1
|
Quigley KG, Fenner M, Pavilionis P, Constantino NL, Moran RN, Murray NG. Minimal Detectable Change for the ImPACT Subtests at Baseline. Arch Clin Neuropsychol 2024; 39:626-634. [PMID: 38273670 PMCID: PMC11269890 DOI: 10.1093/arclin/acae002] [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: 08/29/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To establish the minimal detectable change (MDC) of the subtests that comprise the composite scores from remotely administered Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baselines. METHOD Remote ImPACT baseline data from 172 (male = 45, female = 127) National Collegiate Athletic Association Division I student-athletes from the 2020 and 2021 athletic preseasons were used to calculate the MDC at the 95%, 90%, and 80% confidence intervals (CIs) for all subtest scores used to generate the four core composite scores and the impulse control composite. RESULTS The MDCs for the verbal memory subtests at the 95% CI were 10.31 for word memory percent correct, 4.68 for symbol match total correct hidden, and 18.25 for three letters percentage correct. Visual memory subtest MDCs were 19.03 for design memory total percent correct and 4.90 for XO total correct memory. Visual motor speed subtest MDCs were 18.89 for XO total correct interference and 5.40 for three letters average counted correctly. Reaction time (RT) MDCs were 0.12 for XO average correct, 0.95 for symbol match average correct RT, and 0.28 for color match average correct. Impulse control MDCs were 5.97 for XO total incorrect and 1.15 for color match total commissions. One-way repeated measures MANOVA, repeated measures ANOVAs, and Wilcoxon signed-ranks test all suggested no significant difference between any subtests across two remote ImPACT baselines. CONCLUSIONS The ImPACT subtest scores did not significantly change between athletic seasons. Our study suggests the subtests be evaluated in conjunction with the composite scores to provide additional metrics for clinical interpretation.
Collapse
Affiliation(s)
- Kristen G Quigley
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
| | - Madison Fenner
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
| | - Philip Pavilionis
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
| | - Nora L Constantino
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
| | - Ryan N Moran
- Athletic Training Research Laboratory, Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Nicholas G Murray
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
| |
Collapse
|
2
|
Lemke J, D'Alessio AS, Briggs FBS, Bailey C. Influence of social determinants of health and adversity on computerized neurocognitive assessment. Clin Neuropsychol 2024:1-20. [PMID: 38993089 DOI: 10.1080/13854046.2024.2375801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
Introduction: Social determinants of health and adversity, including poverty, maltreatment, and neighborhood deprivation, are individual-level factors that may significantly affect baseline neurocognitive testing and management that have yet to be thoroughly explored within the computerized neurocognitive assessment.Objectives: Examine individual-level experiences of poverty, abuse, neighborhood deprivation, and social mobility on computerized cognitive testing.Methods: The sample included 3,845 student-athletes who completed a baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and were enrolled in the Child-Household Integrated Longitudinal Data database. Multivariable linear regressions were used to assess independent variables of Supplemental Nutrition Assistance Program enrollment, abuse or neglect cases, Area Deprivation Index scores, and other demographic factors on four baseline ImPACT composite scores: verbal and visual memory, visuomotor, and reaction time.Results: Individual-level factors of persistent poverty and neighborhood deprivation were associated with lower composite scores; however, upward social mobility was not significantly associated with cognitive performance. The effects of mother's race on computerized cognitive testing performance were attenuated when accounting for measures of adversity.Conclusion: Findings highlight the importance of social determinants of health in computerized neurocognitive testing to ensure more culturally sensitive and precise understanding of athletic baselines.
Collapse
Affiliation(s)
- Jillian Lemke
- Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Alena Sorensen D'Alessio
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Farren B S Briggs
- Department of Public Health Sciences, Division of Epidemiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Christopher Bailey
- Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
3
|
Liu BC, Iverson GL, Cook NE, Schatz P, Berkner P, Gaudet CE. The prevalence and correlates of scores falling below ImPACT embedded validity indicators among adolescent student athletes. Clin Neuropsychol 2024; 38:1175-1192. [PMID: 38233364 DOI: 10.1080/13854046.2023.2287777] [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: 07/07/2023] [Accepted: 11/20/2023] [Indexed: 01/19/2024]
Abstract
Objective: Valid performance on preseason baseline neurocognitive testing is essential for accurate comparison between preseason and post-concussion test results. Immediate Post-Concussion and Cognitive Testing (ImPACT) is commonly used to measure baseline neurocognitive function in athletes. We examined the prevalence of invalid performance on ImPACT baseline testing and identified correlates of invalid performance. Method: The sample included 66,998 adolescents (ages 14-18, M = 15.51 years, SD = 1.22) who completed ImPACT baseline tests between 2009 and 2019. Invalid performance was determined by the embedded validity indicators (EVI). Associations between invalid performance, demographic characteristics, and health conditions were assessed using chi-square tests and odds ratios (ORs). Results: Overall, 7.2% of adolescents had baseline tests identified as invalid by one or more of the EVIs. Individual validity indicators classified between 0.5% and 3.7% tests as invalid. Higher frequencies of invalid scores were observed among youth with neurodevelopmental, academic, and medical conditions. Youth who reported having learning disabilities (n = 3126), receiving special education (n = 3563), or problems with attention-deficit/hyperactivity disorder (ADHD; n = 5104) obtained invalid baselines at frequencies of 16.4%, 16.0%, and 11.1%, respectively. Moreover, youth who reported receiving treatment for a substance use disorder (n = 311) or epilepsy (n = 718) obtained invalid baselines at frequencies of 17.0% and 11.1%, respectively. Conclusions: The base rate of invalid performance on ImPACT's EVIs was approximately 7%, consistent with prior research. Adolescents self-reporting neurodevelopmental conditions, academic difficulties, or a history of treatment for medical conditions obtained invalid baseline tests at higher frequencies. More research is needed to better understand invalid scores in youth with pre-existing conditions.
Collapse
Affiliation(s)
- Brian C Liu
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Grant L Iverson
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
| | - Nathan E Cook
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Philip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
| | - Paul Berkner
- College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Charles E Gaudet
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
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.
Collapse
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
| | | |
Collapse
|
5
|
Leggett B, Eliason P, Sick S, Burma JS, Wong SK, Laperrière D, Goulet C, Fremont P, Russell K, Schneider KJ, Emery CA. Youth Preseason Performance on the Sport Concussion Assessment Tool 5 Across Multiple Sports. Clin J Sport Med 2024; 34:288-296. [PMID: 38149828 DOI: 10.1097/jsm.0000000000001201] [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: 05/09/2023] [Accepted: 11/07/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To examine preseason Sport Concussion Assessment Tool 5 (SCAT5) performance of adolescent sport participants by environment (in-person/virtual), sex, age, concussion history, collision/noncollision sport participation, and self-reported medical diagnoses. DESIGN Cross-sectional. SETTING Canadian community and high-school sport settings. PARTICIPANTS Three thousand eight hundred five adolescent (2493 male, 1275 female, and 37 did not disclose; 11- to 19-year-old) sport participants. ASSESSMENT OF RISK FACTORS Sport Concussion Assessment Tool 5 administration method (in-person/virtual), sex (male/female/unreported), age (years), concussion history (0/1/2/3+), collision/noncollision sport participant, and self-reported medical diagnoses [attention deficit disorder or attention-deficit/hyperactivity disorder, headache/migraine, learning disability, and psychiatric disorder (ie, anxiety/depression/other)]. OUTCOME MEASURES Preseason SCAT5 outcomes including total number of symptoms (TNS; /22), symptom severity score (SSS; /132), Standardized Assessment of Concussion (SAC; /50), and modified Balance Error Scoring System (mBESS; /30). RESULTS Multiple multilevel linear or Poisson regression complete case analyses adjusting for clustering and robust standard errors, with β-coefficients (95% CI) back-transformed to indicate an increase/decrease in SCAT5 subdomains when relevant for clinical interpretation. Virtual (V) performance was associated with fewer symptoms reported [TNS Difference V-IP = -1.53 (95% CI, -2.22 to -0.85)], lower SSS [-2.49 (95% CI, -4.41 to -0.58)], and fewer mBESS errors (IP) [-0.52 (95% CI, -0.77 to -0.27)] compared with in-person. For every one-year increase in age, more symptoms [TNS = 0.22 (95% CI, 0.01-0.44)], higher SSS [0.52 (95% CI, 0.01-1.06)], higher SAC [0.27 (95% CI, 0.15-0.38), and poorer balance [mBESS = -0.19 (-0.28 to -0.09)] were observed. Differences between males and females were also seen across all SCAT5 outcomes. Individuals reporting any medical diagnosis or 3+ concussion history also reported more symptoms (TNS) and higher SSS than those who did not. CONCLUSIONS Administration environment, sex, age, concussion history, and medical diagnoses were associated with SCAT5 subdomains and are important considerations when interpreting the SCAT5 results.
Collapse
Affiliation(s)
- Benjamin Leggett
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Paul Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Stacy Sick
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Joel S Burma
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Sophie K Wong
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - David Laperrière
- Pavillon de l'Éducation physique et des sports, Université Laval, Québec City, QC, Canada
- Pediatrics and Child Health, University of Manitoba, Winnipeg, MN, Canada
- Department of Physical Education, Faculty of Education, Université Laval, Québec City, QC, Canada
| | - Claude Goulet
- Department of Physical Education, Faculty of Education, Université Laval, Québec City, QC, Canada
| | - Pierre Fremont
- Pavillon de l'Éducation physique et des sports, Université Laval, Québec City, QC, Canada
| | - Kelly Russell
- Pediatrics and Child Health, University of Manitoba, Winnipeg, MN, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Evidence Sport and Spine, Calgary, AB, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
6
|
Kalagara R, Hrabarchuk EI, Hannah TC, Downes MH, Li T, Vasan V, Li AY, Asfaw ZK, Quinones A, McCarthy L, Schupper AJ, Gometz A, Lovell MR, Choudhri TF. The effect of age on baseline neurocognitive performance. Brain Inj 2024; 38:136-141. [PMID: 38328998 DOI: 10.1080/02699052.2024.2307968] [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: 06/01/2022] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Evaluate the independent effect of age on baseline neurocognitive performance. STUDY DESIGN Baseline ImPACT scores from tests taken by 7454 athletes aged 12-22 from 2009 to 2019 were split into three age cohorts: 12-14 years (3244), 15-17 years (3732), and 18-22 years (477). Linear regression analyses were used to evaluate the effect of age on ImPACT composite scores while controlling for demographic differences, medication-use, and symptom burden. Significance values have been set at p < 0.05. RESULTS Linear regression analyses demonstrated that increased age does not significantly affect symptom score (β = 0.06, p = 0.54) but does improve impulse control (β = -0.45, p < 0.0001), verbal memory (β = 0.23, p = 0.03), visualmotor (β = 0.77, p < 0.0001), and reaction time (β = -0.008, p < 0.0001) scores. However, age did not have an effect on visual memory scores (β = -0.25, p = 0.07). CONCLUSIONS Age was shown to be an independent modifier of impulse control, verbal memory, visual motor, and reaction time scores but not visual memory or symptom scores. This underscores the previous literature showing developmental differences as age increases among the adolescent athlete population. This data also indicates the need for repeat neurocognitive baseline testing every other year as baseline scoring is likely to change as athletes become older.
Collapse
Affiliation(s)
- Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Eugene I Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Margaret H Downes
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Troy Li
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Alex Gometz
- Concussion Management of New York, New York, USA
| | - Mark R Lovell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| |
Collapse
|
7
|
Höllerer D, Kaiser P, Runer A, Steiner E, Koidl C, Arora R, Schneider F. Injury Incidence, Outcomes, and Return to Competition Times after Sports-Related Concussions during One Professional Ice Hockey Season: A Prospective Cohort Study. Healthcare (Basel) 2023; 11:3153. [PMID: 38132042 PMCID: PMC10742495 DOI: 10.3390/healthcare11243153] [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: 08/24/2023] [Revised: 11/26/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE The objective of this study was to analyze the incidence and characteristics of sports-related concussions (SRCs) for a professional ice hockey team during one regular season in the International Central European Hockey League. BACKGROUND Repeated concussions are a common cause of long periods of absence in team contact sports, with a wide range of potential short- and long-term consequences for the affected athlete. Questions mainly regarding early diagnosis and ideal follow-up treatment remain unanswered, especially regarding the timing of return to sports (RTS). METHOD A prospective data analysis for a professional ice hockey team during a regular season was conducted. Firstly, concussions per 1000 athlete exposure (AE) and average time loss due to SRC were calculated. Secondly, the data from ImPACT Applications were analyzed for those players who were diagnosed with an SRC. RESULTS Five SRCs were evaluated during the regular season, which resulted in 1.35 concussions/1000 AEs, a maximum of 17 missed games, and a median of three games per SRC. The average symptom count was 9.6, with the most common symptoms being headache, sensitivity to light, and dizziness. CONCLUSIONS SRCs sustained in professional ice hockey are a common in-competition injury, while practices play a subsidiary role. The duration of RTS is highly individual and can be associated with symptoms lasting days to months.
