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Terry DP, Jo J, Williams KL, Maxwell BA, Berkner PD, Iverson GL, Zuckerman SL. Recovery After Sport-Related Concussion in Collegiate Athletes With Self-Reported Pre-Injury Migraines. J Neurotrauma 2024. [PMID: 38517075 DOI: 10.1089/neu.2023.0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Pre-injury migraines might be a risk factor for prolonged recovery after sport-related concussion (SRC). We sought to examine whether a pre-injury history of migraines is associated with worse recovery following SRC in collegiate athletes. Data were collected through a prospective concussion surveillance system in 11 National Collegiate Athletic Association (NCAA) Division III college athletic programs between September 2014 and March 2020. Our primary independent variable, pre-injury migraines, were self-reported by the athletes. Between those with and without migraines, the outcomes of days to return-to-learn (RTL) without academic accommodations and return-to-play (RTP) were compared using Mann-Whitney U tests. Each athlete's RTL and RTP status was dichotomized (i.e., returned vs. not returned) at various time points for RTL (i.e., 7/14/21/28 days) and RTP (i.e., 14/21/28/56 days). Chi-squared tests were performed to compare the proportions of RTL and RTP status between groups. Multivariable regressions analyzed potential predictors of RTL and RTP adjusting for age, gender, prior concussions, other health conditions, and symptom severity. Of 1409 athletes with an SRC, 111 (7.9%) had a pre-injury history of migraines. Compared with those without migraines, those with migraines had longer median (interquartile range [IQR]) days to RTL (migraines = 7.0 [3.0-12.3] vs. no migraines = 5.0 [2.0-10.0], U = 53,590.5, p = 0.022). No differences were found in RTP between the two groups (migraines = 16.0 [10.0-33.0] vs. nχo migraines 15.0 [11.0-23.0], U = 38,545.0, p = 0.408). Regarding RTL, significantly lower proportions of athletes in the migraine group had fully RTL, without accommodations, at ≤14 days (77.5% vs. 85.2%, χ2 = 4.33, p = 0.037), ≤21 days (85.3% vs. 93.0%, χ2 = 7.99, p = 0.005), and ≤28 days (88.2% vs. 95.6%, χ2 = 10.60, p = 0.001). Regarding RTP, a significantly lower proportion of athletes in the migraine group RTP at ≤28 days (72.0% vs. 82.7%, χ2 = 5.40, p = 0.020) and ≤56 days (84.0% vs. 93.0%, χ2 = 8.19, p = 0.004). In a multivariable model predicting RTL that was adjusted for age, gender, acute concussion symptoms, and other health variables (e.g., attention-deficit/hyperactivity disorder [ADHD], history of mental health difficulties), pre-injury history of migraine was associated with longer RTL (β = 0.06, p = 0.030). In a multivariable model predicting RTP, pre-injury history of migraine was not associated with RTP (β = 0.04, p = 0.192). In collegiate athletes, pre-injury migraine history was independently associated with longer RTL but not RTP. When comparing the proportions of those with successful RTP by days, significantly lower proportions of those with migraines showed successful RTP at ≤28 days and ≤56 days. Futures studies should study the generalizability of our findings in other school levels.
