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Lempke LB, Caccese JB, Syrydiuk RA, Buckley TA, Chrisman SPD, Clugston JR, Eckner JT, Ermer E, Esopenko C, Jain D, Kelly LA, Memmini AK, Mozel AE, Putukian M, Susmarski A, Pasquina PF, McCrea MA, McAllister TW, Broglio SP, Master CL. Female Collegiate Athletes' Concussion Characteristics and Recovery Patterns: A Report from the NCAA-DoD CARE Consortium. Ann Biomed Eng 2024; 52:2741-2755. [PMID: 37751028 DOI: 10.1007/s10439-023-03367-y] [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: 07/14/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
Concussion has been described in the United States (US) collegiate student-athlete population, but female-specific findings are often underrepresented and underreported. Our study aimed to describe female collegiate student-athletes' initial injury characteristics and return to activity outcomes following concussion. Female collegiate student-athletes (n = 1393) from 30-US institutions experienced a concussion and completed standardized, multimodal concussion assessments from pre-injury through unrestricted return to play (uRTP) in this prospective, longitudinal cohort study. Initial injury presentation characteristics, assessment, and return to activity outcomes [<48-h (acute), return to learn, initiate return to play (iRTP), uRTP] were collected. We used descriptive statistics to report injury characteristics, return to activity outcomes, and post-injury assessment performance change categorization (worsened, unchanged, improved) based on change score confidence rank criteria across sport contact classifications [contact (n = 661), limited (n = 446), non-contact (n = 286)]. The median (25th to 75th percentile) days to return to learn was 6.0 (3.0-10.0), iRTP was 8.1 (4.8-13.8), and uRTP was 14.8 (9.9-24.0), but varied by contact classification. Across contact levels, the majority experienced worse SCAT total symptom severity (72.8-82.6%), ImPACT reaction time (91.2-92.6%), and BSI-18 total score (45.2-51.8%) acutely relative to baseline, but unchanged BESS total errors (58.0-60.9%), SAC total score (71.5-76.1%), and remaining ImPACT domains (50.6-66.5%). Our findings provide robust estimates of the typical female collegiate student-athlete presentation and recovery trajectory following concussion, with overall similar findings to the limited female collegiate student-athlete literature. Overall varying confidence rank classification was observed acutely. Our findings provide clinically-relevant insights for athletes, clinicians, researchers, and policymakers to inform efforts specific to females experiencing concussion.
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Affiliation(s)
- Landon B Lempke
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
- Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA.
- , 830 North University Avenue, Suite 4000, Ann Arbor, MI, 48109, USA.
| | - Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Reid A Syrydiuk
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Sara P D Chrisman
- Division of Adolescent Medicine, University of Washington, Seattle, WA, USA
| | - James R Clugston
- Departments of Community Health Family Medicine and Neurology, University of Florida, Gainesville, FL, USA
| | - James T Eckner
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Elsa Ermer
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Divya Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Louise A Kelly
- Department of Exercise Science, California Lutheran University, Thousand Oaks, CA, USA
| | - Allyssa K Memmini
- Department of Health, Exercise & Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Anne E Mozel
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Adam Susmarski
- Department of Orthopedics and Sports Medicine, United States Naval Academy, Annapolis, MD, USA
| | - Paul F Pasquina
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael A McCrea
- Center for Neurotrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Orthopaedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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2
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Abrams MZ, Venkatraman J, Sherman D, Ortiz-Paparoni M, Bercaw JR, MacDonald RE, Kait J, Dimbath ED, Pang DY, Gray A, Luck JF, Bir CA, Bass CR. Biofidelity and Limitations of Instrumented Mouthguard Systems for Assessment of Rigid Body Head Kinematics. Ann Biomed Eng 2024; 52:2872-2883. [PMID: 38910203 DOI: 10.1007/s10439-024-03563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
Instrumented mouthguard systems (iMGs) are commonly used to study rigid body head kinematics across a variety of athletic environments. Previous work has found good fidelity for iMGs rigidly fixed to anthropomorphic test device (ATD) headforms when compared to reference systems, but few validation studies have focused on iMG performance in human cadaver heads. Here, we examine the performance of two boil-and-bite style iMGs in helmeted cadaver heads. Three unembalmed human cadaver heads were fitted with two instrumented boil-and-bite mouthguards [Prevent Biometrics and Diversified Technical Systems (DTS)] per manufacturer instructions. Reference sensors were rigidly fixed to each specimen. Specimens were fitted with a Riddell SpeedFlex American football helmet and impacted with a rigid impactor at three velocities and locations. All impact kinematics were compared at the head center of gravity. The Prevent iMG performed comparably to the reference system up to ~ 60 g in linear acceleration, but overall had poor correlation (CCC = 0.39). Prevent iMG angular velocity and BrIC generally well correlated with the reference, while underestimating HIC and overestimating HIC duration. The DTS iMG consistently overestimated the reference across all measures, with linear acceleration error ranging from 10 to 66%, and angular acceleration errors greater than 300%. Neither iMG demonstrated consistent agreement with the reference system. While iMG validation efforts have utilized ATD testing, this study highlights the need for cadaver testing and validation of devices intended for use in-vivo, particularly when considering realistic (non-idealized) sensor-skull coupling, when accounting for interactions with the mandible and when subject-specific anatomy may affect device performance.
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Affiliation(s)
- Mitchell Z Abrams
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA.
| | - Jay Venkatraman
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Donald Sherman
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Maria Ortiz-Paparoni
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Jefferson R Bercaw
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Robert E MacDonald
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Jason Kait
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Elizabeth D Dimbath
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Derek Y Pang
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Alexandra Gray
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Jason F Luck
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
| | - Cynthia A Bir
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Cameron R Bass
- Department of Biomedical Engineering, Duke University, 101 Science Dr, 1427 FCIEMAS Bldg - Box 90281, Durham, NC, 27708, USA
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
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Lempke LB, Ermer E, Boltz AJ, Caccese J, Buckley TA, Cameron KL, Chrisman SPD, D'Lauro C, Eckner JT, Esopenko C, Hunt TN, Jain D, Kelly LA, Memmini AK, Mozel AE, Putukian M, Susmarski A, Pasquina PF, McCrea MA, McAllister TW, Broglio SP, Master CL. Initial Mild Traumatic Brain Injury Characteristics and Recovery Patterns Among Females Across the United States Military Service Academies: A Report from the NCAA-DoD CARE Consortium. Ann Biomed Eng 2024; 52:2756-2767. [PMID: 37743459 DOI: 10.1007/s10439-023-03374-z] [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: 07/13/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
Mild traumatic brain injury (mTBI) has been described in the United States (US) military service academy cadet population, but female-specific characteristics and recovery outcomes are poorly characterized despite sex being a confounder. Our objective was to describe female cadets' initial characteristics, assessment performance, and return-to-activity outcomes post-mTBI. Female cadets (n = 472) from the four US military service academies who experienced a mTBI completed standardized mTBI assessments from pre-injury to acute initial injury and unrestricted return-to-duty (uRTD). Initial injury presentation characteristics (e.g., delayed symptoms, retrograde amnesia) and return-to-activity outcomes [i.e., return-to-learn, initiate return-to-duty protocol (iRTD), uRTD] were documented. Descriptive statistics summarized female cadets' injury characteristics, return-to-activity outcomes, and post-mTBI assessment performance change categorization (worsened, unchanged, improved) relative to pre-injury baseline using established change score confidence rank criteria for each assessment score. The median (interquartile range) days to return-to-learn (n = 157) was 7.0 (3.0-14.0), to iRTD (n = 412) was 14.7 (8.6-25.8), and to uRTD (n = 431) was 26.0 (17.7-41.8). The majority experienced worse SCAT total symptom severity (77.8%) and ImPACT reaction time (97.0%) acutely < 24-h versus baseline, but unchanged BESS total errors (75.2%), SAC total score (72%), BSI-18 total score (69.6%), and ImPACT verbal memory (62.3%), visual memory (58.4%), and visual motor speed (52.5%). We observed similar return-to-activity times in the present female cadet cohort relative to the existing female-specific literature. Confidence ranks categorizing post-mTBI performance were heterogenous and indicate multimodal assessments are necessary. Our findings provide clinically relevant insights to female cadets experiencing mTBI across the US service academies for stakeholders providing healthcare.
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Affiliation(s)
- Landon B Lempke
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
- Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA.
- , 830 North University Avenue, Suite 4000, Ann Arbor, MI, 48109, USA.
| | - Elsa Ermer
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Adrian J Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Jaclyn Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Kenneth L Cameron
- Keller Army Hospital and United States Military Academy, West Point, NY, USA
| | - Sara P D Chrisman
- Division of Adolescent Medicine, University of Washington, Seattle, WA, USA
| | - Christopher D'Lauro
- Department of Behavioral Science and Leadership, United States Air Force Academy, USAF Academy, El Paso County, CO, USA
| | - James T Eckner
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tamerah N Hunt
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA
| | - Divya Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Louise A Kelly
- Department of Exercise Science, California Lutheran University, Thousand Oaks, CA, USA
| | - Allyssa K Memmini
- Department of Health, Exercise & Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Anne E Mozel
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Adam Susmarski
- Department of Orthopedics and Sports Medicine, United States Naval Academy, Annapolis, MD, USA
| | - Paul F Pasquina
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael A McCrea
- Center for Neurotrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Orthopaedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Tsushima WT, Siu A, Tamashiro KKZ, Murata NM. Effects of repetitive subconcussive head trauma on the neuropsychological functioning and symptom reporting of high school athletes in high and low contact sports: Age and sex. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-7. [PMID: 39192619 DOI: 10.1080/21622965.2024.2394174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
OBJECTIVE The present study was designed to assess the neuropsychological test performances of non-concussed female and male high school athletes of different ages in high and low contact sports. METHOD Large samples of 2,510 high school athletes in High Contact sports (e.g., football) and 1,437 in Low Contact sports (e.g., basketball) were examined. The participants were administered a baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) prior to their respective seasons. RESULTS Multivariate linear regression showed that the High Contact athletes had significantly poorer results than the Low Contact athletes in all four ImPACT Composite scores and the Total Symptom scores. No age differences were found, but in all three age groups, the High Contact athletes had lower Visual Motor Speed scores than the Low Contact athletes. No test score differences were noted between the females in the High and Low Contact groups, but the High Contact males had poorer Visual Motor Speed and Reaction Time than the Low Contact males. CONCLUSIONS The present results were consistent with prior studies of subconcussive head trauma, with High Contact athletes obtaining overall poorer neuropsychological test results than Low Contact athletes. More investigations in this age group seems is warranted.
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Affiliation(s)
- William T Tsushima
- Psychiatry and Psychology Department, Straub Benioff Medical Center, Honolulu, Hawaii, USA
| | - Andrea Siu
- Research Institute, Hawaii Pacific Health, Honolulu, Hawaii, USA
| | | | - Nathan M Murata
- College of Education, University of Hawaii, Honolulu, Hawaii, USA
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Prosak OL, Hajdu KS, Amedy A, Anesi TJ, Williams K, Jo J, Terry DP, Zuckerman SL. Sex Differences in Resource Allocation and Access to Care After Sport-Related Concussion. J Athl Train 2024; 59:785-792. [PMID: 38069828 PMCID: PMC11340675 DOI: 10.4085/1062-6050-0280.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
CONTEXT After sport-related concussion (SRC), immediate access to a certified athletic trainer (AT) is important to ensure proper treatment. However, resource allocation and coverage may differ between male and female youth sports. OBJECTIVE To compare resource allocation between male and female sports in the following areas: (1) rates of immediate on-field evaluation by an AT at the time of injury, (2) time to general health care presentation, and (3) time to SRC clinic presentation. DESIGN Retrospective cohort study. SETTING Regional sports concussion center. PATIENTS OR OTHER PARTICIPANTS Athletes aged 14 to 18 years who presented to a regional sports concussion center from November 2017 to April 2022. MAIN OUTCOME MEASURE(S) The primary exposure of interest was sex (male or female). The primary outcome was immediate on-field evaluation by an AT (yes or no). Secondary outcomes included time to general health care and SRC clinic presentation. Descriptive statistics, χ2 analyses, and linear regressions were performed. Covariates included age, history of prior concussions, and statistically significant demographics. RESULTS A total of 832 patients with SRC were included (age = 16.2 ± 1.2 years, 66.5% male). Female athletes had lower rates of attention-deficit/hyperactivity disorder (χ2 = 10.404, P = .001) and higher rates of anxiety and depression (χ2 = 12.891, P < .001) compared with male athletes. The average time to presentation to general health care and the SRC clinic did not differ between males and females, but AT on-field evaluation occurred more in male (40.3%) than female (32.3%) athletes (χ2 = 8.677, P = .013). Multivariable linear regression found that AT on-field evaluation was a significant predictor of time to general health care presentation (β = -.085, P = .015) but not SRC clinic presentation (β = -.055, P = .099). History of prior concussions was a significant predictor of time to initial health care contact (β = .083, P = .018). History of anxiety and depression (β = .136, P < .001) and initial evaluation by emergency department or urgent care (β = .305, P < .001) were significant predictors of delayed time to SRC clinic presentation. CONCLUSIONS Among 832 concussed youth athletes, female athletes were evaluated less frequently by an AT immediately after injury. Furthermore, not being evaluated by an AT on field was significantly associated with a longer time to health care presentation. Future investigations should elucidate resource equity among male and female athletes.