Collapse
Affiliation(s)
- Dominik Höllerer
- Faculty of Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Peter Kaiser
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- HC TIWAG Innsbruck, 6020 Innsbruck, Austria
| | - Armin Runer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- HC TIWAG Innsbruck, 6020 Innsbruck, Austria
- Department of Sports Orthopaedics, Technical University of Munich, 81675 Munich, Germany
| | | | - Christian Koidl
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- HC TIWAG Innsbruck, 6020 Innsbruck, Austria
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Friedemann Schneider
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- HC TIWAG Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
8
|
Cook NE, Iverson IA, Maxwell B, Zafonte R, Berkner PD, Iverson GL. Neurocognitive Test Performance and Concussion-Like Symptom Reporting Among Adolescent Athletes With Self-Reported Autism on Preseason Assessments. Arch Clin Neuropsychol 2023; 38:1586-1596. [PMID: 37290752 DOI: 10.1093/arclin/acad034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To examine baseline neurocognitive functioning and symptom reporting among adolescents with self-reported autism. METHOD Participants in this cross-sectional, observational study were 60,751 adolescents who completed preseason testing. There were 425 students (0.7%) who self-reported an autism spectrum disorder (ASD) diagnosis. Cognitive functioning was measured by Immediate Post-Concussion Assessment and Cognitive Testing and symptom ratings were obtained from the Post-Concussion Symptom Scale. RESULTS Groups differed significantly across all neurocognitive composites (p values <.002); effect size magnitudes for most differences were small, though among boys a noteworthy difference on visual memory and among girls differences on verbal memory and visual motor speed composites were noted. Among boys, the ASD group endorsed 21 of the 22 symptoms at a greater rate. Among girls, the ASD group endorsed 11 of the 22 symptoms at a greater rate. Some examples of symptoms that were endorsed at a higher rate among adolescents with self-reported autism were sensitivity to noise (girls: odds ratio, OR = 4.38; boys: OR = 4.99), numbness or tingling (girls: OR = 3.67; boys: OR = 3.25), difficulty remembering (girls: OR = 2.01; boys: OR = 2.49), difficulty concentrating (girls: OR = 1.82; boys: OR = 2.40), sensitivity to light (girls: OR = 1.82; boys: OR = 1.76), sadness (girls: OR = 1.72; boys: OR = 2.56), nervousness (girls: OR = 1.80; boys: OR = 2.27), and feeling more emotional (girls: OR = 1.79; boys: OR = 2.84). CONCLUSION Students with self-reported autism participating in organized sports likely experience a low degree of functional impairment, on average. If they sustain a concussion, their clinical management should be more intensive to maximize the likelihood of swift and favorable recovery.
Collapse
Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts 02115, USA
- Mass General for Children Sports Concussion Program, Waltham, Massachusetts 02451, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital; Charlestown, Massachusetts 02129, USA
| | - Ila A Iverson
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Bruce Maxwell
- Department of Computer Science, Colby College, Waterville, Maine 04901, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts 02115, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital; Charlestown, Massachusetts 02129, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Paul D Berkner
- College of Osteopathic Medicine, University of New England, Biddeford, Maine 04005, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts 02115, USA
- Mass General for Children Sports Concussion Program, Waltham, Massachusetts 02451, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital; Charlestown, Massachusetts 02129, USA
- Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts 02129, USA
| |
Collapse
|
9
|
Crane A, Roccaforte A, Webbe F, LoGalbo A. Does Frequency of Baseline Testing Influence Concussion Diagnostic Decision Making Among College Athletes. Arch Clin Neuropsychol 2023; 38:1635-1645. [PMID: 37348054 DOI: 10.1093/arclin/acad047] [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: 05/16/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE Concussion is a growing public health concern given the large number of youth and collegiate athletes participating in collision sports. Sport-related concussions can have an adverse impact on student-athletes' health and academic performance. Athletic programs within academic organizations are motivated to employ the most effective and efficient diagnostic and recovery procedures to minimize the duration and impact of these symptoms on student-athletes' functioning. The present study sought to further our understanding regarding the value and frequency of conducting baseline assessments when evaluating sport-related concussions. METHOD A total of 41 athletes (24 men, 17 women) between the ages of 18 and 22 were evaluated following suspected concussive injury between 2015 and 2018. Post-injury test results were compared to baselines that had been collected either 1 or 2 years prior, and to normative data, to determine consistency in diagnostic outcomes. RESULTS Baseline test/retest reliability using Pearson's bivariate correlations revealed modest correlations on measures of verbal and visual memory (0.437-0.569) and very strong correlations on measures of reaction time and visual-motor speed (0.811-0.821). Meanwhile, minimal if any differences in clinical decision-making regarding the diagnostic outcome was observed when comparing post-injury test results to different baselines and to normative data. CONCLUSIONS Findings indicate that yearly baseline testing may not improve diagnostic accuracy, and in many cases, normative data may be adequate for decision-making. Additional research should evaluate the potential benefit of baseline testing in return-to-play decision-making among broader athletic populations.
Collapse
Affiliation(s)
- Andrew Crane
- Concussion Management Program, Florida Institute of Technology, 150 W University Blvd, Melbourne, FL 32901
| | - Analise Roccaforte
- Concussion Management Program, Florida Institute of Technology, 150 W University Blvd, Melbourne, FL 32901
| | - Frank Webbe
- Concussion Management Program, Florida Institute of Technology, 150 W University Blvd, Melbourne, FL 32901
| | - Anthony LoGalbo
- Concussion Management Program, Florida Institute of Technology, 150 W University Blvd, Melbourne, FL 32901
| |
Collapse
|
10
|
Hicks SD, Onks C, Kim RY, Zhen KJ, Loeffert J, Loeffert AC, Olympia RP, Fedorchak G, DeVita S, Gagnon Z, McLoughlin C, Madeira MM, Zuckerman SL, Lee T, Heller M, Monteith C, Campbell TR, Neville C, Fengler E, Dretsch MN. Refinement of saliva microRNA biomarkers for sports-related concussion. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:369-378. [PMID: 34461327 DOI: 10.1016/j.jshs.2021.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/29/2021] [Accepted: 07/13/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Recognizing sport-related concussion (SRC) is challenging and relies heavily on subjective symptom reports. An objective, biological marker could improve recognition and understanding of SRC. There is emerging evidence that salivary micro-ribonucleic acids (miRNAs) may serve as biomarkers of concussion; however, it remains unclear whether concussion-related miRNAs are impacted by exercise. We sought to determine whether 40 miRNAs previously implicated in concussion pathophysiology were affected by participation in a variety of contact and non-contact sports. Our goal was to refine a miRNA-based tool capable of identifying athletes with SRC without the confounding effects of exercise. METHODS This case-control study harmonized data from concussed and non-concussed athletes recruited across 10 sites. Levels of salivary miRNAs within 455 samples from 314 individuals were measured with RNA sequencing. Within-subjects testing was used to identify and exclude miRNAs that changed with either (a) a single episode of exercise (166 samples from 83 individuals) or (b) season-long participation in contact sports (212 samples from 106 individuals). The miRNAs that were not impacted by exercise were interrogated for SRC diagnostic utility using logistic regression (172 samples from 75 concussed and 97 non-concussed individuals). RESULTS Two miRNAs (miR-532-5p and miR-182-5p) decreased (adjusted p < 0.05) after a single episode of exercise, and 1 miRNA (miR-4510) increased only after contact sports participation. Twenty-three miRNAs changed at the end of a contact sports season. Two of these miRNAs (miR-26b-3p and miR-29c-3p) were associated (R > 0.50; adjusted p < 0.05) with the number of head impacts sustained in a single football practice. Among the 15 miRNAs not confounded by exercise or season-long contact sports participation, 11 demonstrated a significant difference (adjusted p < 0.05) between concussed and non-concussed participants, and 6 displayed moderate ability (area under curve > 0.70) to identify concussion. A single ratio (miR-27a-5p/miR-30a-3p) displayed the highest accuracy (AUC = 0.810, sensitivity = 82.4%, specificity = 73.3%) for differentiating concussed and non-concussed participants. Accuracy did not differ between participants with SRC and non-SRC (z = 0.5, p = 0.60). CONCLUSION Salivary miRNA levels may accurately identify SRC when not confounded by exercise. Refinement of this approach in a large cohort of athletes could eventually lead to a non-invasive, sideline adjunct for SRC assessment.
Collapse
Affiliation(s)
- Steven D Hicks
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA.
| | - Cayce Onks
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; Department of Family Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Raymond Y Kim
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Kevin J Zhen
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Jayson Loeffert
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; Department of Family Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Andrea C Loeffert
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Robert P Olympia
- Department of Emergency Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Gregory Fedorchak
- Department of Research and Development, Quadrant Biosciences Inc., Syracuse, NY 13210, USA
| | - Samantha DeVita
- Department of Research and Development, Quadrant Biosciences Inc., Syracuse, NY 13210, USA
| | - Zofia Gagnon
- Department of Biology, Marist College, Poughkeepsie, NY 12601, USA
| | | | - Miguel M Madeira
- Department of Biology, Marist College, Poughkeepsie, NY 12601, USA
| | - Scott L Zuckerman
- Sports Concussion Center, College of Medicine, Vanderbilt University, Nashville, TN 37212, USA
| | - Timothy Lee
- Sports Concussion Center, College of Medicine, Vanderbilt University, Nashville, TN 37212, USA
| | - Matthew Heller
- Department of Family Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA
| | - Chuck Monteith
- Department of Athletic Training, Colgate University, Hamilton, NY 13346, USA
| | - Thomas R Campbell
- Department of Rehabilitation Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Christopher Neville
- Department of Physical Therapy Education, Orthopedics, and Neuroscience, College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Elise Fengler
- Department of Exercise Science, Syracuse University, Syracuse, NY 13210, USA
| | - Michael N Dretsch
- Department of Medical Research-West, Walter Reed Army Institute of Research, US Army Joint Base Lewis-McChord, Hillhurst, WA 98433, USA
| |
Collapse
|
11
|
Karr JE, Zuccato BG, Ingram EO, McAuley TL, Merker B, Abeare CA. The Post-Concussion Symptom Scale: Normative Data for Adolescent Student-Athletes Stratified by Gender and Preexisting Conditions. Am J Sports Med 2023; 51:225-236. [PMID: 36427014 DOI: 10.1177/03635465221131987] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Post-Concussion Symptom Scale (PCSS) is a self-report questionnaire measuring symptoms that commonly occur after a concussion; however, these symptoms are nonspecific and can be related to co-occurring orthopaedic injuries (eg, cervical strain) or patient characteristics and preexisting conditions, even in the absence of a recent injury. As such, clinicians may have difficulty determining whether symptom elevations are attributable to a recent concussion as opposed to a confounding injury or a preexisting condition, which may be especially difficult when preinjury baseline symptom data are unavailable. PURPOSE This study aimed to further validate the 4-factor model of the PCSS (ie, cognitive, sleep-arousal, physical, and affective symptoms) with adolescent student-athletes and provide normative reference data for each factor and the total score, stratified by gender and preexisting health conditions. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Participants were 9358 adolescent student-athletes who completed the PCSS during a preseason baseline evaluation (mean age, 14.9 years; SD, 1.3 years [range, 13-18 years]; 49.3% boys). The 4-factor model of the PCSS was tested for the full sample and separately for boys and girls using confirmatory factor analysis. Symptom severity percentiles were created for the PCSS total score and each factor, stratified by gender and preexisting conditions (ie, attention-deficit/hyperactivity disorder, mental health history, headache/migraine history, learning disability/dyslexia, academic problems, and concussion history). RESULTS The 4-factor model of the PCSS replicated in the full sample (comparative fit index [CFI] = 0.959) and in both gender groups (boys: CFI = 0.961; girls: CFI = 0.960). The total PCSS score at the 84th percentile varied by preexisting conditions as follows: healthy participants = 8, attention-deficit/hyperactivity disorder = 18, mental health history = 26, headache/migraine history = 18, learning disability = 19, and academic problems = 17. On all PCSS subscales, participants with a mental health history had the highest scores, and high scores were associated with having >1 preexisting condition. Girls had higher scores than boys for each stratification. CONCLUSION The 4-factor model of the PCSS replicates for adolescent student-athletes. Gender, number of preexisting conditions, and mental health history are important factors to account for when interpreting PCSS symptom severity. The normative data provided herein could assist clinicians in determining whether an adolescent student-athlete is presenting with persistent postconcussion symptoms or a typical symptom experience based on their gender and personal health history.