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Affiliation(s)
- Douglas P Terry
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacob Jo
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen L Williams
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce A Maxwell
- Khoury College of Computer Science, Northeastern University - Seattle, Seattle, Washington, USA
| | - Paul D Berkner
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Mass General for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Terry DP, Jurick SM, Huebschmann NA, Silverberg ND, Maxwell BA, Zafonte R, Berkner PD, Iverson GL. Sleep Insufficiency and Baseline Preseason Concussion-Like Symptom Reporting in Youth Athletes. Clin J Sport Med 2022; 32:46-55. [PMID: 34009800 DOI: 10.1097/jsm.0000000000000882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/22/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association between insufficient sleep and baseline symptom reporting in healthy student athletes. DESIGN Cross-sectional cohort study. SETTING Preseason testing for student athletes. PARTICIPANTS Student athletes (n = 19 529) aged 13 to 19 years who completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), including the number of hours slept the night before, and denied having developmental/health conditions, a concussion in the past 6 months, and a previous history of 2 or more concussions. INDEPENDENT VARIABLES Total hours of sleep the night before testing (grouped by ≤5, 5.5-6.5, 7-8.5, and ≥9 hours), gender, and concussion history. MAIN OUTCOME MEASURES Symptom burden on the Post-Concussion Symptom Scale (modified to exclude sleep-related items), cognitive composite scores, and prevalence of athletes who reported a symptom burden resembling the International Classification of Diseases, 10th Revision (ICD-10) diagnosis of postconcussional syndrome (PCS). RESULTS Fewer hours of sleep, gender (ie, girls), and 1 previous concussion (vs 0) were each significantly associated with higher total symptom scores in a multivariable model (F = 142.01, P < 0.001, R2 = 0.04). When a gender-by-sleep interaction term was included, the relationship between sleep and symptoms was stronger for girls compared with boys. In healthy athletes who slept ≤5 hours, 46% of girls and 31% of boys met the criteria for ICD-10 PCS compared with 16% of girls and 11% of boys who slept ≥9 hours. Sleep duration was not meaningfully associated with neurocognitive performance. CONCLUSIONS Insufficient sleep the night before testing is an important factor to consider when interpreting symptom reporting, especially for girls. It will be helpful for clinicians to take this into account when interpreting both baseline and postinjury symptom reporting.
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Affiliation(s)
- Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts
| | - Sarah M Jurick
- Department of Psychology, VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California San Diego, La Jolla Village Drive, San Diego, California
| | - Nathan A Huebschmann
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Noah D Silverberg
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Vancouver Coastal HealthResearch Institute, Vancouver, BC, Canada
| | - Bruce A Maxwell
- Department of Computer Science, Colby College, Waterville, Maine
| | - Ross Zafonte
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul D Berkner
- College of Osteopathic Medicine, University of New England, Biddeford, Maine
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts
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Karr JE, Garcia-Barrera MA, Marsh JM, Maxwell BA, Berkner PD, Iverson GL. Preseason Baseline Neurocognitive Performances and Symptom Reporting on Immediate Post-Concussion Assessment and Cognitive Testing: A Comparison of Adolescent Student-Athletes Tested in Spanish and English. J Athl Train 2021; 56:879-886. [PMID: 33237992 DOI: 10.4085/1062-6050-0345.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Student-athletes are commonly administered the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery at preseason baseline and postconcussion. The ImPACT is available in many languages, but few researchers have examined differences in cognitive performances and symptom ratings based on the language of administration. OBJECTIVE To examine differences in ImPACT neurocognitive composites and symptom reporting at preseason baseline testing between student-athletes who completed ImPACT in Spanish versus English. DESIGN Cross-sectional study. SETTING Preseason baseline testing for a high school concussion-management program in Maine. PATIENTS OR OTHER PARTICIPANTS Adolescent student-athletes who completed testing in Spanish (n = 169) and English (n = 169) were matched on age, gender, and health and academic history. Language groups were compared on each outcome for the full sample and for gender-stratified subsamples. MAIN OUTCOME MEASURE(S) Neurocognitive composite scores and individual and total symptom severity ratings from the ImPACT battery. RESULTS Athletes tested in Spanish displayed lower levels of neurocognitive performance on 2 of 5 composite scores (visual motor speed: P < .001, d = 0.51; reaction time: P = .004, d = 0.33) and reported greater symptom severity (P < .001, r = 0.21). When the analyses were stratified by gender, similar visual motor speed differences were observed between language groups among boys (P = .001, d = 0.49) and girls (P = .001, d = 0.49), whereas reaction time showed a larger group difference for boys (P = .012, d = 0.42) than for girls (P = .128, d = 0.21). Language-group differences in symptom reporting were similar for boys (P = .003, r = 0.22) and girls (P = .008, r = 0.21), with more frequent endorsement of physical and affective symptoms by athletes tested in Spanish. CONCLUSIONS Language-group differences in total symptom severity were small (r = 0.21) and in neurocognitive performances were small to medium (d = 0.05-0.51). Versus previous authors who compared athletes tested in Spanish and English with ImPACT, we observed smaller effects, which may be attributable to close matching on variables related to neurocognitive performances and symptom reporting.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington