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Affiliation(s)
| | | | - Amad Amedy
- Vanderbilt University School of Medicine, Nashville, TN
| | | | - Kristen Williams
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jacob Jo
- Vanderbilt University School of Medicine, Nashville, TN
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Douglas P. Terry
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L. Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
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Edelstein R, Gutterman S, Newman B, Van Horn JD. Assessment of Sports Concussion in Female Athletes: A Role for Neuroinformatics? Neuroinformatics 2024:10.1007/s12021-024-09680-8. [PMID: 39078562 DOI: 10.1007/s12021-024-09680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/31/2024]
Abstract
Over the past decade, the intricacies of sports-related concussions among female athletes have become readily apparent. Traditional clinical methods for diagnosing concussions suffer limitations when applied to female athletes, often failing to capture subtle changes in brain structure and function. Advanced neuroinformatics techniques and machine learning models have become invaluable assets in this endeavor. While these technologies have been extensively employed in understanding concussion in male athletes, there remains a significant gap in our comprehension of their effectiveness for female athletes. With its remarkable data analysis capacity, machine learning offers a promising avenue to bridge this deficit. By harnessing the power of machine learning, researchers can link observed phenotypic neuroimaging data to sex-specific biological mechanisms, unraveling the mysteries of concussions in female athletes. Furthermore, embedding methods within machine learning enable examining brain architecture and its alterations beyond the conventional anatomical reference frame. In turn, allows researchers to gain deeper insights into the dynamics of concussions, treatment responses, and recovery processes. This paper endeavors to address the crucial issue of sex differences in multimodal neuroimaging experimental design and machine learning approaches within female athlete populations, ultimately ensuring that they receive the tailored care they require when facing the challenges of concussions. Through better data integration, feature identification, knowledge representation, validation, etc., neuroinformaticists, are ideally suited to bring clarity, context, and explainabilty to the study of sports-related head injuries in males and in females, and helping to define recovery.
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Affiliation(s)
- Rachel Edelstein
- Department of Psychology, University of Virginia, 409 McCormick Road Gilmer Hall Room 304, Charlottesville, VA, 22904, USA.
| | - Sterling Gutterman
- Department of Psychology, University of Virginia, 409 McCormick Road Gilmer Hall Room 304, Charlottesville, VA, 22904, USA
| | - Benjamin Newman
- Department of Psychology, University of Virginia, 409 McCormick Road Gilmer Hall Room 304, Charlottesville, VA, 22904, USA
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, 409 McCormick Road Gilmer Hall Room 304, Charlottesville, VA, 22904, USA
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Didner N, Boltz AJ, Robison HJ, Chandran A, Quinsey C. Concussion Symptomatology by Symptom Resolution Time in US High School Athletes: Findings From the National Athletic Treatment, Injury and Outcomes Network High School Surveillance Program (NATION-SP). J Athl Train 2024; 59:745-750. [PMID: 38014801 PMCID: PMC11277275 DOI: 10.4085/1062-6050-0201.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
CONTEXT Concussions incurred during high school athletics are a significant health concern, and studies examining concussions with a symptom resolution time (SRT) of 15 to 28 days have been limited. OBJECTIVE To compare concussions that had an SRT of 15 to 28 days with concussions that had an SRT of greater than 28 days among US high school athletes. DESIGN Descriptive epidemiology study. SETTING Secondary school athletic training clinics. PATIENTS OR OTHER PARTICIPANTS Secondary school athletes. MAIN OUTCOME MEASURE(S) Concussion frequency, symptom number, and symptom prevalence. RESULTS Among all 917 reported concussions (of which 50.8% had missing SRT), 88 had an SRT recorded as 15 to 28 days, and 29 had an SRT recorded as greater than 28 days. Greater frequencies of concussions with an SRT of 15 days or more were reported in boys' sports (n = 78) than girls' sports (n = 39). Boys' football (51.7%) and girls' basketball (11.5%) accounted for the largest proportions of all reported concussions with an SRT of 15 to 28 days; boys' football (58.6%) accounted for the greatest proportion of concussions reported with an SRT greater than 28 days. The average number of symptoms was 6.3 ± 3.4 for concussions with an SRT of 15 to 28 days and 7.2 ± 3.8 for those with an SRT greater than 28 days. The most frequently reported symptoms in concussions with both SRT of 15 to 28 days and greater than 28 days were headache, dizziness, sensitivity to light, and difficulty concentrating. The prevalence of irritability was higher in concussions with an SRT of 15 to 28 days as compared with concussions with an SRT greater than 28 days (26.1% versus 13.8%); visual problems (48.3% versus 35.2%) and hyperexcitability (24.1% versus 15.9%) were more prevalent in concussions with an SRT greater than 28 days, although differences were not statistically significant. CONCLUSIONS Symptom prevalence and total count were comparable between concussions with an SRT of 15 to 28 days and those with an SRT of greater than 28 days with no statistically significant difference, suggesting that symptom burdens within these groups are more similar than they are different.
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Affiliation(s)
- Nina Didner
- University of North Carolina School of Medicine, Chapel Hill
| | - Adrian J. Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Hannah J. Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill
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8
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Yeargin S, Hirschhorn RM, Adams WM, Scarneo-Miller SE. Secondary School State Athletic Association Health and Safety Policy Development Processes. THE JOURNAL OF SCHOOL HEALTH 2024; 94:591-600. [PMID: 38621415 DOI: 10.1111/josh.13454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The National Federation of State High School Associations provides recommendations regarding health and safety policies; however, policy development is governed at the state level. Given interstate differences in governance, the primary purpose was to describe processes that State High School Athletic Associations (SHSAAs) utilize to develop a new policy. The secondary objective was to determine what methods associations use to implement new policies. METHODS A cross-sectional survey requested SHSAA (n = 51) representatives to report how athlete health and safety policies are introduced, revised, approved, and implemented within their state. The 22-question survey was developed to gather variables for the aims of the study. Descriptive statistics were calculated for each survey item. RESULTS Of states who responded (n = 33), most reported a 2-committee (n = 24, 72.7%) process for developing and vetting policies, with initiation from the Sports Medicine Advisory Committee (n = 27, 81.8%), followed by an executive-level committee (n = 18, 66.7%). States reported total time from policy initiation to final approval ranged from 2 weeks to over 12 months. When a new policy was approved, most states indicated implementation began with an e-mail (n = 24, 72.7%) sent to Athletic Directors (n = 26, 78.8%). School principal or district superintendent were reported as the position in charge of compliance (36.4%, n = 12). CONCLUSIONS Most SHSAAs use a 2-step process to write and review an athlete health and safety policy before approval. SHSAAs that require a longer policy development time could delay the implementation of important health measures. SHSAAs could consider additional communication methods to ensure information reaches all stakeholders.
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Affiliation(s)
- Susan Yeargin
- University of South Carolina, 921 Assembly St, PHRC Rm 226, Columbia, SC, 29208
| | - Rebecca M Hirschhorn
- Louisiana State University, School of Kinesiology, 2213 Pleasant Hall, Baton Rouge, LA, 70803
| | - William M Adams
- Sports Medicine Research, Division of Sports Medicine, United States Olympic & Paralympic Committee, 1 Olympic Plaza, Colorado Springs, CO, 80917
| | - Samantha E Scarneo-Miller
- School of Medicine, Division of Athletic Training, West Virginia University, 1 Medical Center Drive, 8501A Health Science Center South, Morgantown, WV, 26508
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9
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Hardaker NJ, Hume PA, Sims ST. Differences in Injury Profiles Between Female and Male Athletes Across the Participant Classification Framework: A Systematic Review and Meta-Analysis. Sports Med 2024; 54:1595-1665. [PMID: 38536647 DOI: 10.1007/s40279-024-02010-7] [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: 02/23/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries. OBJECTIVE The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science'(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist. RESULTS Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4-5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17-1.34), bone stress injury (RR 3.4; 95% CI 2.1-5.4) and concussion (RR 8.46; 95% CI 1.04-68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31-3.88) and hamstring injuries (RR 2.4; 95% CI 1.8-3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37-2.7) to 2.8 (2.45-3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition. DISCUSSION Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14-20], tier-4: 16.9 ± 1.9 [11-21], tier-3: 16.9 ± 1.5 [11-20], tier-2: 16.3 ± 2.2 [11-20], tier-1 studies: 15.6 ± 1.3 [14-17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes' propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes. CONCLUSIONS Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury. TRIAL REGISTRY PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).
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Affiliation(s)
- Natalie J Hardaker
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.
- Accident Compensation Corporation, Wellington, New Zealand.
| | - Patria A Hume
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Tech & Policy Lab, Law School, The University of Western Australia, Perth, Australia
| | - Stacy T Sims
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
- Stanford Lifestyle Medicine, Stanford University, Palo Alto, CA, USA
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McPherson AL, Anderson T, Finnoff JT, Adams WM. Head Kinematics and Injury Analysis in Elite Bobsleigh Athletes Throughout a World Cup Tour. J Athl Train 2024; 59:584-593. [PMID: 37648215 PMCID: PMC11220765 DOI: 10.4085/1062-6050-0014.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
CONTEXT The neurocognitive health effects of repetitive head impacts have been examined in many sports. However, characterizations of head impacts for sliding-sport athletes are lacking. OBJECTIVE To describe head impact kinematics and injury epidemiology in elite athletes during the 2021-2022 Bobsleigh World Cup season. DESIGN Cross-sectional study. SETTING On-track training and competitions during the Bobsleigh World Cup season. PATIENTS OR OTHER PARTICIPANTS Twelve elite bobsleigh athletes (3 pilots [1 female], 9 push athletes [5 females]; age = 30 ± 5 years; female height and weight = 173 ± 8 cm and 75 ± 5 kg, respectively; male height and weight = 183 ± 5 cm and 101 ± 5 kg, respectively). MAIN OUTCOME MEASURE(S) Athletes wore an accelerometer-enabled mouthguard to quantify 6-degrees-of-freedom head impact kinematics. Isometric absolute and relative neck strength, number of head acceleration events (HAEs), workload (J), peak linear velocity (m·s-1), peak angular velocity (rad·s-1), peak linear acceleration (g), and peak angular acceleration (rad·s-2) were derived from mouthguard manufacturer algorithms. Linear mixed-effect models tested the effects of sex (male versus female), setting (training versus competition), and position (pilot versus push athlete) on the kinematic variables. RESULTS A total of 1900 HAEs were recorded over 48 training and 53 competition days. No differences were found between the number of HAEs per run per athlete by sex (incidence rate ratio [IRR] = 0.82, P = .741), setting (IRR = 0.94, P = .325), or position (IRR = 1.64, P = .463). No sex differences were observed for workload (mean ± SD: males = 3.3 ± 2.2 J, females = 3.1 ± 1.9 J; P = .646), peak linear velocity (males = 1.1 ± 0.3 m·s-1, females = 1.1 ± 0.3 m·s-1; P = .706), peak angular velocity (males = 4.2 ± 2.1 rad·s-1, females = 4.7 ± 2.5 rad·s-1; P = .220), peak linear acceleration (male = 12.4 ± 3.9g, females = 11.9 ± 3.5g; P = .772), or peak angular acceleration (males = 610 ± 353 rad·s-2, females = 680 ± 423 rad·s-2; P = .547). Also, no effects of setting or position on any kinematic variables were seen. Male athletes had greater peak neck strength than female athletes for all neck movements, aside from right-side flexion (P = .085), but no sex differences were noted in relative neck strength. CONCLUSIONS We provide a foundational understanding of the repetitive HAEs that occur in bobsleigh athletes. Future authors should determine the effects of repetitive head impacts on neurocognitive function and mental health.
