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Donahue CC, Walton SR, Oldham JR, Beidler E, Larson MJ, Broshek D, Cifu DX, Resch JE. Influence of sleep symptoms on recovery from concussion in collegiate athletes: a LIMBIC MATARS consortium investigation. Brain Inj 2024:1-7. [PMID: 38679931 DOI: 10.1080/02699052.2024.2347542] [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] [Received: 03/12/2023] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Changes in sleep quality and quantity are commonly endorsed by individuals following a concussion. Limited data exists examining the role of sleep disturbances within 72 hours, and throughout recovery, from concussion. The objective of this study was to determine if the number of days to symptom resolution varied between collegiate athletes with or without sleep-related symptoms following a concussion. DESIGN Retrospective chart review. METHODS Collegiate athletes (n = 539) who were diagnosed with a concussion between the 2015-2020 sport seasons participated in this retrospective chart review. Participants were divided into groups based on the presence or absence of sleep symptoms within 72 hours of a diagnosed concussion. A Mann-Whitney U test was used to compare days to symptom resolution between groups with α = 0.05. RESULTS Of the 539 participants, 250 (46.3%) reported sleep-related symptoms. Participants with sleep-related symptoms took significantly longer (U = 30656, p = 0.002) to report symptom resolution at rest (median [full range] = 8.00[0-423]) as compared to participants who did not report sleep-related symptoms (6.00[0-243] days). CONCLUSION Collegiate athletes that report sleep-related symptoms immediately following concussion (<72 hours) were observed to take, on median, two days longer to achieve symptom resolution at rest when compared to athletes who did not endorse the same symptoms.
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Affiliation(s)
- Catherine C Donahue
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Michael J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Donna Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health, Charlottesville, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Chandran A, Boltz AJ, Brett BL, Walton SR, Robison HJ, Collins CL, Register-Mihalik JK, Mihalik JP. Patterns and predictors of concussion symptom presentations in NCAA athletes. Res Sports Med 2024; 32:316-330. [PMID: 35916338 DOI: 10.1080/15438627.2022.2105218] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
Sport-related concussion (SRC) is a complex injury, and SRCs are notably prevalent among National Collegiate Athletic Association (NCAA) athletes. We analysed SRCs and associated exposure data collected within the NCAA Injury Surveillance Program during 2014-2019. A total of 1,709 SRCs were reported with complete symptom profiles during the study period (Women's sports n = 499; Men's sports n = 1,210). Event type and academic class year most commonly predicted specific symptom presentations among athletes in men's sports, while symptom presentation among athletes in women's sports was most commonly predicted by class year and sport classification. We observed 78 and 69 significant pairwise symptom dependencies in men's and women's sports athletes, respectively; odds of longer symptom resolution time were higher with greater counts of symptoms with strongest cross-domain associations. Our findings highlight several contextual predictors of specific symptom presentations and identify parsimonious symptom subsets that may indicate protracted recovery among men's and women's sports athletes.
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Affiliation(s)
- Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Benjamin L Brett
- Department of Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Samuel R Walton
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hannah J Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Lang B, Kerr ZY, Chandran A, Walton SR, Mannix R, Lempke LB, DeFreese JD, Echemendia RJ, Guskiewicz KM, Meehan III WP, McCrea MA, Brett BL. The Longitudinal Relationship Between Concussion History, Years of American Football Participation, and Alcohol Use Among Former National Football League Players: an NFL-LONG Study. Arch Clin Neuropsychol 2024; 39:221-226. [PMID: 37609946 PMCID: PMC10879921 DOI: 10.1093/arclin/acad059] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE Investigate the relationships between concussion history and years of football participation (repetitive head impact proxy) with alcohol use across multiple decades in former professional football players. METHODS Participants (n = 348; mean age = 49.0 ± 9.4) completed health questionnaires in 2001 and 2019, which included self-reported concussion history and years of participation. Alcohol use frequency and amount per occasion were reported for three timepoints: during professional career, 2001, and 2019. Ordinal logistic regression models were fit to test associations of concussion history and years of participation with alcohol use at each timepoint. RESULTS There were no significant associations between either concussion history or years of football participation with alcohol use (frequency and amount per occasion) at any timepoint. Effect estimates for concussion history and years of football participation with alcohol use were generally comparable across timepoints. CONCLUSIONS Later life alcohol use by former American football players is not associated with concussion history or years of exposure to football.