Collapse
Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Brandon G Zuccato
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Eric O Ingram
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Tara L McAuley
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Bradley Merker
- Department of Behavioral Health, Henry Ford Health System, Detroit, Michigan, USA
| | | |
Collapse
|
12
|
Samadani U, Spinner RJ, Dynkowski G, Kirelik S, Schaaf T, Wall SP, Huang P. Eye tracking for classification of concussion in adults and pediatrics. Front Neurol 2022; 13:1039955. [DOI: 10.3389/fneur.2022.1039955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
IntroductionIn order to obtain FDA Marketing Authorization for aid in the diagnosis of concussion, an eye tracking study in an intended use population was conducted.MethodsPotentially concussed subjects recruited in emergency department and concussion clinic settings prospectively underwent eye tracking and a subset of the Sport Concussion Assessment Tool 3 at 6 sites. The results of an eye tracking-based classifier model were then validated against a pre-specified algorithm with a cutoff for concussed vs. non-concussed. The sensitivity and specificity of eye tracking were calculated after plotting of the receiver operating characteristic curve and calculation of the AUC (area under curve).ResultsWhen concussion is defined by SCAT3 subsets, the sensitivity and specificity of an eye tracking algorithm was 80.4 and 66.1%, The AUC was 0.718. The misclassification rate (n = 282) was 31.6%.ConclusionA pre-specified algorithm and cutoff for diagnosis of concussion vs. non-concussion has a sensitivity and specificity that is useful as a baseline-free aid in diagnosis of concussion. Eye tracking has potential to serve as an objective “gold-standard” for detection of neurophysiologic disruption due to brain injury.
Collapse
|
13
|
Tsushima WT, Choi SY, Kameoka A, Ahn HJ, Murata NM. Sex comparisons in neuropsychological functioning and reported symptoms following a sports-related concussion among high school athletes. APPLIED NEUROPSYCHOLOGY. CHILD 2022; 11:797-803. [PMID: 34641756 DOI: 10.1080/21622965.2021.1969572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aim of this study was to compare the neuropsychological functioning and symptoms of female and male high school athletes following a single concussion during the school year. The baseline test scores of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) of 309 concussed athletes (169 females, 221 males) in varied sports were obtained. After a sport-related concussion, the athletes were re-administered the ImPACT, on the average, 7.25 days after the injury. MANCOVA compared the ImPACT baseline scores, post-concussion scores, and baseline-to-post-concussion changes of the female and male athletes, with p set at 0.01. The only significant sex comparison found females performing better on baseline visual motor speed (p < 0.001). Otherwise, no sex differences were found in baseline test scores, post-concussion scores, and baseline-to-post-concussion changes. The findings tentatively suggest that there are insignificant sex differences in the consequences of sport-related concussion after a week post-injury. Future studies on sex comparisons after a concussion are needed focusing on the acute and sub-acute phases of the recovery period.
Collapse
Affiliation(s)
- William T Tsushima
- Psychiatry and Psychology Department, Straub Medical Center, Honolulu, Hawaii
| | - So Yung Choi
- Department of Complementary and Integrative Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Alyssa Kameoka
- Department of Neurosciences, Boston University, Aiea, Hawaii
| | - Hyeong Jun Ahn
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Nathan M Murata
- College of Education, University of Hawaii, Honolulu, Hawaii
| |
Collapse
|
14
|
McCarthy L, Hannah TC, Li AY, Schupper AJ, Hrabarchuk E, Kalagara R, Ali M, Gometz A, Lovell MR, Choudhri TF. Effects of a history of headache and migraine treatment on baseline neurocognitive function in young athletes. J Headache Pain 2022; 23:62. [PMID: 35658828 PMCID: PMC9164363 DOI: 10.1186/s10194-022-01432-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/20/2022] [Indexed: 11/25/2022] Open
Abstract
Objective/background Despite the prevalence of concussions in young athletes, the impact of headaches on neurocognitive function at baseline is poorly understood. We analyze the effects of a history of headache treatment on baseline ImPACT composite scores in young athletes. Methods A total of 11,563 baseline ImPACT tests taken by 7,453 student-athletes ages 12-22 between 2009 and 2019 were reviewed. The first baseline test was included. There were 960 subjects who reported a history of treatment for headache and/or migraine (HA) and 5,715 controls (CT). The HA cohort included all subjects who self-reported a history of treatment for migraine or other type of headache on the standardized questionnaire. Chi-squared tests were used to compare demographic differences. Univariate and multivariate regression analyses were used to assess differences in baseline composite scores between cohorts while controlling for demographic differences and symptom burden. Results Unadjusted analyses demonstrated that HA was associated with increased symptoms (β=2.30, 95% CI: 2.18-2.41, p<.0001), decreased visual memory (β=-1.35, 95% CI: -2.62 to -0.43, p=.004), and increased visual motor speed (β=0.71, 95% CI: 0.23-1.19, p=.004) composite scores. Baseline scores for verbal memory, reaction time, and impulse control were not significantly different between cohorts. Adjusted analyses demonstrated similar results with HA patients having greater symptom burden (β=1.40, 95% CI: 1.10-1.70, p<.0001), lower visual memory (β=-1.25, 95% CI: -2.22 to -0.27, p=.01), and enhanced visual motor speed (β=0.60, 95% CI: 0.11-1.10, p=.02) scores. Conclusion HA affected symptom, visual motor speed, and visual memory ImPACT composite scores. Visual memory scores and symptom burden were significantly worse in the HA group while visual motor speed scores were better, which may have been due to higher stimulant use in the HA group. The effects of HA on visual motor speed and visual memory scores were independent of the effects of the increased symptom burden. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01432-w.
Collapse
Affiliation(s)
- Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eugene Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Gometz
- Concussion Management of New York, New York, NY, USA
| | - Mark R Lovell
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
15
|
Ferris LM, Kontos AP, Eagle SR, Elbin RJ, Collins MW, Mucha A, McAllister TW, Broglio SP, McCrea M, Pasquina PF, Port NL. Utility of VOMS, SCAT3, and ImPACT Baseline Evaluations for Acute Concussion Identification in Collegiate Athletes: Findings From the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. Am J Sports Med 2022; 50:1106-1119. [PMID: 35179972 DOI: 10.1177/03635465211072261] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Vestibular/Ocular-Motor Screening (VOMS) is a valuable component of acute (<72 hours) sports-related concussion (SRC) assessments and is increasingly used with the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) instrument and the third edition of the Sport Concussion Assessment Tool (SCAT3). Research has suggested that VOMS acute postinjury scores are useful in identifying acute concussion. However, the utility of preseason baseline measurements to improve diagnostic accuracy remains ambiguous. To this end, there is a need to determine how reliable VOMS baseline assessments are across years and whether incorporating individuals' baseline performance improves diagnostic yield for acute concussions. PURPOSE To analyze VOMS, SCAT3, and ImPACT to evaluate the test-retest reliability of consecutive-year preseason baseline assessments to directly compare the diagnostic utility of these tools when incorporating baseline assessments versus using postinjury data alone to identify acute SRC. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Preseason and postinjury VOMS, SCAT3, ImPACT Post-Concussion Symptom Scale (PCSS), and ImPACT composite scores were analyzed for 3958 preseason (47.7% female) and 496 acute (≤48 hours) SRC (37.5% female) collegiate athlete evaluations in the National Collegiate Athletic Association-Department of Defense Concussion Assessment Research and Education Consortium. Descriptive statistics, Kolmogorov-Smirnov significance, and Cohen d effect size were calculated. Consecutive-year baseline reliability was evaluated for a subset of 447 athlete encounters using Pearson r, Cohen κ, Cohen d, and 2-way mixed intraclass correlation coefficients (ICCs). Wilcoxon signed rank tests were used to determine the statistical significance between population performances, and the 90% reliable change index (RCI) was calculated from the test-retest results. Preseason to postinjury change scores were then calculated from each tool's RCI. Finally, receiver operating characteristic (ROC) curve analyses were conducted, and DeLong method was used to compare the area under the curve (AUC) of raw postinjury scores versus change scores from preseason baseline assessments. Potential effects of sex, medical history (learning disorders or attention-deficit/hyperactivity disorder), and outlier data were also explored. RESULTS Effect sizes were large, and overall predictive utilities were clinically useful for postinjury VOMS Total (d = 2.44; AUC = 0.85), the SCAT3 Symptom Evaluation total severity score (d = 1.74; AUC = 0.82), and the ImPACT PCSS total severity score (d = 1.67; AUC = 0.80). Comparatively, effect sizes were small and predictive utilities were poor for Standardized Assessment of Concussion (SAC), modified Balance Error Scoring System (mBESS), and all ImPACT composites (d = 0.11-0.46; AUC = 0.48-0.59). Preseason baseline test-retest reliability was poor to moderate (r = 0.23-0.52; κ = 0.32-0.36; ICC = 0.36-0.68) for all assessments except ImPACT Visual Motion Sensitivity (r = 0.73; ICC = 0.85). Incorporating baseline scores for VOMS Total, SCAT3 (Symptom Evaluation, SAC, mBESS), ImPACT PCSS, or ImPACT composites did not significantly improve AUCs. CONCLUSION VOMS Total and symptom severity (SCAT3, PCSS) total scores had large effect sizes and clinically useful AUCs for identifying acute concussion. However, all tools demonstrated high within-patient test-retest variability, resulting in poor reliability. The findings in this sample of collegiate athletes suggest that incorporating baseline assessments does not significantly increase diagnostic yield for acute concussion.
Collapse
Affiliation(s)
- Lyndsey M Ferris
- Indiana University School of Optometry, Bloomington, Indiana, USA
| | | | - Shawn R Eagle
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - R J Elbin
- University of Arkansas, Fayetteville, Arkansas, USA
| | | | - Anne Mucha
- UPMC Centers for Rehab Services, Pittsburg, Pennsylvania, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Millwauke, Wisconsin, USA
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nicholas L Port
- Indiana University School of Optometry, Bloomington, Indiana, USA
| |
Collapse
|
16
|
Ellingson CJ, Singh J, Ellingson CA, Dech R, Piskorski J, Neary JP. The influence of external stressors on physiological testing: Implication for return-to-play protocols. Curr Res Physiol 2022; 5:240-245. [PMID: 35756694 PMCID: PMC9213225 DOI: 10.1016/j.crphys.2022.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
External stressors such as alcohol, caffeine, and vigorous exercise are known to alter cellular homeostasis, affecting the autonomic nervous system (ANS) and overall physiological function. However, little direct evidence exists quantifying the impact of these external stressors on physiological testing. We assessed the impact of the above-listed stressors on spontaneous baroreflex sensitivity (BRS), heart rate variability (HRV), heart rate asymmetry (HRA), and systolic blood pressure variability (BPV). Seventeen male university varsity American-style football athletes completed two identical assessments on separate days, once presenting with one or more stressors (recent intake of caffeine, alcohol, or exercise participation; contraindicated assessment) and another with no stressors present (repeat assessment). Both assessments were conducted within one week and at the same time of day. The testing protocol consisted of 5-min of rest followed by 5-min of a squat-stand maneuver (0.05 Hz). Continuous beat-to-beat blood pressure and electrocardiogram measurements were collected and allowed for calculations of BRS, HRV, HRA, and BPV. Significant decreases (p < 0.05) in HRV and HRA metrics (SDNN, SD2, SDNNd, SDNNa, SD2a, SD2d), HRV total power, and BRS-up sequence were found during the contraindicated assessment in comparison to the repeat assessment. When assessing those with exercise as their only stressor, high-frequency HRV and BRS-pooled were significantly decreased and increased, respectively, during the contraindicated assessment. Pre-season physiological baseline testing in sport is becoming increasingly prevalent and thus must consider external stressors to ascertain accurate and reliable data. This data confirms the need for stringent and standardized guidelines for pre-participation baseline physiological testing. External stressors (exercise participation, caffeine consumption, and alcohol consumption) decrease heart rate variability and the asymmetrical contribution of heart rate accelerations and decelerations (SDNN, SD2, Total Power, SDNNd, SDNNa, SD2d, and SD2a). External stressors decrease spontaneous baroreflex sensitivity up-sequence, but no significant changes were found regarding systolic blood pressure variability. The establishment of standardized pre-participation guidelines controlling for external stressors would increase the validity and reliability of physiological testing, improving the clinical utility of such data.
Collapse
Affiliation(s)
- Chase J. Ellingson
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK, Canada
| | - Jyotpal Singh
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK, Canada
| | - Cody A. Ellingson
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK, Canada
| | - Ryan Dech
- Rink Testify Performance, Winnipeg, MB, Canada
| | | | - J. Patrick Neary
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK, Canada
- Corresponding author. Faculty of Kinesiology & Health Studies, 3737 Wascana Pkwy, Regina, SK, S4S 0A2, Canada.
| |
Collapse
|
17
|
Puleo RM, Barreveld A, Rice S, Althausen Plante AM, Kotler DH. Unique Concerns of the Woman Cyclist. Phys Med Rehabil Clin N Am 2021; 33:61-79. [PMID: 34799003 DOI: 10.1016/j.pmr.2021.08.005] [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: 11/27/2022]
Abstract
Previously a male-dominated activity, female cyclists now make up nearly half of all cyclists in the United States. Although cycling provides a significant number of health benefits, it is an activity that carries risk of injury, both traumatic and nontraumatic. Sex differences are seen in chest trauma and breast injury, as well as pelvic, given the inherent differences in anatomy. Understanding the relationship of the bicycle to the anatomy of the rider can help mitigate risks for injury.