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Affiliation(s)
- April L. McPherson
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs
| | - Travis Anderson
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs
| | - Jonathan T. Finnoff
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver
| | - William M. Adams
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs
- Department of Kinesiology, University of North Carolina-Greensboro
- School of Sport, Exercise and Health Sciences, Loughborough University, National Centre for Sport and Exercise Medicine (NCSEM), UK
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11
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Anderson M, Reynolds E, Gilliland T, Hammonds K, Driver S. The Association Among Clinical Profiles, Modifiers, and Prolonged Recovery in Adolescents With Sport-Related Concussion. Clin J Sport Med 2024; 34:266-272. [PMID: 37937954 DOI: 10.1097/jsm.0000000000001197] [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: 06/30/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE The purposes were to (1) describe the prevalence of clinical profiles and modifiers, (2) examine the association between clinical profiles and prolonged recovery, and (3) examine the interaction between clinical profiles and modifiers and prolonged recovery in adolescents with sport-related concussion (SRC). DESIGN Retrospective, cross-sectional. SETTING Interdisciplinary specialty sports concussion clinic. PATIENTS Patients (n = 299) aged 12 to 19 years who were diagnosed with SRC within 30 days of injury. INDEPENDENT VARIABLES Clinical profiles and modifiers were decided by the clinical judgment of the clinical neuropsychologist and sports medicine physician, using data from the Clinical Profile Screen and information gathered from the clinical interview, neurocognitive, and vestibular and ocular motor testing. MAIN OUTCOME MEASURES Prolonged recovery was defined as ≥28 days from the date of injury to the date of clearance. RESULTS The most common clinical profiles were migraine (34.8%) and cognitive-fatigue (23.4%). There were no significant relationships between clinical profiles and prolonged recovery (Wald = 5.89, df = 4, P = 0.21). The presence of a modifier did not significantly affect the relationship between clinical profiles and prolonged recovery ( = 6.5, df = 5, P = 0.26). The presence of any modifier yielded a 10-day increase in median recovery time within the cognitive/fatigue clinical profile (Wilcoxon rank-sum = 268.5, P = 0.01). CONCLUSIONS Although patients with a clinical profile and modifier may not experience prolonged recovery, they may experience longer recovery time than patients with a clinical profile and no modifier.
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Affiliation(s)
- Morgan Anderson
- Baylor Scott & White Sports Therapy and Research, Frisco, Texas
- Baylor Scott & White Research Institute, Dallas, Texas
| | - Erin Reynolds
- Baylor Scott & White Sports Concussion Program, Frisco, Texas; and
| | - Taylor Gilliland
- Baylor Scott & White Sports Therapy and Research, Frisco, Texas
- Baylor Scott & White Research Institute, Dallas, Texas
| | | | - Simon Driver
- Baylor Scott & White Sports Therapy and Research, Frisco, Texas
- Baylor Scott & White Research Institute, Dallas, Texas
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12
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Patel H, Polam S, Joseph R. Overview of Treatment Options for Mild Traumatic Brain Injury: A Literature Review. Cureus 2024; 16:e59021. [PMID: 38800296 PMCID: PMC11127701 DOI: 10.7759/cureus.59021] [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: 01/08/2024] [Accepted: 04/20/2024] [Indexed: 05/29/2024] Open
Abstract
The incidence and prevalence of concussion, a type of mild traumatic brain injury (mTBI), have steadily increased among athletes, both students and professionals, across a wide variety of sports, including, but not limited to, swimming, tennis, football, and boxing. Recent data have demonstrated that sports are one of the leading causes of concussions among student athletes. While the exact mechanism of concussion onset has yet to be fully elucidated, data suggest that the pathophysiology involves rotational acceleration and deceleration of the brain, leading to axon tearing and disturbance in the metabolic cascade of glucose. Concussive events can have debilitating effects on an athlete, including chronic traumatic encephalopathy (gradual degeneration of brain tissue) that is related to personality changes, emotional disorders, and even dementia. Common symptoms associated with concussion include dizziness, nausea, vomiting, and headaches. The physical assessment consists of a combination of tools involving the mental status examination, vital signs, cervical spine exam, eye exam, and neurological testing. The use of osteopathic manipulative medicine (OMM), pharmacotherapy, hyperbaric oxygen therapy (HBOT), aerobic exercise, balance, and/or vestibular therapy are many common treatment approaches for concussion and post-concussion sequelae. This literature review aims to provide insight into concussions, the current treatment options available, and the new developments in concussions per the Amsterdam 2022 International Consensus Statement on Concussion in Sport published in 2023.
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Affiliation(s)
- Hemangi Patel
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Sneha Polam
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Roody Joseph
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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13
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Caeyenberghs K, Imms P, Irimia A, Monti MM, Esopenko C, de Souza NL, Dominguez D JF, Newsome MR, Dobryakova E, Cwiek A, Mullin HAC, Kim NJ, Mayer AR, Adamson MM, Bickart K, Breedlove KM, Dennis EL, Disner SG, Haswell C, Hodges CB, Hoskinson KR, Johnson PK, Königs M, Li LM, Liebel SW, Livny A, Morey RA, Muir AM, Olsen A, Razi A, Su M, Tate DF, Velez C, Wilde EA, Zielinski BA, Thompson PM, Hillary FG. ENIGMA's simple seven: Recommendations to enhance the reproducibility of resting-state fMRI in traumatic brain injury. Neuroimage Clin 2024; 42:103585. [PMID: 38531165 PMCID: PMC10982609 DOI: 10.1016/j.nicl.2024.103585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
Resting state functional magnetic resonance imaging (rsfMRI) provides researchers and clinicians with a powerful tool to examine functional connectivity across large-scale brain networks, with ever-increasing applications to the study of neurological disorders, such as traumatic brain injury (TBI). While rsfMRI holds unparalleled promise in systems neurosciences, its acquisition and analytical methodology across research groups is variable, resulting in a literature that is challenging to integrate and interpret. The focus of this narrative review is to address the primary methodological issues including investigator decision points in the application of rsfMRI to study the consequences of TBI. As part of the ENIGMA Brain Injury working group, we have collaborated to identify a minimum set of recommendations that are designed to produce results that are reliable, harmonizable, and reproducible for the TBI imaging research community. Part one of this review provides the results of a literature search of current rsfMRI studies of TBI, highlighting key design considerations and data processing pipelines. Part two outlines seven data acquisition, processing, and analysis recommendations with the goal of maximizing study reliability and between-site comparability, while preserving investigator autonomy. Part three summarizes new directions and opportunities for future rsfMRI studies in TBI patients. The goal is to galvanize the TBI community to gain consensus for a set of rigorous and reproducible methods, and to increase analytical transparency and data sharing to address the reproducibility crisis in the field.
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Affiliation(s)
- Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia.
| | - Phoebe Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA; Alfred E. Mann Department of Biomedical Engineering, Andrew & Erna Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA; Department of Quantitative & Computational Biology, Dana and David Dornsife College of Arts & Sciences, University of Southern California, Los Angeles, CA, USA.
| | - Martin M Monti
- Department of Psychology, UCLA, USA; Brain Injury Research Center (BIRC), Department of Neurosurgery, UCLA, USA.
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, NY, USA.
| | - Nicola L de Souza
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, NY, USA.
| | - Juan F Dominguez D
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia.
| | - Mary R Newsome
- Michael E. DeBakey VA Medical Center, Houston, TX, USA; H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA.
| | - Ekaterina Dobryakova
- Center for Traumatic Brain Injury, Kessler Foundation, East Hanover, NJ, USA; Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Andrew Cwiek
- Department of Psychology, Penn State University, State College, PA, USA.
| | - Hollie A C Mullin
- Department of Psychology, Penn State University, State College, PA, USA.
| | - Nicholas J Kim
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA; Alfred E. Mann Department of Biomedical Engineering, Andrew & Erna Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.
| | - Andrew R Mayer
- Mind Research Network, Albuquerque, NM, USA; Departments of Neurology and Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Maheen M Adamson
- Women's Operational Military Exposure Network (WOMEN) & Rehabilitation Department, VA Palo Alto, Palo Alto, CA, USA; Rehabilitation Service, VA Palo Alto, Palo Alto, CA, USA; Neurosurgery, Stanford School of Medicine, Stanford, CA, USA.
| | - Kevin Bickart
- UCLA Steve Tisch BrainSPORT Program, USA; Department of Neurology, David Geffen School of Medicine at UCLA, USA.
| | - Katherine M Breedlove
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA.
| | - Emily L Dennis
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Seth G Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Courtney Haswell
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
| | - Cooper B Hodges
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA; Department of Psychology, Brigham Young University, Provo, UT, USA.
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, OH, USA.
| | - Paula K Johnson
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; Neuroscience Center, Brigham Young University, Provo, UT, USA.
| | - Marsh Königs
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Lucia M Li
- C3NL, Imperial College London, United Kingdom; UK DRI Centre for Health Care and Technology, Imperial College London, United Kingdom.
| | - Spencer W Liebel
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Abigail Livny
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Rajendra A Morey
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA.
| | - Alexandra M Muir
- Department of Psychology, Brigham Young University, Provo, UT, USA.
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; NorHEAD - Norwegian Centre for Headache Research, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Adeel Razi
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; Wellcome Centre for Human Neuroimaging, University College London, WC1N 3AR London, United Kingdom; CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON, Canada.
| | - Matthew Su
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
| | - David F Tate
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Carmen Velez
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Elisabeth A Wilde
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Brandon A Zielinski
- Departments of Pediatrics, Neurology, and Neuroscience, University of Florida, Gainesville, FL, USA; Departments of Pediatrics, Neurology, and Radiology, University of Utah, Salt Lake City, UT, USA.
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, University of Southern California, Marina del Rey, CA, USA.
| | - Frank G Hillary
- Department of Psychology, Penn State University, State College, PA, USA; Department of Neurology, Hershey Medical Center, PA, USA.
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14
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D'Lauro C, Register-Mihalik JK, Meier TB, Kerr ZY, Knight K, Broglio SP, Leeds D, Lynall RC, Kroshus E, McCrea MA, McAllister TW, Schmidt JD, Master C, McGinty G, Jackson JC, Cameron KL, Buckley T, Kaminski T, Mihalik JP. Optimizing Concussion Care Seeking: Connecting Care-Seeking Behaviors and Neurophysiological States Through Blood Biomarkers. Am J Sports Med 2024; 52:801-810. [PMID: 38340366 DOI: 10.1177/03635465231221782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Timely and appropriate medical care after concussion presents a difficult public health problem. Concussion identification and treatment rely heavily on self-report, but more than half of concussions go unreported or are reported after a delay. If incomplete self-report increases exposure to harm, blood biomarkers may objectively indicate this neurobiological dysfunction. PURPOSE/HYPOTHESIS The purpose of this study was to compare postconcussion biomarker levels between individuals with different previous concussion diagnosis statuses and care-seeking statuses. It was hypothesized that individuals with undiagnosed concussions and poorer care seeking would show altered biomarker profiles. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Blood samples were collected from 287 military academy cadets and collegiate athletes diagnosed with concussion in the Advanced Research Core of the Concussion Assessment, Research and Education Consortium. The authors extracted each participant's self-reported previous concussion diagnosis status (no history, all diagnosed, ≥1 undiagnosed) and whether they had delayed or immediate symptom onset, symptom reporting, and removal from activity after the incident concussion. The authors compared the following blood biomarkers associated with neural injury between previous concussion diagnosis status groups and care-seeking groups: glial fibrillary acidic protein, ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light chain (NF-L), and tau protein, captured at baseline, 24 to 48 hours, asymptomatic, and 7 days after unrestricted return to activity using tests of parallel profiles. RESULTS The undiagnosed previous concussion group (n = 21) had higher levels of NF-L at 24- to 48-hour and asymptomatic time points relative to all diagnosed (n = 72) or no previous concussion (n = 194) groups. For those with delayed removal from activity (n = 127), UCH-L1 was lower at 7 days after return to activity than that for athletes immediately removed from activity (n = 131). No other biomarker differences were observed. CONCLUSION Individuals with previous undiagnosed concussions or delayed removal from activity showed some different biomarker levels after concussion and after clinical recovery, despite a lack of baseline differences. This may indicate that poorer care seeking can create neurobiological differences in the concussed brain.