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Affiliation(s)
- Brittany Lang
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, United States
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN 46220, United States
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA 23284, United States
| | - Rebekah Mannix
- Boston Children’s Hospital, Boston, MA 02115, United States
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Landon B Lempke
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, United States
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc., State College, PA 16801, United States
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, United States
| | - William P Meehan III
- Boston Children’s Hospital, Boston, MA 02115, United States
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA 02115, United States
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
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Resch JE, Beidler E, Bowman TJ, Kelshaw T, Larson MJ, Munce TA, Oldham J, Walton SR, Cifu DX. Placing the keystone: the LIMBIC Military and Tactical Athlete Research Study. Brain Inj 2024:1-8. [PMID: 38328943 DOI: 10.1080/02699052.2024.2304861] [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] [Received: 03/02/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The LIMBIC Military and Tactical Athletic Research Study (MATARS) framework was established to confirm and extend understanding of concussion with initial studies driven by clinical data collected between 2015 and 2020 in a collegiate sports setting. The LIMBIC MATARS framework will be leveraged to apply gold-standard and innovative research designs to advance the science of concussion. This manuscript provides the background, methodology, and initial demographic data associated with the LIMBIC MATARS. METHODS Consensus-based common data elements were used to conduct a retrospective chart review, specific to collegiate athletes diagnosed with concussions between 2015 and 2020 at 11 universities. RESULTS A final sample of 1,311 (47.8% female) concussions were diagnosed during the five-year study period from athletes participating in a variety of National Collegiate Athlete Association (NCAA) sports. The LIMBIC MATARS demographic data, align with the NCAA and other pioneering multi-site concussion-related studies in terms of biological sex, race and ethnicity, and sport participation. CONCLUSION This pragmatic, methodological approach was used to address several a priori hypotheses related to concussion, align with other multi-site studies of concussion, and establish a consortium for future investigations.
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Affiliation(s)
- J E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - E Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - T J Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - T Kelshaw
- Department of Kinesiology, University of New Hampshire, Durham, New Hampshire, USA
| | - M J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - T A Munce
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - J Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - S R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - D X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Bowman TG, Lininger MR, Oldham JR, Smetana RM, Kelshaw PM, Beidler E, Campbell TR, Walton SR, Munce TA, Larson MJ, Didehbani N, Cullum CM, Rosenblum DJ, Cifu DX, Resch JE. Physical activity and recovery following concussion in collegiate athletes: a LIMBIC MATARS Consortium Investigation. Brain Inj 2024:1-8. [PMID: 38324635 DOI: 10.1080/02699052.2024.2310791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To investigate whether routine daily activities (RDA), non-prescribed exercise (Non-ERx), or prescribed exercise (ERx) were associated with recovery from sport-related concussion (SRC) in collegiate athletes. MATERIALS AND METHODS Data for this cross-sectional, retrospective chart review of collegiate athletes diagnosed with SRC (n = 285[39.6% female], age = 19.5 ± 1.4 years) were collected during the 2015-16 to 2019-20 athletic seasons. The independent variable was group (RDA, Non-ERx, ERx). Dependent variables included days from date of diagnosis to symptom resolution (Dx-SR) and SR to return to sport (SR-RTS). RESULTS Those in the Non-ERx group took nearly 1.3 times longer to achieve SR (IRR = 1.28, 95% CI: 1.11, 1.46) and, 1.8 times longer for RTS (IRR = 1.82, 95% CI: 1.11, 2.71) when compared to those in the RDA group. No other comparisons were significant. CONCLUSION Collegiate athletes in the Non-ERx group took approximately 1 week longer to achieve SR as compared to the RDA and ERx groups. Our findings suggest that if exercise is recommended following SRC, it must be clearly and specifically prescribed. If exercise parameters cannot be prescribed, or monitored, RDA appear to be similarly beneficial during recovery for collegiate athletes with concussion.