Collapse
Affiliation(s)
- Rozanne M Puleo
- Sports Medicine, Lynn Community Health Center, 269 Union Street, Lynn, MA 01902, USA.
| | - Antje Barreveld
- Anesthesiology, Tufts University School of Medicine, Pain Management Services, Newton-Wellesley Hospital, 2014 Washington St, Newton, MA 02462, USA
| | - Sarah Rice
- Athletico Physical Therapy, 2143 W Division St, Chicago IL 60622-3006, USA
| | - Anne M Althausen Plante
- Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - Dana H Kotler
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Outpatient Center - Wellesley, 65 Walnut Street, Wellesley, Boston, MA 02481, USA
| |
Collapse
|
18
|
Kotler DH, Iaccarino MA, Rice S, Herman S. Return to Cycling Following Brain Injury: A Proposed Multidisciplinary Approach. Phys Med Rehabil Clin N Am 2021; 33:91-105. [PMID: 34799005 DOI: 10.1016/j.pmr.2021.08.007] [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: 11/18/2022]
Abstract
Cycling is an important form of exercise, recreation, and transportation. Following traumatic brain injury, the benefits of cycling for health, fitness, and community mobility must be considered alongside potential risk for recurrent injury. In addition to medical concerns and exercise tolerance, key domains include motor function, attention, and visuospatial and executive function, which have previously been explored with regard to driving. Cycling skill is a combination of cognitive and motor function, and can be trained with appropriate education and intervention. We discuss the relationship of brain injury rehabilitation to specific features of cycling, including case studies.
Collapse
Affiliation(s)
- Dana H Kotler
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA. https://twitter.com/@iaccarinomd
| | - Sarah Rice
- Athletico Physical Therapy, Chicago, IL, USA
| | - Seth Herman
- California Rehabilitation Institute, Los Angeles, CA, USA
| |
Collapse
|
19
|
Maietta JE, Kuwabara HC, Cross CL, Flood SM, Kinsora TF, Ross SR, Allen DN. Influence of Autism and Other Neurodevelopmental Disorders on Cognitive and Symptom Profiles: Considerations for Baseline Sport Concussion Assessment. Arch Clin Neuropsychol 2021; 36:1438–1449. [PMID: 33611342 DOI: 10.1093/arclin/acab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The presence of neurodevelopmental disorders (ND) such as attention-deficit/hyperactivity disorder (ADHD) and learning disorders (LD) have demonstrated effects on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) performance. No current research has directly examined whether autism spectrum disorder (ASD) has similar effects. The current study compared ImPACT cognitive and symptom profiles in athletes with self-reported ASD to other NDs and healthy controls using case-control matching. METHOD The current study compared ImPACT baselines of high school athletes with ASD to athletes with other NDs (ADHD, LD, and co-occurring ADHD/LD) and healthy controls on cognitive composites and symptom reporting. Participants included 435 athletes (87 controls, 87 with ASD, 87 with ADHD, 87 with LD, and 87 with ADHD/LD) selected from a larger naturalistic sample. Athletes were matched to the ASD group based on age, sex, and sport using randomized case-matched selection from the larger database. RESULTS Results revealed that athletes with ASD performed more poorly than healthy controls on the Visual Motor Speed composite. No differences were found for Post-concussion Symptom Scale (PCSS) domain scores. Differences in cognitive and symptom profiles among the athletes with other NDs were also found. CONCLUSIONS Results elucidate patterns of baseline performance for athletes with ASD, demonstrating that there may not be significant differences between ASD and healthy controls on four of the five ImPACT composites, and no symptom reporting differences. Cognitive and symptom differences found for other NDs should be considered when interpreting baseline performance and for making return-to-play decisions in the absence of baseline assessment.
Collapse
Affiliation(s)
- Julia E Maietta
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Hana C Kuwabara
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Chad L Cross
- UNLV School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Sarah M Flood
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | | | - Staci R Ross
- Center for Applied Neuroscience, Las Vegas, NV, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| |
Collapse
|
20
|
Asfaw ZK, Hannah TC, Ali M, Li AY, Spiera Z, Marayati NF, Kalagara R, Dreher N, Schupper AJ, Gometz A, Lovell MR, Choudhri T. Impact of Psychiatric Illnesses and Selective Serotonin Reuptake Inhibitor Medications on Baseline Neurocognitive Testing. Arch Clin Neuropsychol 2021; 37:633-640. [PMID: 34664619 DOI: 10.1093/arclin/acab087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Neurocognitive tests are an integral component of sport-related concussion (SRC) workup. A history of psychiatric illness (HPI) is common among young athletes. Investigations of factors that influence athletes' baseline neurocognitive function are crucial for an accurate assessment of SRC. OBJECTIVE In this study, we aim to elucidate the effect of HPI and selective-serotonin reuptake inhibitor (SSRI) medication use on baseline neurocognitive performance in young athletes. METHODS We conducted a retrospective cross-sectional study of Immediate Post-Concussion Assessment and Cognitive Testing assessments. A total of 268 athletes with HPI and a control group of 6,364 athletes were included. The outcomes were total symptom score based on post-concussion symptom scale, verbal memory, visual memory, visual motor, reaction time, and impulse control scores with self-reported HPI status and SSRI use. RESULTS Athletes with HPI had an elevated symptom score in both univariate analysis (p < .0001) and multivariate analysis (p < .0001). HPI influence on visual memory score was not robust to multivariate analysis (p = .24). Athletes with HPI who reported SSRI medication use had the same baseline neurocognitive performance as other athletes with HPI. HPI influences athletes' baseline neurocognitive performance by elevating symptom scores. HPI does not alter any of the objective neurocognitive composite scores in contrast to previous work. CONCLUSIONS Clinicians should consider the impact of HPI on baseline neurocognitive performance during the assessment of a suspected SRC. Additional research is required to bolster our findings on SSRI use and ascertain the effects of other drug classes on baseline neurocognitive performance.
Collapse
Affiliation(s)
- Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zachary Spiera
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naoum Fares Marayati
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nickolas Dreher
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Mark R Lovell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tanvir Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
21
|
MacLean L, Prabhakar D. Attention-Deficit/Hyperactivity Disorder and Sports: A Lifespan Perspective. Psychiatr Clin North Am 2021; 44:419-430. [PMID: 34372998 DOI: 10.1016/j.psc.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD), characterized by inattention, impulsivity and hyperactivity is a major health problem. This paper discusses ADHD across the life span and looks at the impact of debilitating symptoms, diagnosis, and treatment in athletes. Psychosocial interventions, with or without psychopharmacology including stimulants and nonstimulants, are discussed to help athletes achieve their highest level of symptom abatement and functioning. The age of the patient, the sport played, the athlete's overall health, and the regulations of the sport-governing body play a role in determining the most appropriate treatment.
Collapse
Affiliation(s)
- Lisa MacLean
- Henry Ford Health System, One Ford Place, 1C, Detroit, MI 48202, USA
| | - Deepak Prabhakar
- Sheppard Pratt, 6501 North Charles Street, Baltimore, MD 21204, USA.
| |
Collapse
|
22
|
Magill JR, Myers HS, Lentz TA, Pietrosimone LS, Risoli T, Green CL, Reinke EK, Messer MR, Riboh JC. Healthy Pediatric Athletes Have Significant Baseline Limb Asymmetries on Common Return-to-Sport Physical Performance Tests. Orthop J Sports Med 2021; 9:2325967120982309. [PMID: 33614803 PMCID: PMC7869184 DOI: 10.1177/2325967120982309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction
in children is associated with a much higher risk (∼30%) of subsequent ACL
injury than in adults. Most RTS testing protocols use a limb symmetry index
(LSI) ≥90% on physical performance tests (PPTs) to assess an athlete’s
readiness for sport. This assumes that, in a healthy state, the physical
performances across both lower extremities are and should be equal. Purpose: To determine the prevalence of limb asymmetries >10% in the uninjured
pediatric population on common PPTs as well as to explore the relationship
between athlete variables, limb preference, and LSI values. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included healthy volunteers (N = 100) evenly distributed between
the ages of 6 and 18 years (mean age, 11.7 ± 3.6 years; 52% female).
Participants performed 9 common PPTs. For analysis, we developed a composite
score for each limb by averaging trials. We then calculated the LSI for each
test. Univariable and multivariable linear regression analyses were
performed to assess the relationship between athlete variables (age, sex,
height, and weight) and LSI for each PPT. Results: Instances of poor baseline limb symmetry (<90% LSI) were common across all
PPTs. The single-leg timed hop had the highest percentage of participants,
with LSI ≥90% at 73%, while the stork on a Bosu ball had the lowest
percentage at 23%. After adjusting for age, female sex showed a significant
association with LSI for the stork test (P = .010) and the
quadrant hop–counterclockwise (P = .021). Additionally,
after adjusting for sex, increasing age showed a significant association
with LSI for the stork test (P < .001), single-leg squat
on a Bosu ball (P = .010), quadrant hop–clockwise
(P = .016), and quadrant hop–counterclockwise
(P = .009). Conclusion: The majority of healthy athletes 18 years and younger demonstrated
significant (<90%) limb asymmetries. Limb symmetry was not consistently
affected by participant age or sex, and the effect sizes of these
relationships were small. These findings should encourage clinicians and
coaches to exercise caution in using the LSI as an isolated measure of RTS
readiness after injury in pediatric athletes.
Collapse
Affiliation(s)
- John R Magill
- Doctor of Physical Therapy Program, Duke University Medical Center, Durham, North Carolina, USA.,Department of PT/OT, Duke University Health System, Durham, North Carolina, USA
| | - Heather S Myers
- Department of PT/OT, Duke University Health System, Durham, North Carolina, USA
| | - Trevor A Lentz
- Duke Clinical Research Institute, Durham, North Carolina, USA.,Department of Orthopedic Surgery, James Urbaniak Sports Science Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura S Pietrosimone
- Doctor of Physical Therapy Program, Duke University Medical Center, Durham, North Carolina, USA.,Department of PT/OT, Duke University Health System, Durham, North Carolina, USA
| | - Thomas Risoli
- Duke Biostatistics, Epidemiology, and Research Design (BERD) Methods Core, Duke University, Durham, North Carolina, USA
| | - Cindy L Green
- Duke Clinical Research Institute, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Emily K Reinke
- Department of Orthopedic Surgery, James Urbaniak Sports Science Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael R Messer
- Department of PT/OT, Duke University Health System, Durham, North Carolina, USA
| | - Jonathan C Riboh
- Department of Orthopedic Surgery, James Urbaniak Sports Science Institute, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
23
|
Mohler S, Elbin RJ, Ott S, Butts CL, McDermott B, Ganio MS, Covassin T. How long after maximal physical exertion should baseline computerized neurocognitive testing and symptom assessment be administered? Brain Inj 2021; 35:241-247. [PMID: 33459082 DOI: 10.1080/02699052.2021.1872098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Prior research suggests maximal physical exertion (MPE) may negatively affect the reliability and validity of computerized neurocognitive testing (CNT); the purpose of this study was to identify aclinically relevant recovery interval following MPE for the administration of baseline CNT.Design: Random-crossover.Participants: Thirty (M = 21.87 ± 2.29 y), moderately-active,healthy participants, without history of ADHD, learning disabilities, psychological disorders or concussion (within the last six months).Intervention: Participants completed four randomly ordered experimental trials. Except for the control trial, CNT was administered following MPE with assigned recovery intervals [Immediate, 10-minutes,or 20-minutes]. Aseries of repeated measures analysis of variance (ANOVAs) were performed on CNT composite and total symptom scores.Results: Total symptom scores were significantly greater (p < .01) at the immediate, 10-minute,and 20-minuterecovery intervals compared to the control trial. Processing speed was significantly faster at the 20-minuterecovery interval compared to the control trials. Visual memory, verbal memory, or reaction time did not differ across recovery intervals.Conclusions: Clinicians should wait more than 20 minutes before assessing baseline concussion symptoms following about of MPE.