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Affiliation(s)
- Christopher D'Lauro
- Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Johna K Register-Mihalik
- Matthew Gfeller Center & STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Zachary Yukio Kerr
- Matthew Gfeller Center & STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Kristen Knight
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Steven P Broglio
- University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Daniel Leeds
- Computer and Information Sciences, Fordham University, New York, New York, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Emily Kroshus
- University of Washington, Department of Pediatrics & Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, Seattle, Washington, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Christina Master
- Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Gerald McGinty
- United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Jonathan C Jackson
- United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy, West Point, New York, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Thomas Buckley
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Thomas Kaminski
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
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15
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Macknofsky B, Fomunung CK, Brown S, Baran JV, Lavin AC, Sabesan V. Concussion Rates in Youth Lacrosse Players and Comparison With Youth American Football. Orthop J Sports Med 2024; 12:23259671231223169. [PMID: 38390398 PMCID: PMC10883126 DOI: 10.1177/23259671231223169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/31/2023] [Indexed: 02/24/2024] Open
Abstract
Background There has been little focus on concussions in youth lacrosse players in the United States. Purpose To provide a descriptive analysis of the epidemiology and incidence of concussions in youth lacrosse and compare the results with well-documented analyses of concussions in youth American football. Study Design Descriptive epidemiology study. Methods Data on concussions in pediatric patients playing lacrosse from 2006 to 2019 were collected using the National Electronic Injury Surveillance System (NEISS). Weighted calculations and combined participation data obtained from membership in USA Lacrosse were used to estimate injury incidence. A comparison dataset was created using the NEISS data on youth football-related concussions. The cause of concussion was categorized into player-to-player, player-to-stick, player-to-ball, or player-to-ground contact. Results A total of 37,974 concussion injuries related to lacrosse were identified in players with a mean age of 14.5 ± 3.5 years; 70% of concussions occurred in boys. National participation in lacrosse increased from 2006 to 2011 by a mean of 10.3% annually, followed by a lower annual growth rate of 2.5% from 2012 to 2019. The overall incidence of concussion injuries increased over the study period (r = 0.314), with the incidence rate in boys being greater than that of girls from 2009 to 2013. The most common cause of concussion was player-to-ground contact for boys and player-to-ball or player-to-stick contact for girls. The mean annual concussion incidences in youth lacrosse and youth football were 443 and 355 per 100,000 participants, respectively. Conclusion Over the study period, 16% of lacrosse injuries were diagnosed as concussions, a higher mean annual incidence per 100,000 participants than that of youth football (443 vs 355). The cause of concussion was different based on sex, with higher rates of player-to-ball or player-to-stick contact in female players versus player-to-ground contact in male players.
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Affiliation(s)
- Brandon Macknofsky
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Clyde K Fomunung
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Shimron Brown
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Jessica V Baran
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Alessia C Lavin
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Vani Sabesan
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
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16
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Patel H, Polam S, Joseph R. Concussions: A Review of Physiological Changes and Long-Term Sequelae. Cureus 2024; 16:e54375. [PMID: 38505457 PMCID: PMC10948337 DOI: 10.7759/cureus.54375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/15/2024] [Indexed: 03/21/2024] Open
Abstract
A concussion is a type of mild traumatic brain injury (mTBI). It is prevalent among athletes across a wide variety of sports. The exact mechanism of a concussion is unknown, but it is currently accepted that the acceleration and deceleration of the brain is the insult causing disturbances in activity. The most common symptoms of concussions include but are not limited to dizziness, nausea, vomiting, and headaches. With repetitive concussive injuries, athletes can experience permanent changes such as chronic traumatic encephalopathy (gradual degeneration of brain tissue), which can lead to personality changes and memory deficits. This literature review aims to provide insight into concussions and the evaluation of physiological changes and long-term sequelae. A comprehensive literature search was performed from April 2012 to April 2022 using PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) and Embase databases. Nineteen articles were finally included in the literature review. The review shows that neuroimaging results demonstrated significant changes in the brain structure and function including alternations in the thalamus, hippocampus, corpus callosum, and the white matter, which can extend beyond the symptom amelioration. In addition, other approaches include brain metabolism, cerebral blood flow, and glucose utilization. Additional techniques include the evaluation of fatigue levels and the alterations in biomarkers, specifically IL-6. These approaches have demonstrated that consequences of concussions, including alternations in brain structure and function, can extend beyond an athlete's report of symptom resolution, and should be taken into consideration for return to play. The physiological changes present after a concussion have the potential to develop into long-term complications such as academic difficulty, cognitive decline, gut microbiome changes, gait changes, and increased risk of lower extremity injury. The findings in the literature review determine that is important to immediately address the symptoms of concussions to expedite treatment and prevent deleterious changes to the brain.
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Affiliation(s)
- Hemangi Patel
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Sneha Polam
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Roody Joseph
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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17
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Tysklind RG, Kraus KR, Dillon MT. Common Injuries in Female Competitive Softball Players. J Am Acad Orthop Surg 2023; 31:1149-1156. [PMID: 37561944 DOI: 10.5435/jaaos-d-23-00394] [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: 04/27/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
The popularity of softball is rising among female athletes with more than two million players between the ages of 12 and 18 competing per year. As participation rates increase, the frequency of injuries related to softball is on the rise. Softball injuries can differ from baseball injuries, and only a small amount of current literature focuses exclusively on softball injuries. Orthopaedic surgeons need to be prepared to evaluate, diagnose, and treat common injuries sustained while playing softball. The purpose of this study is to investigate the mechanisms of injury that are commonly encountered by female athletes in competitive fast-pitch softball and review current safety initiatives that have been implemented to aide in injury prevention.
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Affiliation(s)
- Robert G Tysklind
- From the Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
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18
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Al-Qahtani MA, Allajhar MA, Alzahrani AA, Asiri MA, Alsalem AF, Alshahrani SA, Alqahtani NM. Sports-Related Injuries in Adolescent Athletes: A Systematic Review. Cureus 2023; 15:e49392. [PMID: 38146581 PMCID: PMC10749669 DOI: 10.7759/cureus.49392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
Sports participation among adolescents is increasing, offering numerous health benefits and exposing them to the risk of sports-related injuries. This paper aims to understand that the prevalence and risk factors associated with these injuries are crucial for effective injury prevention and the overall well-being of adolescent athletes. This systematic review synthesizes the existing literature on sports-related injuries in adolescent athletes. A comprehensive search was conducted, yielding 11 relevant studies. The studies were analyzed to determine the prevalence of injuries and identify associated risk factors. A qualitative synthesis of the findings was performed. The included studies collectively highlight the significant burden of sports-related injuries among adolescent athletes, with prevalence rates ranging from 34.1% to 65%. Specific risk factors associated with these injuries include body mass index (BMI), physical activity patterns, age, gender, sport type, previous injuries, and training practices. Obese adolescents, those engaged in excessive weekly practice hours, younger athletes, and females were found to be at higher risk. Certain sports, such as soccer and football, exhibited higher injury rates. Sports-related injuries in adolescent athletes are a multifaceted issue influenced by various factors. Tailored injury prevention strategies are essential, considering the specific needs of adolescent athletes in different sports and age groups. Interventions should encompass physical and educational components, emphasizing proper warm-ups, protective equipment use, and injury prevention education. Longitudinal studies and standardized injury reporting systems are needed to monitor injury trends and evaluate prevention strategies effectively. This systematic review contributes to our understanding of sports-related injuries in adolescent athletes and underscores the importance of evidence-based injury prevention efforts.
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Affiliation(s)
| | | | | | | | | | - Salha A Alshahrani
- Epidemiology and Public Health, General Directorate of Health Affairs in Assir Region, Assir, SAU
| | - Naif M Alqahtani
- Epidemiology and Public Health, General Directorate of Health Affairs in Assir Region, Abha, SAU
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19
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Tanaka S, Sagisaka R, Sone E, Tanaka H. Sport level and sex differences in sport-related concussion among Japanese collegiate athletes: Epidemiology, knowledge, reporting behaviors, and reported symptoms. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:229-238. [PMID: 37753424 PMCID: PMC10518792 DOI: 10.1016/j.smhs.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 09/28/2023] Open
Abstract
This study investigated the incidence of sport-related concussion (SRC) in sports, effect of athlete knowledge on reporting behavior differences between collegiate and non-collegiate athletes, and differences in SRC symptoms between sexes and level of participation. In this cross-sectional survey, 1 344 Japanese collegiate and non-collegiate athletes from a single institute were analyzed. Using a web-based survey, demographics, general SRC, knowledge of SRC, the most recent SRC reporting behaviors, and symptom presentation were examined. The prevalence of SRC during the academic year 2016-2017 was 2.68 (95% confidence interval [CI]: 1.88-3.69) across all sports. The prevalence of SRC was 33.3 (95% CI: 17.96-51.83) in rugby union and 8.33 (95% CI: 1.03-27.00) in women's soccer. The prevalence of SRC in males (3.47 [95% CI: 2.38-4.86] was 3.65 times higher than that in females (0.95 [95% CI: 0.26-2.41]). In total, the mean total score of knowledge was 5.30 (4.2) across 25 questions; dizziness was the most well-known symptom (867/1 344, 64.5%), followed by headache (59.3%). Being more emotional (44/1 345, 3.3%) was the least frequently known symptom. Level of participation did not affect scores (5.16 [3.96] vs. 5.52 [4.54]; p = 0.131). All 87 disclosing participants experienced drowsiness and irritability and felt more emotional. In terms of sex and participant level, no significant differences were found in any symptoms. This study found very low rates of concussion education in Japan. Dissemination of concussion education is essential in the future to recognize concussion earlier and prevent severe concussive injury.
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Affiliation(s)
- Shota Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Japan
- Kokushikan Sports Promotion Center, Kokushikan University, Japan
| | - Ryo Sagisaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Japan
- Department of Integrated Science and Engineering for Sustainable Societies, Chuo University, Japan
| | - Etsuko Sone
- Research Institute of Disaster Management and EMS, Kokushikan University, Japan
- Kokushikan Sports Promotion Center, Kokushikan University, Japan
| | - Hideharu Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Japan
- Kokushikan Sports Promotion Center, Kokushikan University, Japan
- Department of Sports Medicine, Kokushikan University, Japan
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20
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Lempke LB, Shumski EJ, Prato TA, Lynall RC. Reliability and Minimal Detectable Change of the Standardized Assessment of Reaction Time. J Athl Train 2023; 58:579-587. [PMID: 36252207 PMCID: PMC10496444 DOI: 10.4085/1062-6050-0391.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Postconcussion reaction time deficits are common, but existing assessments lack sport-related applicability. We developed the Standardized Assessment of Reaction Time (StART) tool to emulate the simultaneous cognitive and motor function demands in sport, but its reliability is unestablished. OBJECTIVES To determine the intrarater, interrater, and test-retest reliability of StART and to examine the dual-task effect, time effect, and relationships between StART and computerized and laboratory-based functional reaction time assessments. DESIGN Prospective cohort study. SETTING Clinical laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty healthy, physically active individuals (age = 20.3 ± 1.8 years, females = 12, no concussion history = 75%). MAIN OUTCOME MEASURE(S) Participants completed the StART, computerized reaction time (Stroop task via CNS Vital Signs), and laboratory-based jump landing and cutting reaction time under single-task and dual-task (subtracting by 6s or 7s) cognitive conditions at 2 testing sessions a median of 7 days apart. We used intraclass correlation coefficients (ICCs), repeated-measure analysis of variance, and Pearson r correlations to address our aims. RESULTS Overall, good to strong interrater (ICC [2,k] range = 0.83-0.97), intrarater (ICC [3,k] range = 0.91-0.98), and test-retest (ICC [3,k] range = 0.69-0.89) reliability were observed. A significant reaction time assessment-by-cognitive condition interaction was present (P = .018, ηp2 = 0.14), with StART having the largest dual-task effect. Main time effects for dual-task conditions were seen across all reaction time assessments (mean difference = -25 milliseconds, P = .026, ηp2 = 0.08) with improved performance at the second testing session. No StART outcomes correlated with computerized reaction time (P > .05), although some correlated with single-task (r range = 0.42-0.65) and dual-task (r range = 0.19-0.50) laboratory cutting reaction time. CONCLUSIONS The StART demonstrated overall reliable performance relative to other reaction time measures. Reliability coupled with a strong dual-task effect indicates that StART is a valid measure for examining functional reaction time and may have future utility for sport-related concussion return-to-play decision-making.
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Affiliation(s)
- Landon B. Lempke
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor
- Division of Sports Medicine, Boston Children’s Hospital, MA
- Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Eric J. Shumski
- UGA Concussion Research Laboratory and
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Thomas A. Prato
- UGA Concussion Research Laboratory and
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Robert C. Lynall
- UGA Concussion Research Laboratory and
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens
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21
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Segars MF, Filben TM, Pritchard NS, Miller LE, Miles CM, Stitzel JD, Urban JE. Head Impact Exposure in Female Collegiate Soccer by Activity Type. J Appl Biomech 2023:1-8. [PMID: 37210079 DOI: 10.1123/jab.2022-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 02/08/2023] [Accepted: 03/28/2023] [Indexed: 05/22/2023]
Abstract
Soccer, one of the most popular sports in the world, has one of the highest rates of sports-related concussions. Additionally, soccer players are frequently exposed to nonconcussive impacts from intentionally heading the ball, a fundamental component of the sport. There have been many studies on head impact exposure in soccer, but few focus on soccer practices or practice activities. This study aimed to characterize the frequency and magnitude of head impacts in National Collegiate Athletic Association Division I female soccer practice activities using a custom-fit instrumented mouthpiece. Sixteen players were instrumented over the course of 54 practice sessions. Video analysis was performed to verify all mouthpiece-recorded events and classify practice activities. Category groupings of practice activities include technical training, team interaction, set pieces, position-specific, and other. Differences in head impact rates and peak resultant kinematics were observed across activity types and category groupings. Technical training had the highest impact rate compared to other category groupings. Impacts occurring during set piece activities had the highest mean kinematic values. Understanding drill exposure can help inform coaches on training plans aimed to reduce head impact exposure for their athletes.