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Affiliation(s)
- Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Monica R Lininger
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Racheal M Smetana
- Neuropsychology Assessment Clinic, University of Virginia Health, Charlottesville, Virginia, USA
| | - Patricia M Kelshaw
- Department of Kinesiology, Brain Research and Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham, NH, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas R Campbell
- School of Rehabilitation Sciences, College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Thayne A Munce
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - Michael J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Nyaz Didehbani
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Walton SR, Kelshaw PM, Munce TA, Beidler E, Bowman TG, Oldham JR, Wilmoth K, Broshek DK, Rosenblum DJ, Cifu DX, Resch JE. Access to athletic trainers and sex as modifiers of time to reach clinical milestones after sport-related concussion in collegiate athletes. Brain Inj 2024:1-8. [PMID: 38318792 DOI: 10.1080/02699052.2024.2310787] [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] [Received: 03/02/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Investigate whether an athlete's biological sex and exposure to a dedicated athletic trainer (AT) were related to clinical milestones after a sports-related concussion (SRC). DESIGN Retrospective chart review. METHODS Medical charts of collegiate athletes (n = 196 [70.9% female]) diagnosed with SRC were reviewed to extract: biological sex, dedicated AT exposure for their sport (yes/no), and time (days) to reaching clinical milestones (diagnosis, symptom resolution, unrestricted return to sport [RTS]). Mann-Whitney U tests were used to determine whether time to clinical milestones differed by sex, AT exposure, or their interaction. Proportions of same-day diagnoses and times to diagnosis, symptom resolution, and unrestricted RTS were evaluated with chi-squared and spearman's rank correlations, respectively. RESULTS There were no significant differences in times to reaching any clinical milestone by sex, AT exposure, or their interaction (ps > 0.05). Forty-three percent of participants were diagnosed on the day of their SRC. This did not differ by sex or AT exposure (ps > 0.29). Longer times to SRC diagnosis were associated with more days to symptom resolution (ρ = 0.236, p = 0.001) and unrestricted RTS (ρ = 0.223, p < 0.001). CONCLUSIONS Athlete sex and AT exposure were not associated with times to reach any clinical milestone; however, delayed diagnosis was associated with longer times to reach clinical recovery.
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Affiliation(s)
- Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Patricia M Kelshaw
- Department of Kinesiology, Brain Research and Assessment Initiative of New Hampshire Laboratory, University of New Hampshire, Durham, New Hampshire, USA
| | - Thayne A Munce
- Environmental Influences on Health & Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Kristin Wilmoth
- Departments of Psychiatry and of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Donna K Broshek
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Oldham JR, Bowman TG, Walton SR, Beidler E, Campbell TR, Smetana RM, Munce TA, Larson MJ, Cullum CM, Bushaw MA, Rosenblum DJ, Cifu DX, Resch JE. Sport Type and Risk of Subsequent Injury in Collegiate Athletes Following Concussion: a LIMBIC MATARS Consortium Investigation. Brain Inj 2024:1-9. [PMID: 38317302 DOI: 10.1080/02699052.2024.2310782] [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] [Received: 03/01/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To investigate the association between sport type (collision, contact, non-contact) and subsequent injury risk following concussion in collegiate athletes. MATERIALS AND METHODS This retrospective chart review of 248 collegiate athletes with diagnosed concussions (age: 20.0 ± 1.4 years; height: 179.6 ± 10.9 cm; mass: 79.0 ± 13.6 kg, 63% male) from NCAA athletic programs (n = 11) occurred between the 2015-2020 athletic seasons. Acute injuries that occurred within six months following concussion were evaluated. Subsequent injuries were grouped by lower extremity, upper extremity, trunk, or concussion. The independent variable was sport type: collision, contact, non-contact. A Cox proportional hazard model was used to assess the risk of subsequent injury between sport types. RESULTS Approximately 28% (70/248) of athletes sustained a subsequent acute injury within six months post-concussion. Collision sport athletes had a significantly higher risk of sustaining any injury (HR: 0.41, p < 0.001, 95% CI: 0.28, 0.62), lower extremity (HR: 0.55, p = 0.04, 95% CI: 0.32, 0.97), and upper extremity (HR: 0.41, p = 0.01, 95% CI: 0.20, 0.81) injuries following concussion. No differences between sport types were observed for other injuries. CONCLUSION Collision sport athletes had a higher rate of any subsequent injury, lower, and upper extremity injuries following concussion. Future research should focus on sport-specific secondary injury prevention efforts.