Collapse
Affiliation(s)
- Samantha Mohler
- Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, Arkansas, USA
| | - R J Elbin
- Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, Arkansas, USA
| | - Summer Ott
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Cory L Butts
- Department of Health Promotion & Human Performance, Weber State University, Ogden, Utah, USA
| | - Brendon McDermott
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Matthew S Ganio
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, Lansing, Michigan, USA
| |
Collapse
|
24
|
Factors Associated with Symptom Reporting in U.S. Service Academy Cadets and NCAA Student Athletes without Concussion: Findings from the CARE Consortium. Sports Med 2021; 51:1087-1105. [PMID: 33428120 DOI: 10.1007/s40279-020-01415-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Symptom resolution is a key marker in determining fitness for return to activity following concussion, but in some cases, distinguishing persistent symptoms due to concussion versus symptoms related to other factors can be challenging. OBJECTIVE To determine base rates of postconcussional syndrome (PCS) diagnostic categorization in healthy cadets and student athletes with no recent concussion. METHODS 13,009 cadets and 21,006 student athletes completed baseline preseason testing. After inclusion/exclusion criteria were applied, the final sample included 12,039 cadets [9123 men (75.8%); 2916 women (24.2%)] and 18,548 student athletes [10,192 men (54.9%); 8356 women (45.1%)]. Participants completed the Sport Concussion Assessment Tool-3rd Edition (SCAT3) symptom evaluation as part of baseline preseason testing. The PCS diagnostic categorization was classified by the International Classification of Diseases, 10th Revision (ICD-10) symptom criteria for PCS. RESULTS In the absence of recent concussion, subgroups of cadets (17.8% of men; 27.6% of women) and student athletes (11.4% of men; 20.0% of women) reported a cluster of symptoms that would meet the ICD-10 symptom criteria for PCS. Participants with insufficient sleep and/or preexisting conditions (e.g., mental health problems), freshmen cadets, and cadets at the U.S. Coast Guard Academy and at the U.S. Air Force Academy (freshmen were tested during basic cadet training) were more likely to report a cluster of symptoms that would meet the ICD-10 symptom criteria for PCS. CONCLUSION The ICD-10 symptom criteria for PCS can be mimicked by preexisting conditions, insufficient sleep, and/or stress. Findings support person-specific assessment and management of symptoms following concussion.
Collapse
|
25
|
Sherry N, Trbovich A, Holland C, Eagle S, Bitzer H, Kontos AP. Predictors of poor reading performance in student-athletes following sport-related concussion. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:364-372. [PMID: 33428451 DOI: 10.1080/21622965.2020.1850449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The goal of the current study was to determine which sport/recreation-related concussion (SRC) assessments predict academic reading performance following SRC. The study included 70 concussed students aged 14-22 years (M = 16.21, SD = 1.90) evaluated 2-30 days (M = 8.41, SD = 5.88) post-injury. SRC assessments included: Post-Concussion Symptom Scale, Immediate Post-Concussion Assessment and Cognitive Testing, Vestibular/Ocular Motor Screening, and King-Devick test. The Nelson-Denny Reading Test (NDRT) comprehension subtest measured academic reading accuracy and rate. Pearson correlations examined relationships among SRC assessments and reading accuracy/rate; those assessments that significantly correlated with the NDRT were included in multiple regressions (MRs) predicting reading accuracy and reading rate. Results supported positive correlations between visual motor speed and reading accuracy (r = .31, p = .01), and near point of convergence (NPC) and reading rate (r = .30, p = .01). The MRs for reading accuracy (F = 4.61, p = .01) and reading rate (F = 4.61, p = .01) were significant, and predicted approximately 40% of the variance, with visual motor speed and NPC as the only significant predictors in both models. Symptoms were not predictive of reading accuracy or rate. The present study indicates that visual motor speed and NPC are predictive of academic reading performance after SRC, suggesting clinicians should consider these clinical outcomes to better inform academic accommodations.
Collapse
Affiliation(s)
- Natalie Sherry
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia Trbovich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cyndi Holland
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn Eagle
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hannah Bitzer
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
26
|
Gait Assessment in College Athletes: Do Concussion History, Symptoms, Gender, and Type of Sport Matter? J Sport Rehabil 2021; 30:988-999. [PMID: 33418540 DOI: 10.1123/jsr.2019-0331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/20/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Though previous research has focused on examining the effects of concussion history using a dual-task paradigm, the influence of factors like symptoms (unrelated to concussion), gender, and type of sport on gait in college athletes is unknown. OBJECTIVE To examine the effect of concussion history, symptoms, gender, and type of sport (noncontact/limited contact/contact) individually on gait among college athletes. DESIGN Exploratory cross-sectional study. SETTING Laboratory. PARTICIPANTS In total, 98 varsity athletes (age, 18.3 [1.0] y; height, 1.79 [0.11] m; mass, 77.5 [19.2] kg; 27 with concussion history, 58 reported at least one symptom, 44 females; 8 played noncontact sports and 71 played contact sports) walked under single- and dual-task (walking while counting backward by 7) conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dual-task cost (DTC; % difference between single task and dual task) of gait speed, cadence, step length and width, percentage of swing and double-support phases, symptom score, and total symptom severity score. Independent samples t tests and 1-way analysis of variance were conducted (α value = .05). RESULTS Self-reported concussion history resulted in no significant differences (P > .05). Those who reported symptoms at testing time showed significantly greater DTC of step length (mean difference [MD], 2.7%; 95% confidence interval [CI], 0.3% to 5.1%; P = .012), % of swing phase (MD, 1.0%; 95% CI, -0.2 to 2.1%; P = .042), and % of double-support phase (MD, 3.9%; 95% CI, 0.2% to 7.8%; P = .019). Females demonstrated significantly higher DTC of gait speed (MD, 5.3%; 95% CI, 1.3% to 9.3%; P = .005), cadence (MD, 4.0%; 95% CI, 1.4% to 6.5%; P = .002), % of swing phase (MD, 1.2%; 95% CI, 0.1% to 2.3%; P = .019), and % of double-support phase (MD, 4.1%; 95% CI, 0.4% to 7.9%; P = .018). Noncontact sports athletes had significantly greater step width DTC than contact sports athletes (MD, 14.2%; 95% CI, 0.9% to 27.6%; P = .032). CONCLUSIONS Reporting symptoms at testing time may influence gait under dual-task conditions. Additionally, female athletes showed more gait changes during a dual task. Sports medicine professionals should be aware that these variables, while unrelated to injury, may affect an athlete's gait upon analysis.
Collapse
|
27
|
Caccese JB, Eckner JT, Franco-MacKendrick L, Hazzard JB, Ni M, Broglio SP, McAllister TW, McCrea M, Buckley TA. Clinical Reaction-Time Performance Factors in Healthy Collegiate Athletes. J Athl Train 2020; 55:601-607. [PMID: 32320283 DOI: 10.4085/1062-6050-164-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT In the absence of baseline testing, normative data may be used to interpret postconcussion scores on the clinical reaction-time test (RTclin). However, to provide normative data, we must understand the performance factors associated with baseline testing. OBJECTIVE To explore performance factors associated with baseline RTclin from among candidate variables representing demographics, medical and concussion history, self-reported symptoms, sleep, and sport-related features. DESIGN Cross-sectional study. SETTING Clinical setting (eg, athletic training room). PATIENTS OR OTHER PARTICIPANTS A total of 2584 National Collegiate Athletic Association student-athletes (n = 1206 females [47%], 1377 males [53%], and 1 unreported (<0.1%); mass = 76.7 ± 18.7 kg; height = 176.7 ± 11.3 cm; age = 19.0 ± 1.3 years) from 3 institutions participated in this study as part of the Concussion Assessment, Research and Education Consortium. MAIN OUTCOME MEASURE(S) Potential performance factors were sex; race; ethnicity; dominant hand; sport type; number of prior concussions; presence of anxiety, learning disability, attention-deficit disorder or attention-deficit/hyperactivity disorder, depression, or migraine headache; self-reported sleep the night before the test; mass; height; age; total number of symptoms; and total symptom burden at baseline. The primary study outcome measure was mean baseline RTclin. RESULTS The overall RTclin was 202.0 ± 25.0 milliseconds. Female sex (parameter estimate [B] = 8.6 milliseconds, P < .001, Cohen d = 0.54 relative to male sex), black or African American race (B = 5.3 milliseconds, P = .001, Cohen d = 0.08 relative to white race), and limited-contact (B = 4.2 milliseconds, P < .001, Cohen d = 0.30 relative to contact) or noncontact (B = 5.9 milliseconds, P < .001, Cohen d = 0.38 relative to contact) sport participation were associated with slower RTclin. Being taller was associated with a faster RTclin, although this association was weak (B = -0.7 milliseconds, P < .001). No other predictors were significant. When adjustments are made for sex and sport type, the following normative data may be considered (mean ± standard deviation): female, noncontact (211.5 ± 25.8 milliseconds), limited contact (212.1 ± 24.3 milliseconds), contact (203.7 ± 21.5 milliseconds); male, noncontact (199.4 ± 26.7 milliseconds), limited contact (196.3 ± 23.9 milliseconds), contact (195.0 ± 23.8 milliseconds). CONCLUSIONS Potentially clinically relevant differences existed in RTclin for sex and sport type. These results provide normative data adjusting for these performance factors.
Collapse
Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - James T Eckner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | | | | | - Meng Ni
- The Institute for Concussion Research & Services, Bloomsburg University, Pennsylvania
| | | | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Michael McCrea
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark
| |
Collapse
|
28
|
Wallace J, Learman K, Moran R, Covassin T, Deitrick JM, Delfin D, Shina J. Premorbid anxiety and depression and baseline neurocognitive, ocular-motor and vestibular performance: A retrospective cohort study. J Neurol Sci 2020; 418:117110. [PMID: 32882438 DOI: 10.1016/j.jns.2020.117110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/28/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Concussion has become a growing concern among sport and healthcare practitioners. Experts continue to investigate ways to advance the quality of concussion evaluation, diagnosis and management. Psychological conditions have been reported to influence concussion assessment outcomes at baseline and post-concussion; however, little evidence has examined psychological conditions and their effect on multifaceted measures of concussion. A retrospective cohort design was employed to examine differences between those with and without a premorbid psychological condition for high school and collegiate athletes who completed a preseason baseline battery, consisting of symptom reporting, computerized neurocognitive assessment, Vestibular-Ocular Motor Screening (VOMS), and the King-Devick (KD) test. Forty athletes within the sample self-reported a diagnosed psychological risk factor, consisting of depression and/or anxiety, and each were matched with a discordant control. Controls were matched on sex, age, sport, concussion history and ocular history. Athletes with psychological conditions reported higher symptom severity and had worse visual motor speed than controls. There were no differences between groups on other neurocognitive domains, VOMS, or KD. These results suggest that vestibular-ocular tools may be more consistent or less likely to vary between those with and without a premorbid psychological diagnosis, adding value to tools such as the KD and VOMS.
Collapse
Affiliation(s)
- Jessica Wallace
- Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 Beeghly Center, Youngstown, OH 44555, United States of America; Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America.
| | - Ken Learman
- Department of Physical Therapy, Youngstown State University, 1 University Plaza, Cushwa Hall B307 Youngstown, OH 44555, United States of America.
| | - Ryan Moran
- Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America.
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, 105 IM Sports Circle, East Lansing, MI 48824, United States of America.
| | | | - Danae Delfin
- Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America.
| | - James Shina
- Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 Beeghly Center, Youngstown, OH 44555, United States of America
| |
Collapse
|
29
|
Russell JA, McIntyre L, Stewart L, Wang T. Concussions in Dancers and Other Performing Artists. Phys Med Rehabil Clin N Am 2020; 32:155-168. [PMID: 33198893 DOI: 10.1016/j.pmr.2020.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dancers and other performing artists are subject to head impacts that result in concussion-like symptoms. In spite of this, performing arts do not have access to the continual, focused emphasis on the diagnosis, management, and prevention of concussions that is commonplace in sports. Performing arts present a unique environment in which concussions occur and must be managed. This article outlines what is known about performing arts concussions, describes mechanisms of head impacts sustained by participants in dance and the related artforms of theater, circus, and film and television stunts, and offers concussion management guidelines for these artistic fields.
Collapse
Affiliation(s)
- Jeffrey A Russell
- Ohio University, College of Health Sciences and Professions, School of Applied Health Sciences and Wellness, Grover Center E182, Athens, OH 45701, USA.
| | - Lauren McIntyre
- Harkness Center for Dance Injuries at NYU Langone Health, 614 2nd Avenue, Floor 2, Suite G, New York, NY 10016, USA
| | - Lori Stewart
- Union of British Columbia Performers/ACTRA, 300 - 380 West 2nd Avenue, Vancouver, British Columbia V5Y 1C8, Canada
| | - Tina Wang
- Loma Linda School of Medicine, Loma Linda VA Hospital, 429 N Central Ave, Upland, CA 91786, USA
| |
Collapse
|
30
|
Socioeconomic status and race as social determinants of health to be considered in clinical use of pre-season vestibular and oculomotor tests for concussion. J Clin Transl Res 2020; 6:168-178. [PMID: 33501387 PMCID: PMC7821747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/08/2020] [Accepted: 09/24/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Aside from racial and socioeconomic disparities in computerized neurocognitive testing and symptomology, there is a scarcity of research representing more diverse populations on other widely used tests for concussion, including vestibular and visual assessment. AIM The aim of the study was to investigate if racial and socioeconomic differences exist on baseline vestibular/ocular motor screening (VOMS) and King-Devick (K-D) test performance in high school student-athletes. METHODS A total of 670 participants (66.1% White, 33.9% Black) with a mean age of 15.43±1.2 years were administered a baseline VOMS, average Near Point of Convergence (NPC) distance, and K-D test. The exposure variables included race (White or Black) and socioeconomic status (SES), defined as free and reduced lunch status (FRL or No-FRL). FRL status was determined by each participant's school SES. The outcome variables consisted of baseline VOMS item symptom provocation scores, average NPC distance, and K-D baseline time. A series of Mann-Whitney U tests were performed for K-D baseline time, NPC distance, and VOMS items with FRL status or race as a between-subject factor. Two multivariable linear regressions were run to assess the association of (1) K-D baseline times using FRL, race, sex, and corrected vision as variables in the model and (2) average NPC distance using FRL, race, sex, and corrected vision as variables in the model. RESULTS When adjusting for multiple comparisons, FRL athletes had slower (worse) K-D times (P<0.001) than non-FRL athletes. Black athletes had significantly lower mean NPC distance compared to White athletes at baseline (P=0.02) and FRL status athletes reported a significantly greater (worse) mean symptom provocation following the visual motion sensitivity item on the VOMS (P=0.02); however, these findings were no longer significant following adjustments for multiple comparisons. No differences were noted for any remaining VOMS items. The first model explained 3.9% of the total variance of K-D baseline times, whereas the second model was not significant. CONCLUSIONS Racial and SES differences existed on average NPC distance and the K-D test at baseline. Possible explanations for group differences may be neurobiological, anatomical, and/or disparity in nature. With a higher probability of undiagnosed and uncorrected vision impairment, vestibular dysfunction, and saccadic eye tracking deficits likely to be more apparent as a consequence of poverty or health inequities, it is important that healthcare providers, especially those that diagnose and treat concussions, understand that performance on the VOMS and K-D tests at baseline may be subject to sociodemographic factors of SES and race. RELEVANCE FOR PATIENTS To provide the most culturally competent care, clinicians should consider sociodemographic variables of race and SES as social determinants of health worthy of attention on objective and subjective measures of baseline concussion assessment.