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Affiliation(s)
- Mary Frances Segars
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC,USA
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, NC,USA
| | - Tanner M Filben
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC,USA
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, NC,USA
| | - N Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC,USA
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, NC,USA
| | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC,USA
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, NC,USA
| | - Christopher M Miles
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC,USA
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC,USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC,USA
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, NC,USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC,USA
- School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Winston-Salem, NC,USA
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22
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Bano JM, McAdams RJ, Roberts KJ, Yang J, McKenzie LB. Lacrosse-related injuries in boys and girls treated in U.S. emergency departments, 2000-2016. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:414-422. [PMID: 32810607 DOI: 10.1016/j.jshs.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/07/2020] [Accepted: 06/29/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Lacrosse is one of the fastest-growing sports in the United States. Its rules regarding permitted contact differ by sex and age. There are no known studies using a nationally representative data set to analyze lacrosse injury patterns over several years by sex and age in the youth population. METHODS A retrospective analysis was performed using data from the National Electronic Injury Surveillance System for youth aged 11-18 years who were treated for lacrosse-related injuries in U.S. emergency departments from 2000 to 2016. Based on our review of the case narratives, we created and coded a new injury-mechanism variable. We generated national estimates from 6406 cases. RESULTS An estimated 206,274 lacrosse-related injuries to youths aged 11-18 years were treated in U.S. emergency departments from 2000 to 2016. The rate of injuries per 10,000 significantly increased from 1.9 in 2000 to a peak of 5.3 in 2012 (p < 0.0001), followed by a significant decrease to 3.4 in 2016 (p = 0.020). Injury mechanism, body part injured, and diagnosis differed by sex. Boys were 1.62 times (95% confidence interval (95%CI): 1.25-2.09) more likely than girls to be injured by player-to-player contact. Girls were 2.21 times (95%CI: 1.96-2.49) more likely than boys to have non-contact injuries. Overall, as age increased, the percentage of injuries from lacrosse sticks decreased and player-to-player contact increased. CONCLUSION Despite additional protective regulations in the sport, lacrosse is an important source of injury where we continue to see differences by sex and age. This study supports the continuation, modification, and addition of rules aimed at reducing lacrosse injury risk.
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Affiliation(s)
- Joseph M Bano
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Rebecca J McAdams
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Kristin J Roberts
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH 43205, USA; Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH 43210, USA
| | - Lara B McKenzie
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH 43205, USA; Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH 43210, USA.
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23
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Lempke LB, Bergeron G, O'Connor S, Lynall RC, Resch JE, Walton SR. Concussion Assessment and Management Practices Among Irish and Canadian Athletic Therapists: An International Perspective. J Athl Train 2023; 58:293-304. [PMID: 35724361 PMCID: PMC11215646 DOI: 10.4085/1062-6050-0097.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Certified athletic therapists in Ireland and Canada serve essential concussion assessment and management roles, but their health care practices and concussion knowledge have not been established. OBJECTIVE To examine Irish and Canadian athletic therapist cohorts' (1) concussion knowledge, (2) current concussion assessment and management techniques across all job settings, and (3) the association of concussion assessment and management practices with years of clinical experience and highest degree attained. DESIGN Cross-sectional cohort study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS Licensed Irish (49.7%, n = 91/183) and Canadian (10.1%, n = 211/2090) athletic therapists. MAIN OUTCOME MEASURE(S) Athletic therapists completed an online survey assessing their demographics, concussion knowledge (symptom recognition, patient-clinician scenarios), frequency of concussions assessed annually, and assessment and return-to-play (RTP) measures using a modified, previously validated survey. Symptom recognition consisted of 20 (8 true, 12 false) items on recognition of signs and symptoms that were scored as total correct. Descriptive statistics and odds ratios were used to examine survey responses where appropriate. RESULTS Irish (86.8%, n = 46/53) and Canadian (93.4%, n = 155/166) athletic therapists indicated RTP guidelines were the most common method for determining RTP. Symptom recognition scores were 72.8% ± 17.0% among Irish and 76.6% ± 17.0% among Canadian athletic therapists. Irish (91.2%, n = 52/57) and Canadian (90.4%, n = 161/178) athletic therapists reported standardized sideline assessments as the most used concussion assessment method. Irish and Canadian athletic therapists' use of 2-domain (Irish: 38.6% [n = 22/57]; Canadian: 73.6% [n = 131/178]) and 3-domain (Irish: 3.5% [n = 2/57]; Canadian: 19.7% [n = 35/178]) minimum assessments (ie, symptoms, balance, or neurocognitive) was not associated with education or clinical experience (P ≥ .07), except for Canadian athletic therapists with master's degrees having greater odds of completing 2-domain assessments at initial evaluation than those with bachelor's degrees (odds ratio = 1.80; 95% CI = 1.41, 1.95). CONCLUSIONS Irish and Canadian athletic therapists demonstrated similar concussion knowledge; however, most did not fully adhere to international consensus guidelines for concussion assessment as evidenced by low 2- and 3-domain assessment use. Athletic therapists should aim to implement multidimensional concussion assessments to ensure optimal health care practices and patient safety.
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Affiliation(s)
- Landon B. Lempke
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens
- School of Kinesiology, Michigan Concussion Center, University of Michigan, Ann Arbor
| | - Glen Bergeron
- Department of Kinesiology and Applied Health, The University of Winnipeg, Manitoba, Canada
| | - Siobhán O'Connor
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, School of Health and Human Performance, Dublin City University, Ireland
| | - Robert C. Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Jacob E. Resch
- Exercise and Sport Injury Laboratory, Department of Kinesiology, University of Virginia, Charlottesville
| | - Samuel R. Walton
- Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond
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24
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Bryant AM, Kerr ZY, Walton SR, Barr WB, Guskiewicz KM, McCrea MA, Brett BL. Investigating the association between subjective and objective performance-based cognitive function among former collegiate football players. Clin Neuropsychol 2023; 37:595-616. [PMID: 35670306 PMCID: PMC9726994 DOI: 10.1080/13854046.2022.2083021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Studies have observed variable associations of prior contact sport participation with subjective and objective measures of cognitive function. This study directly investigated the association between subjective self-report and objective performance-based cognition among former collegiate football players, as well as its relationship to self-reported concussion history. METHODS Former collegiate football players (N = 57; mean age = 37.9 years [SD = 1.49]) retired from sport 15-years prior were enrolled. Linear regression models examined associations between subjective cognition (Quality of Life in Neurological Disorders Cognitive Functioning-Short Form), and performance on a neuropsychological battery. Domain specific (executive function) metrics of subjective (Behavior Rating Inventory of Executive Function-Adult) and objective cognition were also exclusively examined. Associations between self-reported concussion history with subjective and objective measures were tested. Potential influential factors (sleep quality and distress) were included as covariates. RESULTS Subjective cognition was not significantly associated with any objective measures of cognitive functioning (p's > .05). Greater self-reported concussion history was inversely associated with subjective cognition (B = -2.49, p = .004), but not objective performance-based cognition (p's > .05). Distress was significantly related to all metrics of subjective cognition (p's < .001) as well as performance on delayed recall and verbal fluency (p's < .05). Sleep quality was only significantly related to timed visuospatial sequencing (p = .033). CONCLUSIONS Reliance on self-reported measures of cognitive functioning alone is insufficient when assessing cognition in former contact sport athletes. Assessment of other factors known to influence subjective cognitive complaints should also be examined in determining the presence of cognitive deficits.
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Affiliation(s)
- Andrew M. Bryant
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Samuel R. Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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ORTIZ MI, VUELVAS-OLMOS CR, GÓMEZ-BUSTO FJ. Baseline scores on sport concussion assessment tool (SCAT-5) in student athletes. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2023. [DOI: 10.23736/s0393-3660.22.04800-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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26
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Ryan L, Daly E, Blackett AD. Sport-related concussion disclosure in women's rugby-A social identity approach. Front Sports Act Living 2023; 5:1058305. [PMID: 37090816 PMCID: PMC10114594 DOI: 10.3389/fspor.2023.1058305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Sport-related concussion (SRC) is a risk of collision sports such as women's rugby. To support appropriate SRC diagnosis and management, an understanding of the factors that encourage SRC disclosure is necessary. To date, research has focused on ascertaining individual player knowledge and attitudes towards SRC disclosure. Methods We chose to investigate the potential influence of group identification effects by examining the role of social identity on SRC disclosure in elite women's rugby. Seventeen elite players from the United Kingdom and Ireland were interviewed and their transcripts thematically analysed. Results The data highlighted that the players shared a very strong social identity as women in rugby and were acutely aware that their experiences were different to their male counterparts. The shared social identity had both positive and negative implications for SRC disclosure. The players interviewed did not feel comfortable disclosing their symptoms to their coach and often felt that medical staff either did not listen to them or were unavailable to them. Mediators such as communication, trust in medical teams, perceived pressure, positive injury management experience, and player role models were identified. Discussion This research could be utilised to inform sport psychology interventions to enhance SRC disclosure in elite women's rugby.
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Affiliation(s)
- Lisa Ryan
- Department of Sport, Exercise and Nutrition, Atlantic Technological University, Galway, Ireland
- Correspondence: Lisa Ryan
| | - Ed Daly
- Department of Sport, Exercise and Nutrition, Atlantic Technological University, Galway, Ireland
| | - Alexander D. Blackett
- Department of Sport and Exercise, School of Health Science & Wellbeing, Staffordshire University, Stoke-on-Trent, United Kingdom
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Younger DS. Mild traumatic brain injury and sports-related concussion. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:475-494. [PMID: 37620086 DOI: 10.1016/b978-0-323-98817-9.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Mild traumatic brain injury (mTBI) and concussion are equivalent terms for the sequela of injury to the head that disrupts brain functioning. Various forces may be causative from seemingly innocuous bumps to the head resulting from sports-related injuries to more severe blows to the head. However, the postconcussive motor, cognitive, emotional, and psychosocial sequelae can be just as devastating and long lasting, leading to loss of independent function and safe performance of activities. Taken together, they pose a significant challenge to recovery, requiring a multifaceted dynamic rehabilitative strategy. The current systems of health care pose challenges to suboptimal management of sports-related concussion (SRC) that goes beyond the acute injury, and into the school setting, failing to be identified by school staff, and inconsistencies in communicating medical information regarding school modifications, follow-up health services, or concussion-related educational services. Children who sustain SRC at different ages face different challenges. Young children face increased vulnerability due to SRC that coincides with periods of brain motor maturation and development.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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Hadjisavvas S, Efstathiou MA, Malliou V, Giannaki CD, Stefanakis M. Risk factors for shoulder injuries in handball: systematic review. BMC Sports Sci Med Rehabil 2022; 14:204. [PMID: 36461053 PMCID: PMC9717475 DOI: 10.1186/s13102-022-00588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Handball is a sport with a high number of severe injuries. The shoulder is one of the most commonly injured joints, with an average prevalence of 17-41%. OBJECTIVE The primary aim is to identify the most significant risk factors related to shoulder injuries in handball. The secondary aim is to propose recommendations based on the available evidence concerning potential injury prevention strategies. METHODS Systematic searches of PubMed, MEDLINE, CINAHL, Proquest, SPORTDiscus, Web of Science, EMBASE, and Scopus were undertaken for peer reviewed articles published between 15 July 1995 and 15 July 2019. The same search strategy was repeated on 24 April 2022. Prospective cohort studies, written in English and published in a journal with a peer-review process aiming to investigate at least one modifiable or/and a non-modifiable potential risk factor for shoulder injuries, specifically in handball players, were included. Only papers published after 1995 were included. The methodological quality of the eligible studies was assessed using the modified version of the Downs and Black Checklist. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results. RESULTS 1849 studies were identified, of which 8 were included. A total of 2536 (males = 1354, females = 1182) participants of which 2522 were handball athletes, were included. Four of the eight studies were rated as high methodological quality studies (> 85%) while the rest were rated as medium (50-85%). The risk factors for shoulder injuries in handball identified in the studies were strength imbalances (n = 6), glenohumeral range of motion (ROM) imbalances (n = 5), scapular dyskinesis (n = 5), incorrect dosage of training load (n = 2), previous injury (n = 1), sex (n = 2), player's position, school grade, playing level (n = 1), altered shoulder joint position sense (n = 1). CONCLUSION Overall, from all the risk factors evaluated, there was strong evidence that the weakness of the shoulder external rotator muscles and the female sex increase the probability of shoulder injury in handball athletes. Nevertheless, the evidence for the other risk factors was moderate due to the methodological quality and the limited number of studies. PROTOCOL REGISTRATION PROSPERO ID: CRD42020138233.
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Affiliation(s)
- Stelios Hadjisavvas
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.
| | | | - Vivian Malliou
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | | | - Manos Stefanakis
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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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.