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Affiliation(s)
- Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas R Campbell
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Racheal M Smetana
- Neuropsychology Assessment Clinic, University of Virginia Health, Charlottesville, Virginia, USA
| | - Thayne A Munce
- Environmental Influences on Health & Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - Michael J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Daniel J Rosenblum
- United States Navy, Virginia Beach, Virginia, USA
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- United States Navy, Virginia Beach, Virginia, USA
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Allen AT, Cole WR, Walton SR, Kerr ZY, Chandran A, Mannix R, Guskiewicz KM, Meehan WP, Echemendia RJ, McCrea MA, Brett BL. Subjective and Performance-Based Cognition and Their Associations with Head Injury History in Older Former National Football League Players. Med Sci Sports Exerc 2023; 55:2170-2179. [PMID: 37443456 PMCID: PMC10787800 DOI: 10.1249/mss.0000000000003256] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
PURPOSE Investigate the association between self-reported subjective and performance-based cognition among older (50-70 years) former professional American football players, as well as the relationship of cognitive measures with concussion history and years of football participation, as a proxy for repetitive head impact exposure. METHODS Among older former National Football League (NFL) players ( N = 172; mean age = 60.69 ± 5.64), associations of subjective (Patient Reported Outcome Measurement Information System Cognitive Function-Short Form) and performance-based cognitive measures (Brief Test of Adult Cognition by Telephone [BTACT] Executive Function and Episodic Memory indices) were assessed via univariable and multivariable regression models, with a priori covariates of depression and race. A similar univariate and multivariable regression approach assessed associations between concussion history and years of football participation with subjective and performance-based cognitive measures. In a sample subset ( n = 114), stability of subjective cognitive rating was assessed via partial correlation. RESULTS Subjective ratings of cognition were significantly associated with performance-based assessment, with moderate effect sizes (episodic memory ηp2 = 0.12; executive function ηp2 = 0.178). These associations were weakened, but remained significant ( P s < 0.05), with the inclusion of covariates. Greater concussion history was associated with lower subjective cognitive function ( ηp2 = 0.114, P < 0.001), but not performance-based cognition. The strength of association between concussion history and subjective cognition was substantially weakened with inclusion of covariates ( ηp2 = 0.057). Years of participation were not associated with measures of subjective or objective cognition ( P s > 0.05). CONCLUSIONS These findings reinforce the importance of comprehensive evaluation reflecting both subjective and objective measures of cognition, as well as the consideration of patient-specific factors, as part of a comprehensive neurobehavioral and health assessment of older former contact sport athletes.
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Affiliation(s)
- Andrew T. Allen
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Wesley R. Cole
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Samuel R. Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Avinash Chandran
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA
| | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - William P. Meehan
- Sports Medicine Division, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
| | - Ruben J. Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, PA
- University Orthopedics Center Concussion Clinic, State College, PA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI
| | - Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI
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Walker WC, Clark SW, Eppich K, Wilde EA, Martin AM, Allen CM, Cortez MM, Pugh MJ, Walton SR, Kenney K. Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study. Front Neurol 2023; 14:1242871. [PMID: 37808506 PMCID: PMC10552781 DOI: 10.3389/fneur.2023.1242871] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Headache (HA) is a common persistent complaint following mild traumatic brain injury (mTBI), but the association with remote mTBI is not well established, and risk factors are understudied. Objective Determine the relationship of mTBI history and other factors with HA prevalence and impact among combat-exposed current and former service members (SMs). Design Secondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Methods We examined the association of lifetime mTBI history, demographic, military, medical and psychosocial factors with (1) HA prevalence ("lately, have you experienced headaches?") using logistic regression and (2) HA burden via the Headache Impact Test-6 (HIT-6) using linear regression. Each lifetime mTBI was categorized by mechanism (blast-related or not) and setting (combat deployed or not). Participants with non-credible symptom reporting were excluded, leaving N = 1,685 of whom 81% had positive mTBI histories. Results At a median 10 years since last mTBI, mTBI positive participants had higher HA prevalence (69% overall, 78% if 3 or more mTBIs) and greater HA burden (67% substantial/severe impact) than non-TBI controls (46% prevalence, 54% substantial/severe impact). In covariate-adjusted analysis, HA prevalence was higher with greater number of blast-related mTBIs (OR 1.81; 95% CI 1.48, 2.23), non-blast mTBIs while deployed (OR 1.42; 95% CI 1.14, 1.79), or non-blast mTBIs when not deployed (OR 1.23; 95% CI 1.02, 1.49). HA impact was only higher with blast-related mTBIs. Female identity, younger age, PTSD symptoms, and subjective sleep quality showed effects in both prevalence and impact models, with the largest mean HIT-6 elevation for PTSD symptoms. Additionally, combat deployment duration and depression symptoms were factors for HA prevalence, and Black race and Hispanic/Latino ethnicity were factors for HA impact. In sensitivity analyses, time since last mTBI and early HA onset were both non-significant. Conclusion The prevalence of HA symptoms among formerly combat-deployed veterans and SMs is higher with more lifetime mTBIs regardless of how remote. Blast-related mTBI raises the risk the most and is uniquely associated with elevated HA burden. Other demographic and potentially modifiable risk factors were identified that may inform clinical care.