| | | | - Jacqueline M Marsh
- Department of Psychiatry, Harvard Medical School, Charlestown, MA.,Massachusetts General Hospital, Charlestown, MA.,Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA
| | - Bruce A Maxwell
- Department of Computer Science, Colby College, Waterville, ME
| | - Paul D Berkner
- Health Services, College of Osteopathic Medicine, University of New England, Biddeford, ME
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School.,Spaulding Rehabilitation Hospital, Boston, MA.,Spaulding Research Institute, Charlestown, MA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA
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Iverson GL, Wojtowicz M, Brooks BL, Maxwell BA, Atkins JE, Zafonte R, Berkner PD. High School Athletes With ADHD and Learning Difficulties Have a Greater Lifetime Concussion History. J Atten Disord 2020; 24:1095-1101. [PMID: 27431932 DOI: 10.1177/1087054716657410] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Examine lifetime history of concussions in adolescents who have developmental problems in comparison with those with no developmental problems. Method: Thirty-two thousand four hundred eighty-seven adolescent athletes completed baseline/pre-season evaluations. Based on self-reported histories, athletes were divided into four groups: ADHD only, ADHD and learning difficulties (LD), LD only, and controls. Results: Athletes with ADHD, LD, or ADHD plus LD reported a greater prevalence of prior concussions than athletes without these developmental conditions (ps < .05). When adjusting for sex differences in concussion prevalence rates (boys are greater than girls), there was an increase in prevalence of prior injuries in those with ADHD, and ADHD plus learning difficulties compared with those with LD only. This pattern was found for both girls and boys. There was no additive effect of having both conditions. Conclusion: Developmental conditions in adolescent athletes, such as ADHD and learning difficulties, are associated with a greater prevalence rate of prior concussion.
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Affiliation(s)
- Grant L Iverson
- Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, USA.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, USA
| | - Magdalena Wojtowicz
- Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, USA.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, USA
| | - Brian L Brooks
- Alberta Children's Hospital, Calgary, Canada.,University of Calgary, Alberta, Canada
| | | | | | - Ross Zafonte
- Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, USA.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, USA.,Massachusetts General Hospital, Boston, USA.,Brigham and Women's Hospital, Boston, MA, USA
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Terry DP, Wojtowicz M, Cook NE, Maxwell BA, Zafonte R, Seifert T, Silverberg ND, Berkner PD, Iverson GL. Factors Associated With Self-Reported Concussion History in Middle School Athletes. Clin J Sport Med 2020; 30 Suppl 1:S69-S74. [PMID: 32132480 DOI: 10.1097/jsm.0000000000000594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Identifying personal characteristics associated with sustaining a concussion is of great interest, yet only a few have examined this in children. The purpose of this study was to examine the association between sex, neurodevelopmental disorders, health history, and lifetime history of self-reported concussion in 12- and 13-year-old athletes. DESIGN Cross-sectional study. SETTING Middle schools. PARTICIPANTS Participants were 1744 twelve- and thirteen-year-old student athletes who completed preseason Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) testing, including a self-report questionnaire about previous concussions, developmental diagnoses, and previous medical treatment. INDEPENDENT VARIABLES Age, sex, attention-deficit/hyperactivity disorder (ADHD), learning disabilities (LDs), and previous treatment for migraine. MAIN OUTCOME MEASURES Self-reported history of concussion. RESULTS A minority of athletes (13.7%) reported previous concussions (1 concussion, n = 181; 2 concussions, n = 41; and 3+ concussions, n = 17). A small proportion reported a history of ADHD (4.4%), LD (2.8%) or migraine treatment (4.0%). Higher rates of self-reported previous concussions were associated with male sex [16.9% vs 9.1%; χ(1) = 21.47, P < 0.001] and previous migraine treatment [31.9% vs 13.0%; χ(1) = 20.08, P < 0.001]. There were no differences in self-reported concussion history between 12- and 13-year olds (P = 0.18) and those with/without ADHD (P = 0.41) or LDs (P = 0.06). The overall logistic regression model was statistically significant [χ(5) = 42.01, P < 0.001] but explained only 4.3% of the variance. Previous treatment for migraine [P < 0.001, Exp(B) = 3.30] and male sex [P < 0.001, Exp(B) = 2.06] were independently associated with a self-reported concussion history, whereas age, LD, and ADHD were not (P's > 0.05). CONCLUSIONS Male sex and previous migraine treatment were associated with higher rates of self-reported previous concussions in both independent and multivariate models in middle school athletes, whereas age, ADHD, and LDs were not.