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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
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Migotto BDJ, Gill S, Sem M, Macpherson AK, Hynes LM. Sex-related differences in sternocleidomastoid muscle morphology in healthy young adults: A cross-sectional magnetic resonance imaging measurement study. Musculoskelet Sci Pract 2022; 61:102590. [PMID: 35667320 DOI: 10.1016/j.msksp.2022.102590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Changes in sternocleidomastoid (SCM) muscle cross-sectional area (CSA) and volume may contribute to neck-related concussion symptoms and whiplash-associated disorders. Magnetic resonance imaging (MRI) data on healthy SCM morphology can provide information that may lead to targeted treatment protocols. OBJECTIVES To examine sex-related differences in MRI-based SCM CSA, SCM volume and neck area in healthy young adults, to analyze associations between measurements and participant variables and to assess inter-rater reliability for measurement quantification. DESIGN Cross-sectional study. METHODS 13 males and 14 females underwent MRI scans. Slices obtained from C3-C7 were analyzed by three raters. SCM CSA at C4, total SCM volume from C3-C7 and neck area at C4 were quantified. Measurements were calculated as absolute and normalized values by body mass. Multivariable regression was used to analyze associations between normalized measurement values and participant variables. Inter-rater reliability was determined using intraclass correlation coefficients (ICC). RESULTS Females had significantly lower normalized overall average SCM CSA (mean difference 1.3 mm2/kg (95% CI 0.4-2.2, p = 0.006) and total SCM volume (mean difference 140.8 mm3/kg (95% CI 66.1-215.5, p < 0.001) than males. Regression models indicated female sex was associated with lower normalized overall average SCM CSA (p = 0.004) and total SCM volume (p < 0.001). Inter-rater reliability was excellent for SCM CSA (ICC3,3 = 0.909), SCM volume (ICC3,3 = 0.910) and neck area (ICC3,3 = 0.995). CONCLUSIONS These results enhance our understanding of sex-related differences in SCM morphology and will inform future research and clinical practice related to cervical muscle injury.
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Affiliation(s)
- Ben D J Migotto
- Whiplash and Head Injury Prevention/Rehabilitation (WHIPR) Lab, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada; School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Sandeep Gill
- Whiplash and Head Injury Prevention/Rehabilitation (WHIPR) Lab, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada; School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Matthew Sem
- Whiplash and Head Injury Prevention/Rehabilitation (WHIPR) Lab, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada; School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Alison K Macpherson
- School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada; York University Sport Medicine Team, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Loriann M Hynes
- Whiplash and Head Injury Prevention/Rehabilitation (WHIPR) Lab, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada; School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada; York University Sport Medicine Team, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
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Chaychi S, Valera E, Tartaglia MC. Sex and gender differences in mild traumatic brain injury/concussion. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:349-375. [PMID: 36038209 DOI: 10.1016/bs.irn.2022.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The high incidence of concussions/mild traumatic brain injury and the significant number of people with persisting concussion symptoms as well as the concern for delayed, neurodegenerative effects of concussions makes them a major public health concern. There is much to learn on concussions with respect to pathophysiology as well as vulnerability and resiliency factors. The heterogeneity in outcome after a concussion warrants a more personalized approach to better understand the biological and psychosocial factors that may affect outcome. In this chapter we address biological sex and gender as they impact different aspects of concussion including incidence, risk factors and outcome. As well, this chapter will provide a more fulsome overview of intimate partner violence, an often-overlooked cause of concussion in women. Applying the sex and gender lens to concussion/mild traumatic brain injury is imperative for discovery of its pathophysiology and moving closer to treatments.
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Affiliation(s)
- Samaneh Chaychi
- Memory Clinic, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Eve Valera
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
| | - Maria Carmela Tartaglia
- Memory Clinic, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.
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Bretzin AC, Tomczyk CP, Wiebe DJ, Covassin T. Avenues for Sport-Related Concussion Prevention in High School Football: Effect of Limiting Collision Practices. J Athl Train 2022; 57:733-740. [PMID: 35192702 PMCID: PMC9661931 DOI: 10.4085/1062-6050-0341.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Football continues to demonstrate the highest rate of sport-related concussion (SRC) in high school athletics. To mitigate the SRC risk, the Michigan High School Athletic Association (MHSAA) implemented rules aimed at reducing the number of collisions occurring in practices. OBJECTIVE To estimate the rates of SRC in MHSAA football programs and evaluate progressive limitations to collision practices over 5 consecutive seasons. DESIGN Retrospective cohort study. SETTING Michigan high school football. PATIENTS OR OTHER PARTICIPANTS High school (9th-12th grade) football athletes (>99% male) participating in MHSAA-sanctioned events. MAIN OUTCOME MEASURE(S) Designated administrators at each school recorded the total number of participating athletes and SRCs (defined as head injuries resulting from athletic participation that required the student-athletes to be withheld from activity after exhibiting signs, symptoms, or behaviors consistent with an SRC) in the MHSAA injury-surveillance system each season (2015-2016 through 2019-2020). Progressive limitations to collision practices occurred across the study period. We estimated athlete-exposures (AEs) as the total number of players multiplied by the total number of possible practices (11 weeks, 4 days each) or competitions (9 weeks, 1 day each) during each season. Incidence rates and rate ratios (RRs) with 95% CIs were used to compare practice and competition SRCs and each season with the most recent season. RESULTS A total of 7755 football SRCs were diagnosed across the 5-year period. The overall SRC rate was 8.03 per 10 000 AEs (95% CI = 7.85, 8.21). The competition SRC rate (30.13/10 000 AEs) was higher than the practice rate (3.51/10 000 AEs; RR = 8.58; 95% CI = 8.19, 9.00). The practice SRC rate was lower in 2017-2018 (RR = 0.86; 95% CI = 0.77, 0.97), 2018-2019 (RR = 0.89; 95% CI = 0.79, 1.0), and 2019-2020 (RR = 0.83; 95% CI = 0.74, 0.94) relative to 2015-2016. CONCLUSIONS We found that the progressive limitations to collision practices were protective against SRCs, as the rate of SRC was lower in the 3 most recent seasons relative to 2015-2016.
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Affiliation(s)
- Abigail C. Bretzin
- Penn Injury Science Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | | | - Douglas J. Wiebe
- Penn Injury Science Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing
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Chrisman SPD, Bollinger BJ, Mendoza JA, Palermo TM, Zhou C, Brooks MA, Rivara FP. Mobile Subthreshold Exercise Program (MSTEP) for concussion: study protocol for a randomized controlled trial. Trials 2022; 23:355. [PMID: 35473570 PMCID: PMC9040347 DOI: 10.1186/s13063-022-06239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subthreshold exercise, defined as aerobic exercise below the level that causes symptoms, has been utilized as a treatment for youth with persistent postconcussive symptoms (PPCS), but there is currently little evidence to guide use. In addition, prior studies of exercise for PPCS have all required multiple in-person visits. We developed a virtual approach for delivering subthreshold exercise to youth with PPCS called the Mobile Subthreshold Exercise Program (MSTEP), and we have now been funded to conduct a large national randomized controlled trial (RCT) to test its efficacy for reducing concussive symptoms and improving health-related quality of life. METHODS This investigation is an RCT comparing MSTEP to an active control. We will recruit 200 adolescents 11-18 years old with postconcussive symptoms persisting for at least 1 week but less than 1 year. Youth will be randomized to receive either 6 weeks of subthreshold exercise (MSTEP) or a stretching condition (control). Youth and parents will complete surveys of concussive symptoms at baseline, weekly during the intervention, and at 3 and 6 months. The primary outcomes will be trajectory of concussive symptoms and health-related quality of life over the 6 months of the study. Secondary outcomes will include depression, anxiety, and sleep quality. We will also assess potential mediators of treatment effects including moderate-vigorous physical activity and fear avoidance of concussive symptoms. DISCUSSION This multisite RCT of MSTEP will provide vital information regarding the efficacy of a virtually delivered subthreshold exercise program for youth with PPCS, and insight regarding potential mediators of treatment effects, including objectively measured physical activity and fear avoidance of concussive symptoms. TRIAL REGISTRATION ClinicalTrials.gov NCT04688255. Registered on December 29, 2020.
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Affiliation(s)
- Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA. .,Department of Pediatrics, University of Washington, Seattle, USA.
| | - Beth J Bollinger
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA
| | - Jason A Mendoza
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA.,Department of Pediatrics, University of Washington, Seattle, USA.,Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA
| | | | - Frederick P Rivara
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA.,Department of Pediatrics, University of Washington, Seattle, USA
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Juan SMA, Daglas M, Adlard P. Tau pathology, metal dyshomeostasis and repetitive mild traumatic brain injury: an unexplored link paving the way for neurodegeneration. J Neurotrauma 2022; 39:902-922. [PMID: 35293225 DOI: 10.1089/neu.2021.0241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Repetitive mild traumatic brain injury (r-mTBI), commonly experienced by athletes and military personnel, causes changes in multiple intracellular pathways, one of which involves the tau protein. Tau phosphorylation plays a role in several neurodegenerative conditions including chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disorder linked to repeated head trauma. There is now mounting evidence suggesting that tau phosphorylation may be regulated by metal ions (such as iron, zinc and copper), which themselves are implicated in ageing and neurodegenerative disorders such as Alzheimer's disease (AD). Recent work has also shown that a single TBI can result in age-dependent and region-specific modulation of metal ions. As such, this review explores the link between TBI, CTE, ageing and neurodegeneration with a specific focus on the involvement of (and interaction between) tau pathology and metal dyshomeostasis. The authors highlight that metal dyshomeostasis has yet to be investigated in the context of repeat head trauma or CTE. Given the evidence that metal dyshomeostasis contributes to the onset and/or progression of neurodegeneration, and that CTE itself is a neurodegenerative condition, this brings to light an uncharted link that should be explored. The development of adequate models of r-mTBI and/or CTE will be crucial in deepening our understanding of the pathological mechanisms that drive the clinical manifestations in these conditions and also in the development of effective therapeutics targeted towards slowing progressive neurodegenerative disorders.
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Affiliation(s)
- Sydney M A Juan
- The Florey Institute of Neuroscience and Mental Health, 56369, 30 Royal Parade, Parkville, Melbourne, Victoria, Australia, 3052;
| | - Maria Daglas
- The Florey Institute of Neuroscience and Mental Health, 56369, Parkville, Victoria, Australia;
| | - Paul Adlard
- Florey Institute of Neuroscience and Mental Health, 56369, Parkville, Victoria, Australia;
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Sex and Gender Science: The World Writes on the Body. Curr Top Behav Neurosci 2022; 62:3-25. [PMID: 35253110 DOI: 10.1007/7854_2022_304] [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: 10/18/2022]
Abstract
Sex and Gender Science seeks to better acknowledge that the body cannot be removed from the world it inhabits. We believe that to best answer any neuroscience question, the biological and the social need to be addressed through both objective means to learn, "how it is like" and subjective means to learn, "what it is like." We call bringing the biological and social together, "Situated Neuroscience" and the mixing of approaches to do so, Very Mixed Methods. Taken together, they constitute an approach to Sex and Gender Science. In this chapter, we describe neural phenomena for which considering sex and gender together produces a fuller knowledge base: sleep, pain, memory, and concussion. For these brain phenomena examples, studying only quantitative measures does not reveal the full impact of these lived experiences on the brain but studying only the qualitative would not reveal how the brain responds. We discuss how Sex and Gender Science allows us to begin to bring together biology and its social context and acknowledge where context can contribute to resolving ignorance to offer more expansive, complementary, and interrelating pictures of an intricate neuro-landscape.
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Theodoroff SM, Papesh M, Duffield TC, Novak M, Gallun FJ, King L, Chesnutt J, Rockwood R, Palandri M, Hullar TE. Concussion Management Guidelines Neglect Auditory Symptoms. Clin J Sport Med 2022; 32:82-85. [PMID: 32941367 PMCID: PMC7956904 DOI: 10.1097/jsm.0000000000000874] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tinnitus, noise sensitivity, and hearing difficulties are commonly reported secondary to head injury. These auditory deficits have been shown to negatively impact daily functioning, and yet, often go unnoticed by health care professionals. The purpose of this editorial is to explain why it is essential for clinical practice guidelines that address the management of patients who have experienced a head injury to incorporate assessment and rehabilitation of auditory symptoms.