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Affiliation(s)
- William C. Walker
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United States
| | - Sarah W. Clark
- Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United States
| | - Kaleb Eppich
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Elisabeth A. Wilde
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT, United States
- Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT, United States
| | - Aaron M. Martin
- Mental Health and Behavioral Science Service, James A. Haley Veterans’ Hospital, Tampa, FL, United States
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Chelsea M. Allen
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Melissa M. Cortez
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Samuel R. Walton
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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10
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Beidler E, Kelshaw PM, Wallace J, Larson MJ, Munce TA, Donahue CC, Bowman TG, Pappadis MR, Decker MN, Walton SR, Didehbani N, Cifu DX, Resch JE. Racial identity and concussion diagnosis and recovery trajectories in collegiate athletes: a LIMBIC MATARS investigation. Brain Inj 2023:1-9. [PMID: 37691328 DOI: 10.1080/02699052.2023.2253528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/20/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To determine if there were concussion diagnosis and recovery disparities between collegiate athletes with Black and White racial identities. DESIGN Retrospective cohort study. METHODS Concussion information was extracted from NCAA athlete medical files at LIMBIC MATARS member institutions from the 2015-16' to 2019-20' academic years. A total of 410 concussions from 9 institutions were included that provided all independent (i.e. racial identity of Black or White) and dependent variable information (i.e. dates of injury, diagnosis, symptom resolution, and return to sport) that were analyzed using Mann-Whitney U tests. The sample consisted of 114 (27.8%) concussions sustained by Black athletes and 296 (72.1%) sustained by White athletes. RESULTS The overall sample had a median of 0 days between injury occurrence to diagnosis, 7 days to symptom resolution, and 12 days to return to sport. No significant timing differences were observed for concussion diagnosis (p = .14), symptom resolution (p = .39), or return to sport (p = 0.58) between collegiate athletes with Black versus White racial identities. CONCLUSIONS These findings may reflect equitable access to onsite sports medicine healthcare resources that facilitate concussion management in the collegiate sport setting. Future work should explore these associations with a larger and more diverse sample of collegiate athletes.