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Affiliation(s)
- Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
| | | | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
| | - Bruce A Maxwell
- Department of Computer Science, Colby College, Waterville, Maine
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
| | - Tad Seifert
- Departments of Neurology and Sports Health, Norton Healthcare, Louisville, Kentucky
- Kentucky Boxing and Wrestling Commission, Frankfort, Kentucky
| | - Noah D Silverberg
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Institute Rehabilitation Research Program, Vancouver, BC, Canada; and
| | - Paul D Berkner
- Department of Biology and Health Services, Colby College, Waterville, Maine
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
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Cook NE, Sapigao RG, Silverberg ND, Maxwell BA, Zafonte R, Berkner PD, Iverson GL. Attention-Deficit/Hyperactivity Disorder Mimics the Post-concussion Syndrome in Adolescents. Front Pediatr 2020; 8:2. [PMID: 32117823 PMCID: PMC7014960 DOI: 10.3389/fped.2020.00002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/07/2020] [Indexed: 01/01/2023] Open
Abstract
The objective of this study was to evaluate concussion-like symptom reporting among uninjured adolescents with Attention-deficit/hyperactivity disorder (ADHD), stratified by several cooccurring conditions, and to examine the base rate and predictors of uninjured adolescents with ADHD meeting diagnostic criteria for the International Classification of Diseases, 10th Revision (ICD-10) post-concussional syndrome (PCS). Participants in this cross-sectional, observational study, were drawn from a cohort of 48,834 adolescent student athletes from Maine (ages 13-18) with no concussion in the past 6 months who completed a preseason, baseline testing program between 2009 and 2015. The final sample included 3,031 students with ADHD, 2,146 (70.8%) boys and 885 (29.2%) girls. They were 15.2 years old on average (SD = 1.3). Concussion-like symptom reporting was more common in girls than boys. Most students with ADHD reported one or more symptoms (69.3% of boys and 81.1% of girls). The presence of an additional, co-occurring condition or comorbidity was associated with increased symptom reporting. In the absence of a recent concussion, 28.8% percent of boys and 47.1% of girls with ADHD endorsed symptoms resembling an ICD-10 diagnosis of post-concussional syndrome (PCS). Adolescents with pre-existing conditions were even more likely to endorse symptoms that resembled PCS (28-47% of boys and 45-69% of girls). Prior treatment for a psychiatric condition was the strongest independent predictor for meeting PCS criteria in boys, followed by treatment for migraines and co-occurring learning disorder. For girls, the only independent predictor was prior treatment of a psychiatric condition. In uninjured adolescent student athletes, ADHD appears to mimic the post-concussion syndrome. Adolescents with ADHD commonly endorse concussion-like symptoms in the absence of a recent concussion. Demographic characteristics (sex) and the presence of co-occurring conditions are related to symptom reporting in adolescents with ADHD. Understanding factors associated with baseline symptom reporting, such as pre-existing ADHD, is important when evaluating youth who have persistent symptoms following concussion as well as making both return to school and return to athletics decisions.