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Affiliation(s)
- SM Theodoroff
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - M Papesh
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - TC Duffield
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - M Novak
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - FJ Gallun
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - L King
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - J Chesnutt
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - R Rockwood
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - M Palandri
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - TE Hullar
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Non-Time-Loss and Time-Loss Injuries in Secondary School Girls' Volleyball Athletes: A Report From the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program. J Sport Rehabil 2022; 31:536-543. [PMID: 35196647 DOI: 10.1123/jsr.2021-0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Volleyball is a popular sport with a risk of injury to the entire body. Insight into non-time-loss (NTL) and time-loss (TL) injuries is needed to inform seasonal injury trends that may lead to appropriate prevention and management strategies. This study provides a descriptive analysis of volleyball injuries among secondary school athletes. STUDY DESIGN Descriptive epidemiology study. METHODS Data were collected from 72 secondary schools, representing 135 team seasons of data from the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (2014-2015 to 2018-2019 academic years). Injury counts, injury rates (IR) per 1000 athlete exposures (AEs), and incidence rate ratios (IRR) were reported with 95% confidence intervals (CIs). RESULTS In total, 529 injuries over 193,858 AEs for girls' volleyball were captured, producing an IR of 2.73/1000AEs (95% CI = 2.50-2.96). The overall IR was highest during the preseason compared with regular season (IRR = 1.31, 95% CI = 1.09-1.59). Overall IRs were higher in competition (IR: 3.56, 95% CI = 3.07-4.05) compared with practice (IR: 2.38, 95% CI = 2.12-2.64; IRR = 1.49, 95% CI = 1.25-1.79). Common body locations injured were ankle (n = 141, 26.7%; NTL: n = 56, 21.7%; TL: n = 85, 31.7%), knee (n = 61, 11.5%; NTL: n = 33, 12.8%, TL: n = 28, 10.5%), hand/wrist (n = 59, 11.2%; NTL: n = 32, 12.4%, TL: n = 27, 10.1%), and head/face (n = 62, 11.7%; NTL: n = 14, 5.4%; TL: n = 47, 17.5%). CONCLUSIONS Volleyball IRs were highest in preseason and during competition. Most injuries affected the lower-extremity which is notable considering the high upper-extremity load in volleyball. Consideration of strategies to reduce injuries prior to the start of the formal sports season may be needed to help reduce the incidence of preseason injuries.
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Swartz EE, Register-Mihalik JK, Broglio SP, Mihalik JP, Myers JL, Guskiewicz KM, Bailes J, Hoge M. National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players. J Athl Train 2022; 57:113-124. [PMID: 35201304 PMCID: PMC8876879 DOI: 10.4085/1062-6050-0062.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries. BACKGROUND In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy. CONCLUSIONS The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.
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Affiliation(s)
- Erik E. Swartz
- Department of Physical Therapy and Kinesiology, University of Massachusetts, Lowell
| | - Johna K. Register-Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | | | - Jason P. Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | - Jay L Myers
- Department of Physical Therapy and Kinesiology, University of Massachusetts, Lowell
| | - Kevin M. Guskiewicz
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
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Memmini AK, Van Pelt KL, Wicklund A, Breedlove KM, Broglio SP. Evaluating Adult Decision-Making Modifiers in Support of Youth Contact-Sport Participation. J Athl Train 2022; 57:44-50. [PMID: 35040986 PMCID: PMC8775283 DOI: 10.4085/1062-6050-0125.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Nearly 44 million youth participate in organized youth sports programs in the United States each year. However, approximately 25% of parents have considered removing their children from sports due to the fear of concussion. OBJECTIVE To determine which adult decision-making modifiers (eg, gender, educational attainment, career type) influenced support for youth contact-sports participation. DESIGN Cross-sectional study. SETTING Midwestern university and medical center. PATIENTS OR OTHER PARTICIPANTS Convenience sample of staff and faculty (N = 5761; 73.9% female) from 2017 to 2018. MAIN OUTCOME MEASURE(S) Support for youth contact-sports participation using multivariate binary logistic regression to calculate odds ratios and 95% CIs. RESULTS The sample was split between adults with children (AWCs; n = 3465, age = 45.39 ± 13.27 years, 76.72% female) and adults without children (AWOCs; n = 2296, age = 30.84 ± 9.01 years, 70.26% female). Among AWCs, those who obtained a bachelor's degree or higher were more likely to support contact-sports participation. Females were more inclined to allow all contact sports, specifically football (odds ratio [OR] = 2.22; 95% CI = 1.64, 3.01) and ice hockey (OR = 1.98; 95% CI = 1.42, 2.78). Overall, previous adult sport participation, increasing number of children, and child gender were significant modifying variables in greater support of youth contact-sports participation among AWCs (P < .001). Among AWOCs, previous sport participation in football (OR = 3.27; 95% CI = 2.14, 4.87), ice hockey (OR = 4.26; 95% CI = 2.23, 8.17), or soccer (OR = 2.29; 95% CI = 1.48, 3.54) increased the likelihood of an adult supporting contact-sports participation. Lastly, all adults were less inclined to support a daughter participating in any contact sport than a son. CONCLUSIONS These results reveal adult- and child-specific variables that may influence youth contact-sports participation. These decisions may be developed through the lens of certain gender role beliefs and may lead adults to perceive certain sports as more appropriate for sons than daughters.
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Affiliation(s)
| | | | | | - Katherine M. Breedlove
- Department of Radiology, Harvard Medical School, Boston, MA
,Center for Clinical Spectroscopy, Brigham and Women's Hospital, Boston, MA
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Weber Rawlins ML, Johnson BR, Register-Mihalik JK, DeAngelis K, Schmidt JD, D'Lauro CJ. United States Air Force Academy Cadets' Unprompted Knowledge of Concussions and "Bell Ringers" or "Dings": Perceived Differences and Similarities. J Athl Train 2022; 57:25-31. [PMID: 34129664 PMCID: PMC8775285 DOI: 10.4085/1062-6050-0685.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT After a possible concussion mechanism, cadets are unlikely to have a list of concussion signs and symptoms at their disposal. As such, unprompted concussion knowledge may be an essential factor in personal recognition of injury. OBJECTIVE To explore determinants that contributed to United States Air Force Academy (USAFA) cadets' disclosure of a concussion. This research focused on 1 of 8 overall discovered themes of unprompted concussion knowledge. DESIGN Qualitative study. SETTING Military academy. PATIENTS OR OTHER PARTICIPANTS Cadets at the USAFA (males = 23, females = 11, age = 19.91 ± 1.14 years). MAIN OUTCOME MEASURE(S) We conducted 34 semistructured interviews. The transcribed text was analyzed in a 5-cycle process. From this process, 8 overall themes emerged, including unprompted concussion knowledge. Subthemes were concussion definition, concussion symptoms, "bell-ringer" or "ding" definition, "bell-ringer" or "ding" symptoms, and concussion versus "bell ringer" or "ding." RESULTS Many participants were able to describe a concussion fairly accurately. The most commonly listed concussion signs and symptoms were dizziness (n = 22/34, 64.7%); "can't remember"/"memory loss"/"forgetful" (n = 19/34, 55.9%); and headache (n = 16/34, 47.1%). The cadet participants characterized the most common bell-ringer or ding signs and symptoms as dizziness (n = 2/34, 5.9%) and headache (n = 2/34, 5.9%). Cadets also described how a bell ringer or ding differs from a concussion, often commenting that concussions were more severe than bell ringers or dings. CONCLUSIONS Overall, USAFA cadet participants listed common concussion signs and symptoms. However, they perceived differences between a concussion and a bell ringer or ding. Although decreasing the use of colloquial terms for concussion is recommended, use of these terms when examining a concussion history may be helpful. Concussion-education interventions should continue to focus on describing concussion signs and symptoms using cadets' own words to describe the injury (eg, "forgetful") but differentiating between what may and may not be a concussion and encouraging individuals to consult health care providers regarding possible concussion symptoms.
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41
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Pankow MP, Syrydiuk RA, Kolstad AT, Hayden AK, Dennison CR, Mrazik M, Hagel BE, Emery CA. Head Games: A Systematic Review and Meta-analysis Examining Concussion and Head Impact Incidence Rates, Modifiable Risk Factors, and Prevention Strategies in Youth Tackle Football. Sports Med 2021; 52:1259-1272. [PMID: 34894348 DOI: 10.1007/s40279-021-01609-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth football (high school level or younger); (2) identify modifiable risk factors for concussion and head impact; and (3) evaluate the effectiveness of prevention strategies in tackle football at any level. METHODS Nine databases (CINAHL Plus with Full Text; Cochrane Central Register of Controlled Trials; EMBASE; ERIC; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; ProQuest Dissertations & Theses Global Database; PsycINFO; Scopus; and SPORTDiscus with Full Text) were searched using the search strategy focusing on four main concepts: concussion/head impact, tackle football, modifiable risk factors, and primary prevention. Two reviewers completed title, abstract, and full-text screening as well as risk of bias assessment (using the Downs and Black checklist), with a third author available to resolve any disagreements. MAIN RESULTS After removing duplicates, 1911 articles were returned. Fifty-eight articles were included in the review and 20 in the meta-analysis. The overall combined rates of concussion (including game and practice-related concussion) based on the meta-analysis were 0.78 concussions/1000 athlete exposures [95% confidence interval (CI) 0.67-0.89] for high school football (ages 13-19) and 1.15 concussions/1000 athlete exposures (95% CI 0.89-1.41) for minor football players (ages 5-15). There is evidence that contact training and practice contact restrictions have reduced the rate of head impacts and concussion. Heads Up Football (an intervention focused on coach education and contact training) has been shown to reduce the rate of concussion by 32% and head impacts by 38% amongst high school football players. Limiting contact practices in high schools to 2 days per week reduced practice head impacts per player-season by 42%, and limiting full contact in practice to 75 min per week in the second week of the season and 60 min in week 3 and beyond resulted in a 54% decrease in the practice-related concussion rate (p = 0.003). CONCLUSIONS This review identified a critical need for interventions to address the high rates of concussion and head impact in youth football. To date, contact training and contact restrictions have the strongest evidence supporting their effectiveness at reducing these rates. Future research should use consistent concussion definitions and validated injury surveillance systems, and ensure complete reporting of participant characteristics and sampling details. Prospero ID CRD42020193775.
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Affiliation(s)
- Mark Patrick Pankow
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada. .,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada. .,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada. .,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | - R A Syrydiuk
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - A T Kolstad
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - A K Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - C R Dennison
- Department of Mechanical Engineering, University of Victoria, Victoria, Canada.,Biomedical Instrumentation Lab, Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - M Mrazik
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - B E Hagel
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - C A Emery
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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42
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Scanaliato JP, Wells ME, Dunn JC, Garcia EJ. Overview of Sport-Specific Injuries. Sports Med Arthrosc Rev 2021; 29:185-190. [PMID: 34730116 DOI: 10.1097/jsa.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Athletes are at risk for a variety of injuries not typically sustained in everyday life. The team physician must be capable of not only identifying and treating injuries as they occur, but he or she must be armed with the knowledge to minimize the risk of injuries before they occur. This review serves to provide an overview of the various sport-specific injuries typically encountered by team physicians. Injuries are grouped by body part and/or organ system, when possible. We do not aim to cover in detail the various treatments for these injuries; rather, we hope that this article provides a comprehensive overview of sport-specific injury, and demonstrate the well-roundedness in skills that must be possessed by team physicians.
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43
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Cairo AL, Räisänen AM, Shill I, Black AM, Emery CA. High Injury and Concussion Rates in Female Youth Team Sport: An Opportunity for Prevention. Int J Sports Med 2021; 43:608-615. [PMID: 34781391 DOI: 10.1055/a-1697-2195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to investigate sport-related injury rates, types, locations, and mechanisms in female youth team sports.This was a secondary analysis of a cross-sectional study. An anonymous online survey was administered to high school students (ages 14-19) in Canada. The survey included questions regarding demographic information, sport participation and self-reported injuries sustained in the past year. Results were analyzed for girls who reported playing a top ten team sports for female participation. For girls participating in team sports, the overall injury rate was 55.5 injuries/100 participants/year. The rate of at least one concussion was 9.4 concussions/100 participants/year. Injury and concussion rates were highest in ringette (Injury rate=42.9 injuries/100 participants/year, Concussion rate=19.0 concussions/100 participants/year) and rugby (Injury rate=40.0, Concussion rate=15.3). The top three most serious injury locations were the knee (24.7%), ankle (21.6%) and head (16.1%). The most common injury types were joint/ligament sprain (26.71%), fracture (13.0%) and concussion (11.8%). Contact mechanisms accounted for 73.4% of all serious injuries reported in girls team sports.Team sport injury rates are high in female youth team sports. Specific consideration of sport-specific injury rates, types and mechanisms in girls' team sports will inform development and evaluation of targeted sport-specific prevention strategies.
