alone and Anxiety Alone groups. The Depression Alone and Anxiety Alone groups did not differ from the Healthy Mood group on memory IIV. None of the groups differed on A/PS or global IIV. CONCLUSIONS Athletes with co-occurring depression/anxiety demonstrated greater variability in performance on memory tasks. Greater dispersion is predictive of greater cognitive decline following concussion; therefore, it is important that neuropsychological performance is interpreted beyond measures of central tendency. These findings also highlight the importance of having baseline data available for athletes with affective disturbance, as these factors may influence performance, place athlete at risk for poorer outcomes, and skew future post-concussion comparisons.
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Affiliation(s)
- Garrett A Thomas
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Megan L Bradson
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Kaitlin E Riegler
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
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