Collapse
|
31
|
Walton SR, Broshek DK, Freeman JR, Hertel J, Meyer JP, Erdman NK, Resch JE. Institutionally Based ImPACT Test® Normative Values May Differ from Manufacturer-Provided Normative Values. Arch Clin Neuropsychol 2020; 35:275-282. [PMID: 31711107 DOI: 10.1093/arclin/acz068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/30/2019] [Accepted: 10/15/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The necessity for pre-injury baseline computerized neurocognitive assessments versus comparing post-concussion outcomes to manufacturer-provided normative data is unclear. Manufacturer-provided norms may not be equivalent to institution-specific norms, which poses risks for misclassifying the presence of impairment when comparing individual post-concussion performance to manufacturer-provided norms. The objective of this cohort study was to compare institutionally derived normative data to manufacturer-provided normative values provided by ImPACT® Applications, Incorporated. METHOD National Collegiate Athletic Association Division 1 university student athletes (n = 952; aged 19.2 ± 1.4 years, 42.5% female) from one university participated in this study by completing pre-injury baseline Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) assessments. Participants were separated into 4 groups based on ImPACT's age and gender norms: males <18 years old (n = 186), females <18 years old (n = 165), males >19 years old (n = 361) or females >19 years old (n = 240). Comparisons were made between manufacturer-provided norms and institutionally derived normative data for each of ImPACT's clinical composite scores: Verbal (VEM) and Visual (VIM) Memory, Visual Motor Speed (VMS), and Reaction Time (RT). Outcome scores were compared for all groups using a Chi-squared goodness of fit analysis. RESULTS Institutionally derived normative data indicated above average performance for VEM, VIM, and VMS, and slightly below average performance for RT compared to the manufacturer-provided data (χ2 ≥ 20.867; p < 0.001). CONCLUSIONS Differences between manufacturer- and institution-based normative value distributions were observed. This has implications for an increased risk of misclassifying impairment following a concussion in lieu of comparison to baseline assessment and therefore supports the need to utilize baseline testing when feasible, or otherwise compare to institutionally derived norms rather than manufacturer-provided norms.
Collapse
Affiliation(s)
- Samuel R Walton
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Jason R Freeman
- Department of Athletics, Sports Psychology, University of Virginia, Charlottesville, VA 22903, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
| | - J Patrick Meyer
- Department of Leadership, Foundations and Policy, University of Virginia, Charlottesville, VA 22903, USA.,Northwest Evaluation Association, Portland, OR 97209, USA
| | - Nicholas K Erdman
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
| |
Collapse
|
32
|
Effects of College Athlete Life Stressors on Baseline Concussion Measures. J Sport Rehabil 2020; 29:976-983. [PMID: 31810056 DOI: 10.1123/jsr.2018-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 08/30/2019] [Accepted: 10/05/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Concussion baseline testing helps injury evaluation by allowing postinjury comparisons to preinjury measures. To facilitate best practice, common neurocognitive, balance, and symptom report metrics used in concussion baseline testing merit examination relative to participant life stressors. OBJECTIVE The purpose of this study was to determine if life stressors are associated with college athlete neurocognitive function, postural control, and symptom scores at preseason baseline assessment. DESIGN All study variables were collected in a single laboratory session where athletes completed valid and reliable psychometrics as well as a computerized neurocognitive and balance assessments. SETTING Sports medicine research center on an American university campus. PARTICIPANTS A convenience sample of 123 college student-athletes: 47 females (age = 18.9 [4.3] y) and 76 males (age = 19.4 [1.6] y). MAIN OUTCOME MEASURES Participants were categorized into low, moderate, or high life stressors groups using scores from the Social Readjustment Rating Scale-Revised. Dependent variables included outcomes from the CNS Vitals Signs test, the Sensory Organization Test, and the graded symptom checklist indexing neurocognition, balance, and symptom severity, respectfully. RESULTS One-way analysis of variance revealed that the moderate life stressors group performed significantly worse than the low life stressors group on the baseline verbal memory domain of the CNS Vital Signs (F2,119 = 3.28; P = .04) only. CONCLUSION In the current college athlete sample, few baseline concussion assessment variables were found to be significantly associated with life stressors. Considering the clinical significance of these variables, psychological life stressors may not be a confounding factor in concussion evaluation.
Collapse
|
33
|
Evans RW, Strutt AM. Medico‐Legal Aspects of Concussion. Headache 2020; 60:1749-1760. [DOI: 10.1111/head.13926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Adriana M. Strutt
- Department of Neurology BCM Medical Center Houston TX USA
- Department of Psychiatry & Behavioral Sciences BCM Medical Center Houston TX USA
| |
Collapse
|
34
|
LoGalbo A, DaCosta A, Webbe F. Comparison of the PHQ9 and ImPACT symptom cluster scores in measuring depression among college athletes. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:703-709. [PMID: 32780591 DOI: 10.1080/23279095.2020.1805611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Accurate identification of athletes in need of mental health services is essential. The clinical utility of the Patient Health Questionnaire - 9 (PHQ-9), a stand-alone measure of depression, was explored among Division II college athletes (n = 1,209) completing pre-participation concussion baseline assessments (mean age = 19.28), which also included Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). ImPACT's symptom inventory can be divided into four clusters: affective, cognitive, physical/somatic, and sleep. Most athletes (81.9%) did not endorse any items on the affective symptom cluster; however, 90 athletes (7.4%) fell above the cutoff of 5 for depression on the PHQ-9, and approximately half of all athletes endorsed one or more PHQ-9 items. Simple linear regressions revealed ImPACT's sleep symptom cluster as the best predictor of PHQ-9 total score; however, affective, cognitive, and physical symptom clusters significantly predicted PHQ-9 total score as well. Due to relative under-endorsement of items on ImPACT's affective symptom cluster compared to the PHQ-9, the clinical utility of incorporating a stand-alone measure of depression such as the PHQ-9 during baseline testing is supported.
Collapse
Affiliation(s)
| | | | - Frank Webbe
- School of Psychology, Florida Tech, Melbourne, FL, USA
| |
Collapse
|
35
|
Petit KM, Savage JL, Bretzin AC, Anderson M, Covassin T. The Sport Concussion Assessment Tool-5 (SCAT5): Baseline Assessments in NCAA Division I Collegiate Student-Athletes. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2020; 13:1143-1155. [PMID: 32922635 PMCID: PMC7449330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this study was to report baseline values for the SCAT5 in NCAA Division I collegiate student-athletes, while also evaluating if sex, health diagnoses, or sport type influenced baseline performance. A sample of 462 collegiate student-athletes (212 females, 250 males, (19.21±1.32 years)) completed the SCAT5 prior to the 2017-18, 2018-19 or 2019-20 athletic seasons. Descriptive statistics were reported for symptom total (22 possible), symptom severity (132 possible), orientation (5 possible), immediate memory (30 possible), concentration (5 possible), delayed recall (10 possible), total SAC score (50 possible), 3 mBESS stances (10 possible), and mBESS score (30 possible). Separate Mann-Whitney U tests were conducted to identify sex, health diagnoses (concussion history, ADD/ADHD, depression/anxiety), and sport type (contact, non-contact) differences for all SCAT5 components. Alpha level was set a priori <.05. Student-athletes reported 1.96± 3.37 symptoms with a severity of 3.43±7.63, and an overall SAC score of 35.14±5.23 (orientation 4.96±0.20, immediate memory 20.18±3.40, concentration 3.60±1.14, delayed recall 6.41±1.94). Student-athletes participating in contact sports, had ADD/ADHD, or depression/anxiety reported more symptoms and at greater severity (p=<.001-.01). Those with ADD/ADHD performed worse on mBESS (p=.01-.03). No sex differences were found for any SCAT5 components (p=.08-.90). This study presents reference values for the SCAT5 by sex, health diagnoses, and sport type. Healthcare professionals may utilize these normative values when individual baseline references are unavailable.
Collapse
Affiliation(s)
- Kyle M Petit
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Jennifer L Savage
- Rudy School of Nursing and Health Professions, Cumberland University, Lebanon, TN, USA
| | - Abigail C Bretzin
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Morgan Anderson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
36
|
Ledreux A, Pryhoda MK, Gorgens K, Shelburne K, Gilmore A, Linseman DA, Fleming H, Koza LA, Campbell J, Wolff A, Kelly JP, Margittai M, Davidson BS, Granholm AC. Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers. Front Neurosci 2020; 14:761. [PMID: 32848549 PMCID: PMC7406890 DOI: 10.3389/fnins.2020.00761] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
Concussion or mild traumatic brain injury (mTBI) in athletes can cause persistent symptoms, known as post-concussion syndrome (PCS), and repeated injuries may increase the long-term risk for an athlete to develop neurodegenerative diseases such as chronic traumatic encephalopathy (CTE), and Alzheimer's disease (AD). The Center for Disease Control estimates that up to 3.8 million sport-related mTBI are reported each year in the United States. Despite the magnitude of the phenomenon, there is a current lack of comprehensive prognostic indicators and research has shown that available monitoring tools are moderately sensitive to short-term concussion effects but less sensitive to long-term consequences. The overall aim of this review is to discuss novel, quantitative, and objective measurements that can predict long-term outcomes following repeated sports-related mTBIs. The specific objectives were (1) to provide an overview of the current clinical and biomechanical tools available to health practitioners to ensure recovery after mTBIs, (2) to synthesize potential biological mechanisms in animal models underlying the long-term adverse consequences of mTBIs, (3) to discuss the possible link between repeated mTBI and neurodegenerative diseases, and (4) to discuss the current knowledge about fluid biomarkers for mTBIs with a focus on novel exosomal biomarkers. The conclusions from this review are that current post-concussion clinical tests are not sufficiently sensitive to injury and do not accurately quantify post-concussion alterations associated with repeated mTBIs. In the current review, it is proposed that current practices should be amended to include a repeated symptom inventory, a cognitive assessment of executive function and impulse control, an instrumented assessment of balance, vestibulo-ocular assessments, and an improved panel of blood or exosome biomarkers.
Collapse
Affiliation(s)
- Aurélie Ledreux
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
| | - Moira K. Pryhoda
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Kim Gorgens
- Graduate School of Professional Psychology, University of Denver, Denver, CO, United States
| | - Kevin Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Anah Gilmore
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
| | - Daniel A. Linseman
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
- Biological Sciences, University of Denver, Denver, CO, United States
| | - Holly Fleming
- Biological Sciences, University of Denver, Denver, CO, United States
| | - Lilia A. Koza
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
- Biological Sciences, University of Denver, Denver, CO, United States
| | - Julie Campbell
- Pioneer Health and Performance, University of Denver, Denver, CO, United States
| | - Adam Wolff
- Denver Neurological Clinic, Denver, CO, United States
| | - James P. Kelly
- Marcus Institute for Brain Health, Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Martin Margittai
- Department of Chemistry and Biochemistry, University of Denver, Denver, CO, United States
| | - Bradley S. Davidson
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | | |
Collapse
|
37
|
Rebchuk AD, Brown HJ, Koehle MS, Blouin JS, Siegmund GP. Using Variance to Explore the Diagnostic Utility of Baseline Concussion Testing. J Neurotrauma 2020; 37:1521-1527. [PMID: 31928134 DOI: 10.1089/neu.2019.6829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and King-Devick Test (KDT) are considered important components of concussion assessment. Whether baseline testing improves the diagnostic utility of these tests remains unclear. We performed an observational cohort study to investigate the within-subject and between-subjects variability of these tests over repeated assessments during two football seasons to examine whether baseline testing reduces variability in test performance. Thirty-five male collegiate football players completed weekly clinical concussion assessments over two seasons. Within-subject (week-to-week) and between-subjects (player-to-player) variability for each test were compared using a bootstrap analysis. Within-subject and between-subjects proportions of overall variance for each test score were calculated. Mixed-model analyses were used to quantify practice effects resulting from repeated testing. For the GSC and BESS, within-subject and between-subjects variability did not significantly differ. For the KDT, the proportion of within-subject variance (20.2%) was significantly less than the between-subjects variance (79.8%). For SAC, however, the proportion of within-subject variance (66.8%) was significantly greater than the between-subjects variance (33.8%). A small, but significant, practice effect was observed for the BESS and KDT tests. When athletes are evaluated during a football season for concussion using the GSC, SAC, and BESS, comparing their scores to baseline performance is likely no more beneficial than comparing them to normative population data for identifying neurological changes associated with concussion. For the KDT, comparison to baseline testing is likely beneficial because of significantly higher between-subjects variability.