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Affiliation(s)
- Alexis L Cairo
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Anu M Räisänen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Department of Physical Therapy Education, College of Health Sciences, Western University of Health Sciences, Lebanon, United States
| | - Isla Shill
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Amanda M Black
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - C A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.,Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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44
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Philipson EB, Gause E, Conrick KM, Erickson S, Muma A, Liu Z, Ayyagari RC, Vavilala MS. Concussion symptoms and temporary accommodations using a student-centered return to learn care plan. NeuroRehabilitation 2021; 49:655-662. [PMID: 34776424 DOI: 10.3233/nre-210182] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many students return to school after concussion with symptoms but without formal support. OBJECTIVE To examine concussion symptoms and temporary academic accommodations during school use of a four-week student-centered return to learn (RTL) care plan. METHODS Five public high schools used the RTL care plan and contributed student-level data after student report of concussion. Data on concussion symptoms, temporary academic accommodations corresponding to reported symptoms, and accommodations provided during RTL care plan use were examined. RESULTS Of 115 students, 55%used the RTL care plan for three (34%) or four (21%) weeks. Compared to students whose symptoms resolve within the first two weeks, students who used the RTL care plan for three or four weeks reported more unique symptoms (P = 0.038), higher total severity score (P = 0.005), and higher average severity per symptom (P = 0.007) at week one. Overall, 1,127 weekly accommodations were provided. While least reported, emotional symptoms received corresponding accommodations most often (127/155 reports: 82%of occurrences). CONCLUSIONS Use of an RTL care plan can facilitate the RTL of students with a concussion and may aid in the identification of students who are in need of longer-term support.
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Affiliation(s)
- Erik B Philipson
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA.,The Undergraduate Program in Neuroscience, University of Washington, Seattle, WA, USA
| | - Emma Gause
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA
| | - Kelsey M Conrick
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA.,School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Amy Muma
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA
| | - Zhinan Liu
- Department of Biochemistry, University of Washington, Seattle, WA, USA
| | - Rajiv C Ayyagari
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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45
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Jin S, Rabinowitz AR, Weiss J, Deshpande S, Gupta N, Buford May RA, Small DS. Retrospective survey of youth sports participation: Development and assessment of reliability using school records. PLoS One 2021; 16:e0257487. [PMID: 34534246 PMCID: PMC8448309 DOI: 10.1371/journal.pone.0257487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/03/2021] [Indexed: 11/21/2022] Open
Abstract
Many youths participate in sports, and it is of interest to understand the impact of youth sports participation on later-life outcomes. However, prospective studies take a long time to complete and retrospective studies may be more practical and time-efficient to address some questions. We pilot a retrospective survey of youth sports participation and examine agreement between respondent’s self-reported participation with high school records in a sample of 84 adults who graduated from high school between 1948 and 2018. The percent agreement between our survey and the school resources for individual sports ranged between 91.5% and 100%. These findings provide preliminary evidence for the reliability of retrospective self-report of youth sports participation. This survey may serve as an efficient approach for evaluating relationships between involvement in youth sports and health outcomes later in adulthood.
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Affiliation(s)
- Steven Jin
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Amanda R. Rabinowitz
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, United States of America
- * E-mail:
| | - Jordan Weiss
- Population Studies Center and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sameer Deshpande
- Computer Sciences and Artificial Intelligence Library, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Nitika Gupta
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, United States of America
| | - Reuben A. Buford May
- Department of Sociology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Dylan S. Small
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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46
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Wallace J, Mulenga D, Bretzin A, Delfin D, Muyinda G, Sichizya KA, Mulenga J. Diversifying sport-related concussion measures with baseline balance and ocular-motor scores in professional Zambian football athletes. PHYSICIAN SPORTSMED 2021; 49:289-296. [PMID: 32876504 DOI: 10.1080/00913847.2020.1819149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Normative values of common sport-related concussion assessment tools may assist clinical diagnosis and management. However, current baseline normative values are not representative of athletic participants across international domains. This study develops healthy baseline norms on the Balance Error Scoring System (BESS), and King-Devick (K-D), providing baseline reference values for professional Zambian football athletes. METHODS Of the 125 male participants (aged 24.48 ± 5.41 years) screened for this study, 9 (7.2%) reported a previous history of concussion, 98 (78.4%) completed the Balance Error Scoring System and 88 (70.4%) completed the King-Devick. Descriptive statistics calculated for the BESS and the K-D test included mean, standard deviation, median, interquartile range (IQR), and percentiles ranks. MAIN FINDINGS Participants scored a mean ± standard deviation of 10.15 ± 5.6 and a median [IQR] of 9 [6-12.25] errors on the total BESS and completed the K-D test in a mean ± standard deviation 56.85 ± 10.55 seconds and a median [IQR] 55.28 [48.7-64.8] seconds. CONCLUSIONS Cross-cultural awareness and management of sport-related concussion are continuously improving the safety and well-being of athletic participants around the world. The diverse representation in these data may aid in interpretation of post-injury performance during sport-related concussion management in Zambia. This study develops baseline reference values currently lacking within African cultures and demonstrates the feasibility and global clinical utility of two sport-related concussion assessment resources.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA.,Department of Epidemiology, Harvard University TH Chan School of Public Health, Boston, USA
| | - Davie Mulenga
- Department of Physiotherapy, University Teaching Hospital, University of Zambia (UTH), Lusaka, Zambia
| | - Abigail Bretzin
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Danae Delfin
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Gabriel Muyinda
- Department of Physiotherapy, University Teaching Hospital, University of Zambia (UTH), Lusaka, Zambia
| | - Kachinga Agrippa Sichizya
- Department of Physiotherapy, University Teaching Hospital, University of Zambia (UTH), Lusaka, Zambia
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47
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Sex Differences and Reporting of SCAT-5 Concussion Symptoms in Adolescent Athletes. Clin J Sport Med 2021; 31:e229-e234. [PMID: 31985537 DOI: 10.1097/jsm.0000000000000788] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/21/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To elucidate specific symptoms that may differ between adolescent female and male athletes after a sports-related concussion (SRC) and identify symptoms that may require greater clinical attention by medical and athletic staff. DESIGN Prospective. SETTING This study is part of a larger research project conducted at clinics in the North Texas Concussion Network (ConTex) Registry. PARTICIPANTS Subjects (N = 491) aged 12 to 18 years who sustained a diagnosed SRC within 30 days of clinic visit. INDEPENDENT VARIABLES Sex (female vs male). Covariates included age, race, current mood (anxiety and depression), learning disability/ADHD, and time to clinic. MAIN OUTCOME MEASURES Twenty-two individual postconcussion symptoms as measured by the Post-Concussion Symptom Scale from the Sport Concussion Assessment Tool-5 (SCAT-5). RESULTS Girls endorsed higher levels of anxiety and depression symptoms at initial clinic visit. analysis of covariance results revealed that girls had significantly greater symptom severity of headache, dizziness, sensitivity to light, sensitivity to noise, pressure in the head, feeling slowed down, fatigue, and drowsiness than boys. Ordinal logistic regression results also revealed that girls had significantly greater predicted odds of higher symptom severity on these 8 symptoms and in trouble concentrating than boys. CONCLUSIONS Closer examination of specific symptoms with attention to patients' current levels of anxiety and depression symptoms may better inform medical and athletic staff to anticipate and address symptoms that may present greater challenges for adolescent girls than boys.
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48
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Zynda AJ, Petit KM, Anderson M, Tomczyk CP, Covassin T. Removal From Activity After Sports- Related Concussion in Sex-Comparable Sports From the Michigan High School Athletic Association. Am J Sports Med 2021; 49:2810-2816. [PMID: 34181487 DOI: 10.1177/03635465211020007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Research has demonstrated that female athletes are more likely to report their sports-related concussion (SRC) symptoms compared with male athletes; however, it is unknown if these reporting behaviors correspond to immediate removal from activity in sex-comparable sports. PURPOSE To compare the incidence of high school student-athletes removed and not removed from activity after SRC in sex-comparable sports in Michigan. STUDY DESIGN Descriptive epidemiology study. METHODS Participants included student-athletes diagnosed with SRC participating in Michigan High School Athletic Association-sponsored athletic activities (22 sex-comparable sports) between 2016 and 2019. All SRCs were recorded in the association's Head Injury Reporting System (HIRS) by certified athletic trainers, administrators, or coaches. Removal from activity indicated that the student-athlete was removed from play at the time of an injury event. If the student-athlete reported that his or her suspected injury event occurred earlier during activity or if symptom onset was delayed, "not removed from activity" was entered into the HIRS. Incidence proportions were calculated by dividing SRCs not removed by total SRCs in each sport. Risk ratios were calculated by dividing the incidence proportions of girls not removed by boys not removed in each sport. RESULTS A total of 4418 (2773 female, 1645 male) SRCs were reported, with the most occurring in female soccer players (n = 1023). Overall, 515 girls and 243 boys were not removed from activity, resulting in incidences of 0.19 (95% CI, 0.17-0.20) and 0.15 (95% CI, 0.13-0.17), respectively. Across all sports, girls were 1.26 (95% CI, 1.09-1.45) times as likely to not be removed from activity compared with boys. Of the sports with the most SRCs-soccer, basketball, baseball/softball, and lacrosse-girls had 1.37 (95% CI, 1.09-1.72), 1.15 (95% CI, 0.89-1.47), 1.19 (95% CI, 0.77-1.84), and 1.35 (95% CI, 0.94-1.95) times the risk of not being removed, respectively. CONCLUSION Girls were at greater risk of not being removed from activity compared with boys in sex-comparable sports. Results from this study should be incorporated into SRC education in Michigan and potentially elsewhere to inform affiliated personnel of potential sex differences and protect female student-athletes from further harm.
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Affiliation(s)
- Aaron J Zynda
- Michigan State University, East Lansing, Michigan, USA
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49
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Ashina H, Eigenbrodt AK, Seifert T, Sinclair AJ, Scher AI, Schytz HW, Lee MJ, De Icco R, Finkel AG, Ashina M. Post-traumatic headache attributed to traumatic brain injury: classification, clinical characteristics, and treatment. Lancet Neurol 2021; 20:460-469. [PMID: 34022171 DOI: 10.1016/s1474-4422(21)00094-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
Post-traumatic headache is a common sequela of traumatic brain injury and is classified as a secondary headache disorder. In the past 10 years, considerable progress has been made to better understand the clinical features of this disorder, generating momentum to identify effective therapies. Post-traumatic headache is increasingly being recognised as a heterogeneous headache disorder, with patients often classified into subphenotypes that might be more responsive to specific therapies. Such considerations are not accounted for in three iterations of diagnostic criteria published by the International Headache Society. The scarcity of evidence-based approaches has left clinicians to choose therapies on the basis of the primary headache phenotype (eg, migraine and tension-type headache) and that are most compatible with the clinical picture. A concerted effort is needed to address these shortcomings and should include large prospective cohort studies as well as randomised controlled trials. This approach, in turn, will result in better disease characterisation and availability of evidence-based treatment options.
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Affiliation(s)
- Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anna K Eigenbrodt
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Alexandra J Sinclair
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ann I Scher
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
| | - Henrik W Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
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Houston MN, Bookbinder HA, Roach SP, Ross JD, Aderman MJ, Peck KY, Malvasi SR, Svoboda SJ, Cameron KL. Reference Values for the Headache Impact Test-6 Questionnaire. Arch Phys Med Rehabil 2021; 102:2369-2376. [PMID: 34175274 DOI: 10.1016/j.apmr.2021.05.013] [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: 03/12/2021] [Revised: 05/03/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine reference values for the Headache Impact Test-6 (HIT-6) in a young, physically active cohort and to examine the influence of sex, concussion history, headache history, and competitive sport level on HIT-6 scores. DESIGN Cross-sectional. SETTING United States Service Academy. PARTICIPANTS United States Service Academy cadets (N=2678) completed an HIT-6 questionnaire as part of their annual concussion baseline assessment. Cadets with a recent concussion were excluded from baseline testing. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Reference values were calculated and stratified by sex, concussion history, headache history, and competitive sport level. Mann-Whitney U and Kruskal-Wallis tests were used to examine the effect of sex, concussion history, headache history, and competitive sport level on HIT-6 scores (P<.05). RESULTS Of the 3599 cadets baselined, 2687 cadets (23% female) agreed to participate in the study and completed the HIT-6. Female participants reported significantly worse HIT-6 scores compared with male participants both with (P<.001) and without (P<.001) a concussion history. In both sexes, participants with a headache history reported worse scores than those with no headache/concussion history and a concussion history (all P<.005). Female cadets who participated in intramural athletics reported worse HIT-6 scores at baseline than female intercollegiate athletes (P=.003). CONCLUSIONS This is the first study to stratify HIT-6 data by sex, concussion history, headache history, and sport level in a collegiate population at risk for concussions. Sex and headache history appear to influence HIT-6 scores and should be given special consideration when interpreting health-related quality of life deficits due to headache.
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Affiliation(s)
- Megan N Houston
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY.
| | - Haley A Bookbinder
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
| | | | - Jeremy D Ross
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
| | - Michael J Aderman
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
| | | | - Steven R Malvasi
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
| | | | - Kenneth L Cameron
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
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