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Affiliation(s)
- Nathan E. Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Massachusetts General Hospital, Boston, MA, United States
| | - Rosemarie G. Sapigao
- T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Noah D. Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Bruce A. Maxwell
- Department of Computer Science, Colby College, Waterville, ME, United States
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Massachusetts General Hospital, Boston, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Paul D. Berkner
- Health Services and Department of Biology, Colby College, Waterville, ME, United States
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Massachusetts General Hospital, Boston, MA, United States
- Spaulding Research Institute, Boston, MA, United States
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Karr JE, Maxwell BA, Zafonte R, Berkner PD, Iverson GL. Differences in Symptom Clusters at Baseline Testing among Student Athletes with ADHD or Migraines. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
This study was designed to determine whether the factor structure of the Post-Concussion Symptom Scale (PCSS) is consistent (i.e., invariant) in subgroups of youth with pre-existing attention-deficit/hyperactivity disorder (ADHD) or migraines. A four-factor model of the PCSS has empirical support (i.e., cognitive-sensory, sleep-arousal, vestibular-somatic, and affective symptoms), and the current investigation examined (i) whether this model is invariant across athletes with and without ADHD or migraines and (ii) group differences across symptom clusters.
Methods
Participants included a large sample of adolescent athletes (N=39,242; 54.4% boys; 13–18 years-old, M=15.50±1.27 years), among which 2,543 reported ADHD and 2,638 reported having migraines. The 22-item PCSS was administered at pre-season baseline. Statistical analyses included invariance testing across ADHD and migraine groups. Good fit was defined as CFI≥0.95. Effect sizes for group differences in symptom clusters were calculated.
Results
Configural invariance was established across participants with and without ADHD (CFI=0.967) and with and without migraines (CFI=0.965); however, weak invariance was not established for either diagnostic group. Effect sizes (Cohen’s d) of group differences varied by symptom cluster: cognitive-sensory (ADHD=0.44; migraine=0.38), sleep-arousal (0.33, 0.37), vestibular-somatic (0.17, 0.45), and affective (0.27, 0.28).
Conclusion
Although the four-factor model has been previously published and replicated among healthy student athletes, this model was only partially invariant for participants with ADHD or migraines. The cognitive-sensory factor showed the largest differences based on ADHD, whereas the vestibular-somatic factor showed the largest differences based on migraine history.
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Karr JE, Maxwell BA, Zafonte R, Berkner PD, Iverson GL. A Four-Factor Symptom Model for Student Athletes with and without Prior Concussions. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
This study was designed to determine whether the factor structure of the Post-Concussion Symptom Scale (PCSS) is consistent (i.e., invariant) in subgroups of youth stratified by their history of prior concussions. A four-factor model of the PCSS has empirical support (i.e., cognitive-sensory, sleep-arousal, vestibular-somatic, and affective symptoms), and the current investigation examined (i) whether this model is invariant across athletes with 0, 1, or ≥2 prior concussions and (ii) group differences across symptom clusters.
Methods
Participants included a large sample of adolescent athletes (54.4% boys; 13–18 years-old, M=15.50±1.27 years) with 0 (n=32,668), 1 (n=4,110), or ≥2 prior concussions (n=1,681) administered the 22-item PCSS at pre-season baseline. Measurement invariance was tested (good fit=CFI≥0.95; significant change-in-fit=∆CFI≥0.01) and effect sizes for group differences in symptom clusters were calculated.
Results
The four-factor model showed configural (CFI=0.968) and weak invariance (∆CFI=0.006), but not strong invariance. Comparisons based on concussion history across symptom clusters indicated very small differences between athletes with 0 and 1 prior concussion(s) (d=0.05-0.15), slightly larger differences between athletes with 1 and ≥2 prior concussion(s) (d=0.12-0.24), and modestly larger differences between athletes with 0 and ≥2 prior concussion(s) (d=0.17-0.35).
Conclusion
These findings support partial invariance of the four-factor PCSS model across athletes with and without a history of concussion. The association with prior concussion was greatest for cognitive-sensory symptoms and smallest for vestibular symptoms. Future research should explore whether alternative factor models are invariant across athletes with different numbers of prior concussions.