Collapse
Affiliation(s)
- Alexander D. Rebchuk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harrison J. Brown
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S. Koehle
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Sport and Exercise Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Sébastien Blouin
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Computing, Information and Cognitive Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gunter P. Siegmund
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- MEA Forensic Engineers and Scientists, Richmond, British Columbia, Canada
| |
Collapse
|
38
|
Brett BL, Breedlove K, McAllister TW, Broglio SP, McCrea MA, Hoy AMR, Hazzard JB, Kelly LA, Port N, Putukian M, Pasquina P, Jackson J, McGinty G, O'Donnell P, Cameron KL, Houston MN, Giza C, Benjamin HJ, Buckley T, Clugston JR, Schmidt JD, Feigenbaum LA, Mihalik JP, Guskiewicz K, Anderson S, Master CL, Collins MW, Kontos AP, Chrisman SPD, Brooks MA, Rowson S, Miles CM, Susmarski A. Investigating the Range of Symptom Endorsement at Initiation of a Graduated Return-to-Play Protocol After Concussion and Duration of the Protocol: A Study From the National Collegiate Athletic Association-Department of Defense Concussion, Assessment, Research, and Education (CARE) Consortium. Am J Sports Med 2020; 48:1476-1484. [PMID: 32298132 DOI: 10.1177/0363546520913252] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Organizations recommend that athletes should be asymptomatic or symptom-limited before initiating a graduated return-to-play (GRTP) protocol after sports-related concussion, although asymptomatic or symptom-limited is not well-defined. HYPOTHESES (1) There will be a range (ie, beyond zero as indicator of "symptom-free") in symptom severity endorsement when athletes are deemed ready to initiate a GRTP protocol. (2) Baseline symptom severity scores and demographic/preinjury medical history factors influence symptom severity scores at the commencement of the GRTP protocol. (3) Greater symptom severity scores at GRTP protocol initiation will result in longer protocol duration. (4) Symptom severity scores will not differ between those who did and did not sustain a repeat injury within 90 days of their initial injury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Across 30 universities, athletes (N = 1531) completed assessments at baseline and before beginning the GRTP protocol, as determined by local medical staff. Symptom severity scores were recorded with the symptom checklist of the Sport Concussion Assessment Tool-3rd Edition. Nonparametric comparisons were used to examine the effect of medical, demographic, and injury factors on symptom endorsement at GRTP protocol initiation, as well as differences in symptom severity scores between those who did and did not sustain a repeat injury within 90 days. A Cox regression was used to examine the association between symptom severity scores at GRTP protocol initiation and protocol duration. RESULTS Symptom severity scores at the time when the GRTP protocol was initiated were as follows: 0 to 5 (n = 1378; 90.0%), 6 to 10 (n = 76; 5.0%), 11 to 20 (n = 42; 3.0%), and ≥21 (n = 35; 2.0%). Demographic (sex and age), medical (psychiatric disorders, attention-deficit/hyperactivity disorder, learning disorder), and other factors (baseline symptom endorsement and sleep) were significantly associated with higher symptom severity scores at the GRTP initiation (P < .05). The 4 GRTP initiation time point symptom severity score groups did not significantly differ in total time to unrestricted RTP, χ2(3) = 1.4; P = .73. When days until the initiation of the GRTP protocol was included as a covariate, symptom severity scores between 11 and 20 (P = .02; hazard ratio = 1.44; 95% CI, 1.06-1.96) and ≥21 (P < .001; hazard ratio = 1.88; 95% CI, 1.34-2.63) were significantly associated with a longer GRTP protocol duration as compared with symptom severity scores between 0 and 5. Symptom severity scores at GRTP initiation did not significantly differ between those who sustained a repeat injury within 90 days and those who did not (U = 29,893.5; P = .75). CONCLUSION A range of symptom severity endorsement was observed at GRTP protocol initiation, with higher endorsement among those with higher baseline symptom endorsement and select demographic and medical history factors. Findings suggest that initiation of a GRTP protocol before an absolute absence of all symptoms is not associated with longer progression of the GRTP protocol, although symptom severity scores >10 were associated with longer duration of a GRTP protocol. Results can be utilized to guide clinicians toward optimal GRTP initiation (ie, balancing active recovery with avoidance of premature return to activity).
Collapse
Affiliation(s)
- Benjamin L Brett
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine Breedlove
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas W McAllister
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven P Broglio
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | -
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - April Marie Reed Hoy
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph B Hazzard
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Louise A Kelly
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nicholas Port
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Margot Putukian
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paul Pasquina
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan Jackson
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gerald McGinty
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Patrick O'Donnell
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kenneth L Cameron
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Megan N Houston
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher Giza
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Holly J Benjamin
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas Buckley
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - James R Clugston
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Julianne D Schmidt
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Luis A Feigenbaum
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason P Mihalik
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin Guskiewicz
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Scott Anderson
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christina L Master
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael W Collins
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anthony P Kontos
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sara P D Chrisman
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - M Alison Brooks
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven Rowson
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher M Miles
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adam Susmarski
- Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
39
|
Roach SP, Houston MN, Peck KY, Svoboda SJ, Kelly TF, Malvasi SR, McGinty GT, Campbell DE, Cameron KL. The Influence of Self-Reported Tobacco Use on Baseline Concussion Assessments. Mil Med 2020; 185:e431-e437. [PMID: 31603220 DOI: 10.1093/milmed/usz352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Baseline symptom, balance, and neurocognitive scores have become an integral piece of the concussion management process. Factors such as sleep, learning disorders, fitness level, and sex have been linked to differences in performance on baseline assessments; however, it is unclear how tobacco use may affect these scores. The objective of this study was to compare baseline concussion assessment scores between service academy cadets who use and do not use tobacco. METHODS Cadets completed a standard battery of concussion baseline assessments per standard of care and were classified into two groups: tobacco users (n = 1,232) and nonusers (n = 5,922). Dependent variables included scores on the Balance Error Scoring System, Standardized Assessment of Concussion, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Brief Symptom Inventory-18, and Brief Sensation Seeking Scale (BSSS). Separate Mann-Whitney U-tests were used to compare all baseline assessment scores between groups with an adjusted P-value < 0.004. RESULTS Cadets that used tobacco performed significantly worse on the impulse control (P < 0.001) section of the ImPACT, reported greater ImPACT symptom severity scores (P < 0.001), and were more likely to take risks as measured by the BSSS (P < 0.001). No differences were detected for Balance Error Scoring System, Standardized Assessment of Concussion, Brief Symptom Inventory-18, and Sport Concussion Assessment Tool-3 symptom scores, verbal memory, visual memory, visual-motor speed, or reaction time on the ImPACT (P > 0.004). CONCLUSIONS Tobacco users performed significantly worse than tobacco nonusers on the impulse control section of the ImPACT, reported greater symptom severity scores on the ImPACT, and were more likely to take risks as measured by the BSSS. Despite statistical significance, these results should be interpreted with caution, as the overall effect sizes were very small. Future research should examine the influence of tobacco use on recovery post-concussion.
Collapse
Affiliation(s)
- Sean P Roach
- Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996
| | - Megan N Houston
- Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996
| | - Karen Y Peck
- United States Military Academy, 606 Thayer Road, West Point, NY 10996
| | - Steven J Svoboda
- MedStar Health, 1120 20th Street Northwest, Suite 115, Washington, DC 20036
| | - Tim F Kelly
- United States Military Academy, 606 Thayer Road, West Point, NY 10996
| | - Steven R Malvasi
- Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996
| | - Gerald T McGinty
- United States Air Force Academy, 2355 Faculty Drive, Suite 1N207, USAFA, CO 80840
| | | | - Kenneth L Cameron
- Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996
| |
Collapse
|
40
|
Sundaram V, Ding VY, Desai M, Lumba-Brown A, Little J. Reliable sideline ocular-motor assessment following exercise in healthy student athletes. J Sci Med Sport 2019; 22:1287-1291. [DOI: 10.1016/j.jsams.2019.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/07/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
|
41
|
Moran RN, Wallace J, Murray NG, Covassin T. Effects of attention deficit hyperactivity disorder and learning disability on vestibular and ocular baseline concussion assessment in pediatric athletes. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:276-282. [PMID: 31650856 DOI: 10.1080/21622965.2019.1683453] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Vestibular and ocular motor assessment has gained popularity as a tool for sport-related concussion among healthcare professionals. With awareness of premorbid risk factors, such as attentional problems, it is imperative to understand their effects at baseline. The purpose of this study was to examine the effects of attention deficit/hyperactivity disorder (ADHD) and diagnosed learning disability (LD) on vestibular and oculomotor baseline concussion assessment in pediatrics. Pediatric athletes between the ages of 8 and 14 years with ADHD/LD (n = 30) and match controls without ADHD/LD (n = 30) completed baseline concussion testing, consisting of symptom provocation on the Vestibular/Ocular Motor Screening (VOMS) and oculomotor performance on near point of convergence (NPC) and King-Devick (K-D) tools. Those diagnosed with ADHD/LD performed worse on baseline saccades (p range = .02-.10), convergence (p = .04), vestibular ocular reflex (VOR) (p = .03) and visual motion sensitivity (VMS) (p = .04) of the VOMS. Base rate analyses revealed that 26% of athletes in the ADHD/LD group had ≥1 and 13.3% had ≥2 VOMS domains over clinical cutoff levels, compared to 3.3% (≥1 domain) and 0 (≥2 domains) of controls. Individuals with ADHD/LD also performed worse on K-D assessment (p = .005). However, no differences were reported on NPC distance (p = .19). These findings suggest worse baseline concussion assessment scores on vestibular/ocular motor assessment domains in pediatric athletes diagnosed with ADHD/LD. Additional research is needed on assessment outcomes to determine if special consideration to those diagnosed with ADHD/LD is warranted.
Collapse
Affiliation(s)
- Ryan N Moran
- Athletic Training Research Laboratory, Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Jessica Wallace
- Athletic Training Research Laboratory, Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Nicholas G Murray
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Tracey Covassin
- Sport Injury Research Laboratory, Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
42
|
Gupte R, Brooks W, Vukas R, Pierce J, Harris J. Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know. J Neurotrauma 2019; 36:3063-3091. [PMID: 30794028 PMCID: PMC6818488 DOI: 10.1089/neu.2018.6171] [Citation(s) in RCA: 264] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is growing recognition of the problem of male bias in neuroscience research, including in the field of traumatic brain injury (TBI) where fewer women than men are recruited to clinical trials and male rodents have predominantly been used as an experimental injury model. Despite TBI being a leading cause of mortality and disability worldwide, sex differences in pathophysiology and recovery are poorly understood, limiting clinical care and successful drug development. Given growing interest in sex as a biological variable affecting injury outcomes and treatment efficacy, there is a clear need to summarize sex differences in TBI. This scoping review presents an overview of current knowledge of sex differences in TBI and a comparison of human and animal studies. We found that overall, human studies report worse outcomes in women than men, whereas animal studies report better outcomes in females than males. However, closer examination shows that multiple factors including injury severity, sample size, and experimental injury model may differentially interact with sex to affect TBI outcomes. Additionally, we explore how sex differences in mitochondrial structure and function might contribute to possible sex differences in TBI outcomes. We propose recommendations for future investigations of sex differences in TBI, which we hope will lead to improved patient management, prognosis, and translation of therapies from bench to bedside.