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Terry DP, Huebschmann NA, Maxwell BA, Cook NE, Mannix R, Zafonte R, Seifert T, Berkner PD, Iverson GL. Preinjury Migraine History as a Risk Factor for Prolonged Return to School and Sports following Concussion. J Neurotrauma 2018; 36:142-151. [PMID: 29732944 DOI: 10.1089/neu.2017.5443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Having a preexisting migraine disorder might be a risk factor for a prolonged recovery following a sport-related concussion. We examined whether having a migraine history was associated with a prolonged return to academics and athletics following a concussion. High school and collegiate athletes (n = 1265; 42% female) who sustained a sport-related concussion were monitored by athletic trainers using a web-based surveillance system that collects information about concussion recovery. Nonparametric Kolmogorov-Smirnov tests (KS) were used to compare days to return to academics/athletics across groups due to non-normally distributed outcome variables and unequal distributions of scores between groups. Chi-squared tests were used to examine the proportion of players who had not returned to academics/athletics at 7, 14, and 21 days post-injury stratified by self-reported migraine history. There were 117 athletes (9.2%) who reported a preinjury migraine history. Athletes with a history of migraine took a median of 6 days to return to academics (mean [M] = 10.6, standard deviation [SD] = 14.2) and 15.5 days to return to athletics (M = 23.8, SD = 30.8), while those with no migraine history took a median of 5 days to return to academics (M = 7.5, SD = 10.9) and 14 days to return to athletics (M = 19.4, SD = 19.4). There were no statistically significant differences in days to return to school or athletics between the groups (KS p > 0.05). However, a lower percentage of athletes with a history of migraine had returned to school after 7 days (57% vs. 68%, χ2 = 5.53, p = 0.02), 14 days (75% vs. 88%, χ2 = 14.21, p < 0.001), and 21 days post-injury (89% vs. 94%, χ2 = 4.90, p = 0.03). Stratifying the analyses by sex showed that this effect was significant in girls and women with preexisting migraines, but not boys and men with preexisting migraines. There were no group differences in recovery rates when examining return to athletics. Athletes with a preinjury migraine history may be at an elevated risk for a protracted return to school after concussion, especially girls and women.
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Affiliation(s)
- Douglas P Terry
- 1 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 2 Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
- 3 MassGeneral Hospital for Children™ Sport Concussion Program , Charlestown, Massachusetts
| | | | - Bruce A Maxwell
- 5 Department of Computer Science, Colby College , Waterville, Maine
| | - Nathan E Cook
- 1 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 3 MassGeneral Hospital for Children™ Sport Concussion Program , Charlestown, Massachusetts
| | - Rebekah Mannix
- 6 Division of Emergency Medicine, Boston Children's Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 10 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ross Zafonte
- 1 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 2 Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
- 7 Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
| | - Tad Seifert
- 8 Sports Neurology Program, Norton Healthcare, Kentucky Boxing and Wrestling Commission , Louisville, Kentucky
| | - Paul D Berkner
- 9 Health Services and the Department of Biology, Colby College , Waterville, Maine
| | - Grant L Iverson
- 1 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital , Harvard Medical School, Boston Massachusetts
- 2 Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
- 3 MassGeneral Hospital for Children™ Sport Concussion Program , Charlestown, Massachusetts
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Gerrard PB, Iverson GL, Atkins JE, Maxwell BA, Zafonte R, Schatz P, Berkner PD. Factor Structure of ImPACT® in Adolescent Student Athletes. Arch Clin Neuropsychol 2017; 32:117-122. [DOI: 10.1093/arclin/acw097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 11/13/2022] Open
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11
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Iverson GL, Silverberg ND, Mannix R, Maxwell BA, Atkins JE, Zafonte R, Berkner PD. Factors Associated With Concussion-like Symptom Reporting in High School Athletes. JAMA Pediatr 2015; 169:1132-40. [PMID: 26457403 PMCID: PMC5333772 DOI: 10.1001/jamapediatrics.2015.2374] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Every state in the United States has passed legislation for sport-related concussion, making this health issue important for physicians and other health care professionals. Safely returning athletes to sport after concussion relies on accurately determining when their symptoms resolve. OBJECTIVE To evaluate baseline concussion-like symptom reporting in uninjured adolescent student athletes. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional, observational study, we studied 31 958 high school athletes from Maine with no concussion in the past 6 months who completed a preseason baseline testing program between 2009 and 2013. RESULTS Symptom reporting was more common in girls than boys. Most students with preexisting conditions reported one or more symptoms (60%-82% of boys and 73%-97% of girls). Nineteen percent of boys and 28% of girls reported having a symptom burden resembling an International Classification of Diseases, 10th Revision (ICD-10) diagnosis of postconcussional syndrome (PCS). Students with preexisting conditions were even more likely to endorse a symptom burden that resembled PCS (21%-47% for boys and 33%-72% for girls). Prior treatment of a psychiatric condition was the strongest independent predictor for symptom reporting in boys, followed by a history of migraines. For girls, the strongest independent predictors were prior treatment of a psychiatric condition or substance abuse and attention-deficit/hyperactivity disorder. The weakest independent predictor of symptoms for both sexes was history of prior concussions. CONCLUSIONS AND RELEVANCE In the absence of a recent concussion, symptom reporting is related to sex and preexisting conditions. Consideration of sex and preexisting health conditions can help prevent misinterpretation of symptoms in student athletes who sustain a concussion.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts2Spaulding Rehabilitation Hospital, Boston, Massachusetts3MassGeneral Hospital for Children Sports Concussion Program, Boston4Red Sox Foundation and Massachus
| | - Noah D. Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, and GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Bruce A. Maxwell
- Department of Computer Science, Colby College, Waterville, Maine
| | | | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts3MassGeneral Hospital for Children Sports Concussion Program, Boston4Red Sox Foundation and Massachusetts General Hospital Home Base Program Boston
| | - Paul D. Berkner
- Health Services and Department of Biology, Colby College, Waterville, Maine
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Abstract
Computer vision is a broad-based field of computer science that requires students to understand and integrate knowledge from numerous disciplines. Computer science (CS) majors, however, do not necessarily have an interdisciplinary background. In the rush to integrate, we can forget, or fail to plan for the fact that our students may not possess a broad undergraduate education. To explore the appropriateness of our education materials, this paper begins with a discussion of what we can expect CS majors to know and how we can use that knowledge to make a computer vision course a more enriching experience. The paper then provides a review of a number of the currently available computer vision textbooks. These texts differ significantly in their coverage, scope, approach, and audience. This comparative review shows that, while there are an increasing number of good textbooks available, there is still a need for new educational materials. In particular, the field would benefit from both an undergraduate computer vision text aimed at computer scientists and from a text with a stronger focus on color computer vision and its applications.
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Affiliation(s)
- Bruce A. Maxwell
- Department of Engineering, Swarthmore College, Swarthmore, PA 19081, USA
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Maxwell BA. Building robot systems to interact with people in real environments. Auton Robots 2007. [DOI: 10.1007/s10514-006-9020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Crossland CJ, Baird D, Ducrotoy JP, Lindeboom H, Buddemeier RW, Dennison WC, Maxwell BA, Smith SV, Swaney DP. The Coastal Zone — a Domain of Global Interactions. Coastal Fluxes in the Anthropocene 2005. [DOI: 10.1007/3-540-27851-6_1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
1. Nursing home residents have the right to be involved in decision making relative to their care, which researchers have demonstrated has a positive effect on residents. 2. The authors designed a study to explore discrepancies between residents' perceptions of choice and the amount of choice preferred and their relationship to self-care abilities and functional abilities in nursing home residents. 3. The results indicate that residents desired more choice than they felt they were given, but that this difference was not related to their perceptions of their self-care abilities. As residents' functional abilities increased, actual choice as well as desired choice increased slightly. 4. Nurses should structure the nursing home's approach to residents so that choice is maximized within the constraints of the institution.
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Fleischer AB, Maxwell BA, Baird DB, Woosley JT. Hansen's disease (leprosy): the North Carolina experience. Cutis 1990; 45:427-34. [PMID: 2350979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hansen's disease presents a large public health problem throughout much of the world but it occurs infrequently in the United States. Only 8,501 cases have been reported since 1921 and 81 percent of these have been from just six states. Typical of many states, North Carolina has had only twenty-two case reports over this sixty-eight year period. We present two typical cases we have seen in the past year and briefly review some of the epidemiologic, clinical, and treatment aspects of the disease.
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Affiliation(s)
- A B Fleischer
- Department of Dermatology, University of North Carolina, Chapel Hill 27514
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