Collapse
Affiliation(s)
- Raeesa Gupte
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - William Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Clinical and Translational Sciences Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Rachel Vukas
- School of Medicine, Dykes Library of Health Sciences, University of Kansas Medical Center, Kansas City, Kansas
| | - Janet Pierce
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Janna Harris
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- Address correspondence to: Janna Harris, PhD, Hoglund Brain Imaging Center, MS 1052, 3901 Rainbow Boulevard, Kansas City, KS 66160
| |
Collapse
|
43
|
Moser RS, Olek L, Schatz P. Gender Differences in Symptom Reporting on Baseline Sport Concussion Testing Across the Youth Age Span. Arch Clin Neuropsychol 2019; 34:50-59. [PMID: 29420685 DOI: 10.1093/arclin/acy007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/17/2018] [Indexed: 11/15/2022] Open
Abstract
Background Little is known regarding gender differences in concussion symptom reporting developmentally across the age span, specifically in pre-adolescent athletes. The present study asks: Do boys and girls differ in symptom reporting across the pre-adolescent to post-adolescent age span? Method This retrospective study utilized baseline assessments from 11,695 10-22 year-old athletes assigned to 3 independent groups: Pre-adolescent 10-12 year olds (n = 1,367; 12%), Adolescent 13-17 year olds (n = 2,974; 25%), and Late Adolescent 18-22 year olds (n = 7,354; 63%). Males represented 60% of the sample. Baseline ImPACT composite scores and Post-Concussion Symptom Scale scores (Total, Physical, Cognitive, Emotional, Sleep) were analyzed for the effects of age and gender. Results Statistically significant main effects were found for age and gender on all ImPACT composites, Total Symptoms, and Symptom factors. Significant interaction effects were noted between age and gender for all ImPACT composites, Total Symptoms, and Symptom factors. Total Symptoms and all Symptom factors were highest in adolescents (ages 13-17) for males and females. In the 10-12 age group, females displayed lower Total Symptoms, Physical, and Sleep factors than males. Conclusion The notion of females being more likely than males to report symptoms does not appear to apply across the developmental age span, particularly prior to adolescence. Females show greater emotional endorsement across the youth age span (10-22 years). Adolescence (13-17 years) appears to be a time of increased symptomatology that may lessen after the age of 18.
Collapse
Affiliation(s)
| | - Lauren Olek
- Saint Joseph's University, Philadelphia, PA, USA
| | | |
Collapse
|
44
|
Brett BL, Huber DL, Wild A, Nelson LD, McCrea MA. Age of First Exposure to American Football and Behavioral, Cognitive, Psychological, and Physical Outcomes in High School and Collegiate Football Players. Sports Health 2019; 11:332-342. [PMID: 31173699 PMCID: PMC6600580 DOI: 10.1177/1941738119849076] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although some studies have observed a relationship between age of first exposure (AFE) to American football and long-term outcomes, recent findings in collegiate athletes did not observe a relationship between AFE and more intermediate outcomes at early adulthood. This, however, requires independent replication. HYPOTHESIS There will be no association between AFE to football and behavioral, cognitive, emotional/psychological, and physical functioning in high school and collegiate athletes. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Active high school and collegiate football players (N = 1802) underwent a comprehensive preseason evaluation on several clinical outcome measures. Demographic and health variables that significantly differed across AFE groups were identified as potential covariates. General linear models (GLMs) with AFE as the independent variable were performed for each clinical outcome variable. Similar GLMs that included identified covariates, with AFE as the predictor, were subsequently performed for each clinical outcome variable. RESULTS After controlling for covariates of age, concussion history, race, and a diagnosis of ADHD, earlier AFE (<12 vs ≥12 years) did not significantly predict poorer performance on any clinical outcome measures (all P > 0.05). A single statistically significant association between AFE group and somatization score was recorded, with AFE <12 years exhibiting lower levels of somatization. CONCLUSION In a large cohort of active high school and collegiate football student-athletes, AFE before the age of 12 years was not associated with worse behavioral, cognitive, psychological, and physical (oculomotor functioning and postural stability) outcomes. CLINICAL RELEVANCE The current findings suggest that timing of onset of football exposure does not result in poorer functioning in adolescence and young adults and may contribute to resilience through decreased levels of physically related psychological distress.
Collapse
Affiliation(s)
- Benjamin L. Brett
- Department of Neurology, Medical College
of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical
College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel L. Huber
- Department of Neurosurgery, Medical
College of Wisconsin, Milwaukee, Wisconsin
| | - Alexa Wild
- Department of Neurosurgery, Medical
College of Wisconsin, Milwaukee, Wisconsin
| | - Lindsay D. Nelson
- Department of Neurology, Medical College
of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical
College of Wisconsin, Milwaukee, Wisconsin
| | - Michael A. McCrea
- Department of Neurology, Medical College
of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical
College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
45
|
Kaye S, Sundman MH, Hall EE, Williams E, Patel K, Ketcham CJ. Baseline Neurocognitive Performance and Symptoms in Those With Attention Deficit Hyperactivity Disorders and History of Concussion With Previous Loss of Consciousness. Front Neurol 2019; 10:396. [PMID: 31068890 PMCID: PMC6491760 DOI: 10.3389/fneur.2019.00396] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/01/2019] [Indexed: 12/01/2022] Open
Abstract
Previous consensus statements on sports concussion have highlighted the importance of Attention Deficit Hyperactivity Disorder (ADHD) and loss of consciousness (LOC) as risk factors related to concussion management. The present study investigated how self-reported history of either ADHD diagnosis or history of previous concussion resulting in LOC influence baseline neurocognitive performance and self-reported symptoms. This analysis was performed retrospectively on data collected primarily from student-athletes, both Division 1 and club sports athletes. The dataset (n = 1460) is comprised of college students (age = 19.1 ± 1.4 years). Significant differences were found for composite scores on the ImPACT for both history of concussion (p = 0.016) and ADHD (p = 0.014). For concussion history, those with a previous concussion, non-LOC, performed better on the visual motor speed (p = 0.004). Those with diagnosis of ADHD performed worse on verbal memory (p = 0.001) and visual motor speed (p = 0.033). For total symptoms, concussion history (p < 0.001) and ADHD (p = 0.001) had an influence on total symptoms. Those with ADHD reported more symptoms for concussion history; those with previous LOC concussion reported more symptoms than those with non-LOC concussion (p = 0.003) and no history (p < 0.001). These results highlight the importance of baseline measures of neurocognitive function and symptoms in concussion management in order to account for pre-existing conditions such as ADHD and LOC from previous concussion that could influence these measures.
Collapse
Affiliation(s)
- Sarah Kaye
- Mailman Research Center, McLean Hospital, Belmont, MA, United States
| | - Mark H Sundman
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Eric E Hall
- Department of Exercise Science, Elon University, Elon, NC, United States
| | - Ethan Williams
- Office of the Dean of Students, Elon University, Elon, NC, United States
| | - Kirtida Patel
- Department of Sports Medicine, Elon University, Elon, NC, United States
| | - Caroline J Ketcham
- Department of Exercise Science, Elon University, Elon, NC, United States
| |
Collapse
|
46
|
Moran RN, Covassin T, Wallace J. Premorbid migraine history as a risk factor for vestibular and oculomotor baseline concussion assessment in pediatric athletes. J Neurosurg Pediatr 2019; 23:465-470. [PMID: 30641840 DOI: 10.3171/2018.10.peds18425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Migraine history has recently been identified as a risk factor for concussion and recovery. The authors performed a cross-sectional study examining baseline outcome measures on newly developed and implemented concussion assessment tools in pediatrics. The purpose of this study was to examine the effects of premorbid, diagnosed migraine headaches as a risk factor on vestibular and oculomotor baseline assessment in pediatric athletes. METHODS Pediatric athletes between the ages of 8 and 14 years with a diagnosed history of migraine headache (n = 28) and matched controls without a history of diagnosed migraine headache (n = 28) were administered a baseline concussion assessment battery, consisting of the Vestibular/Ocular Motor Screening (VOMS), near point of convergence (NPC), and the King-Devick (K-D) tests. Between-groups comparisons were performed for vestibular symptoms and provocation scores on the VOMS (smooth pursuit, saccades, convergence, vestibular/ocular reflex, visual motion sensitivity), NPC (average distance), and K-D (time). RESULTS Individuals diagnosed with migraine headaches reported greater VOMS smooth pursuit scores (p = 0.02), convergence scores (p = 0.04), vestibular ocular reflex scores (p value range 0.002-0.04), and visual motion sensitivity scores (p = 0.009). Differences were also observed on K-D oculomotor performance with worse times in those diagnosed with migraine headache (p = 0.02). No differences were reported on NPC distance (p = 0.06) or headache symptom reporting (p = 0.07) prior to the VOMS assessment. CONCLUSIONS Pediatric athletes diagnosed with migraine headaches reported higher baseline symptom provocation scores on the VOMS. Athletes with migraine headaches also performed worse on the K-D test, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated concussion assessment outcomes at baseline. Special consideration may be warranted for post-concussion assessment in athletes with migraine headaches.
Collapse
Affiliation(s)
- Ryan N Moran
- 1Athletic Training Research Laboratory, Department of Health Science, The University of Alabama, Tuscaloosa, Alabama
| | - Tracey Covassin
- 2Sport Injury Research Laboratory, Department of Kinesiology, Michigan State University, East Lansing, Michigan; and
| | - Jessica Wallace
- 3Department of Kinesiology and Sport Science, Youngstown State University, Youngstown, Ohio
| |
Collapse
|
47
|
Makwana B, Xu XM. C3Logix assessment of neuropsychological performance in athletes and nonathletes. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:490-496. [PMID: 30793975 DOI: 10.1080/23279095.2019.1570927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Physical activity (PA) has been shown to enhance physical health, mental health, and cognitive functioning. Adult and older adult research shows that PA positively influences neuropsychological performance and protects against cognitive decline. This study investigated neuropsychological performance in uninjured athletes and nonathletes using an iPad-based neuropsychological battery called C3Logix. Since literature suggests that PA enhances cognitive functioning, athletes may perform better on neurocognitive measures than nonathletes due to athletes' assumed higher level of PA. We hypothesized that collegiate athletes would outperform nonathletes on all cognitive tasks. Ninety-five athletes and 92 nonathletes completed the neurocognitive assessments and results showed that athletes outperformed nonathletes on reaction time tasks, but not in other cognitive domains. The implications of this study included extending the work of previous research using C3Logix and added to our understanding of a possible difference in reaction time between healthy collegiate athletes and nonathletes.
Collapse
Affiliation(s)
- Bindal Makwana
- Department of Psychology, Idaho State University, Pocatello, Idaho, USA
| | - Xiaomeng Mona Xu
- Department of Psychology, Idaho State University, Pocatello, Idaho, USA
| |
Collapse
|
48
|
Blake AL, McVicar CL, Retino M, Hall EE, Ketcham CJ. Concussion history influences sleep disturbances, symptoms, and quality of life in collegiate student-athletes. Sleep Health 2019; 5:72-77. [DOI: 10.1016/j.sleh.2018.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 11/28/2022]
|
49
|
Abstract
Although concussions are common, they are complex, variable, and not entirely understood in terms of pathophysiology and treatment. The incidence of concussion is expected to continue to rise with the increased participation of youth in sports and improved awareness. The role of orthopedic surgeons in concussion management is murky. However, the existing literature does provide a foundation from which orthopedic surgeons who are exposed to concussed patients can function. [Orthopedics. 2019; 42(1):12-21.].
Collapse
|
50
|
WALTON SAMUELR, BROSHEK DONNAK, FREEMAN JASONR, CULLUM CMUNRO, RESCH JACOBE. Valid but Invalid: Suboptimal ImPACT Baseline Performance in University Athletes. Med Sci Sports Exerc 2018; 50:1377-1384. [PMID: 29485429 DOI: 10.1249/mss.0000000000001592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to investigate the frequency of valid yet suboptimal Immediate Postconcussion Assessment and Cognitive Test (ImPACT) performance in university athletes and to explore the benefit of subsequent ImPACT administrations. METHODS This descriptive laboratory study involved baseline administration of ImPACT to 769 university athletes per the institution's concussion management protocol. Testing was proctored in groups of ≤2 participants. Participants who scored below the 16th percentile according to ImPACT normative data were readministered the ImPACT test up to two additional times because these scores were thought to be potentially indicative of suboptimal effort or poor understanding of instructions. Descriptive analyses were used to examine validity indicators and individual Verbal and Visual Memory, Visual Motor Speed, and Reaction Time ImPACT composite scores in initial and subsequent administrations. RESULTS On the basis of ImPACT's validity criteria, 1% (9/769) of administrations were invalid and 14.6% (112/769) had one or more composite score of <16th percentile but were considered valid. After one readministration, 71.4% (80/112) achieved scores of ≥16th percentile and an additional 18 of 32 scored ≥16th percentile after a third administration. Verbal Memory was most commonly <16th percentile on the first administration (43%), Verbal Memory and Visual Motor Speed on the second administration (44% each), and Visual Motor Speed alone on the third administration (50%). CONCLUSIONS Approximately 16% of ImPACT records were flagged as invalid or had one or more composite scores of <16th percentile, potentially indicative of suboptimal performance. Upon readministration, 88% of those participants scored >16th percentile. Clinicians must be aware of suboptimal ImPACT performance as it limits the clinical utility of the baseline assessment. Further research is needed to address factors leading to "valid" but invalid baseline performance.
Collapse
|