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Affiliation(s)
- Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - P M Kelshaw
- Department of Kinesiology, Brain Research & Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham, New Hampshire, USA
| | - J Wallace
- Department of Health Science, Athletic Training Program, The University of Alabama, Tuscaloosa, Alabama, USA
| | - M J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - T A Munce
- Environmental Influences on Health & Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - C C Donahue
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - T G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - M R Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - M N Decker
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - S R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - N Didehbani
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - D X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - J E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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11
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Jurick SM, McCabe CT, Watrous JR, MacGregor AJ, Walton SR, Stewart IJ, Walker LE, Galarneau MR. Associations between health-related behaviors and self-reported cognitive symptoms in U.S. military personnel injured on deployment. J Psychiatr Res 2023; 165:48-55. [PMID: 37459778 DOI: 10.1016/j.jpsychires.2023.07.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/03/2023]
Abstract
Health behaviors may be core contributors to cognition and mental health following mild traumatic brain injury (TBI). The aims of the present study examined: (1) whether health behaviors including sleep duration, alcohol use, and physical activity differed in injured military personnel with and without deployment-related mild TBI history and (2) the relative contributions of health behaviors and deployment-related mild TBI history to self-reported cognitive, posttraumatic stress disorder (PTSD), and depressive symptoms. Participants included 3076 military personnel injured on deployment participating in the Wounded Warrior Recovery Project, an ongoing web-based study. Military personnel with deployment-related mild TBI history reported similar rates of physical activity and levels of alcohol problems as those without, but were less likely to report receiving the recommended duration of sleep. When adjusting for demographic and injury variables, all three health behaviors were associated with cognitive, PTSD, and depressive symptoms. Alcohol problems demonstrated significant but small effects across all outcomes measures (ηp2=.01) whereas physical activity was associated with slightly larger effects albeit still within the small range (ηp2=.02-0.04). Duration of sleep bordered a medium effect for cognitive symptoms (ηp2=.05) and was in the medium range for PTSD and depressive symptoms (ηp2=.06). Although deployment-related mild TBI history was significant in all models, effect sizes were small (ηp2=.01). Findings from the present study provide support that health behaviors have stronger effects with regard to cognitive, PTSD, and depressive symptoms compared to deployment-related mild TBI history in military personnel and, given their modifiable nature, may represent treatment targets in this population.
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Affiliation(s)
- Sarah M Jurick
- Leidos, 4161 Campus Point Ct, San Diego, CA, 92121, USA; Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
| | - Cameron T McCabe
- Leidos, 4161 Campus Point Ct, San Diego, CA, 92121, USA; Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA; Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Jessica R Watrous
- Leidos, 4161 Campus Point Ct, San Diego, CA, 92121, USA; Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA; Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Andrew J MacGregor
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Samuel R Walton
- School of Medicine Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Ian J Stewart
- Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Lauren E Walker
- David Grant USAF Medical Center, 101 Bodin Circle, Bldg. 777, Travis AFB, CA, 94535, USA
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12
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Powell JR, Hopfinger JB, Giovanello KS, Walton SR, DeLellis SM, Kane SF, Means GE, Mihalik JP. Mild traumatic brain injury history is associated with lower brain network resilience in soldiers. Brain Commun 2023; 5:fcad201. [PMID: 37545546 PMCID: PMC10400114 DOI: 10.1093/braincomms/fcad201] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/12/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023] Open
Abstract
Special Operations Forces combat soldiers sustain frequent blast and blunt neurotrauma, most often classified as mild traumatic brain injuries. Exposure to repetitive mild traumatic brain injuries is associated with persistent behavioural, cognitive, emotional and neurological symptoms later in life. Identifying neurophysiological changes associated with mild traumatic brain injury exposure, in the absence of present-day symptoms, is necessary for detecting future neurological risk. Advancements in graph theory and functional MRI have offered novel ways to analyse complex whole-brain network connectivity. Our purpose was to determine how mild traumatic brain injury history, lifetime incidence and recency affected whole-brain graph theoretical outcome measures. Healthy male Special Operations Forces combat soldiers (age = 33.2 ± 4.3 years) underwent multimodal neuroimaging at a biomedical research imaging centre using 3T Siemens Prisma or Biograph MRI scanners in this cross-sectional study. Anatomical and functional scans were preprocessed. The blood-oxygen-level-dependent signal was extracted from each functional MRI time series using the Big Brain 300 atlas. Correlations between atlas regions were calculated and Fisher z-transformed to generate subject-level correlation matrices. The Brain Connectivity Toolbox was used to obtain functional network measures for global efficiency (the average inverse shortest path length), local efficiency (the average global efficiency of each node and its neighbours), and assortativity coefficient (the correlation coefficient between the degrees of all nodes on two opposite ends of a link). General linear models were fit to compare mild traumatic brain injury lifetime incidence and recency. Nonparametric ANOVAs were used for tests on non-normally distributed data. Soldiers with a history of mild traumatic brain injury had significantly lower assortativity than those who did not self-report mild traumatic brain injury (t148 = 2.44, P = 0.016). The assortativity coefficient was significantly predicted by continuous mild traumatic brain injury lifetime incidence [F1,144 = 6.51, P = 0.012]. No differences were observed between recency groups, and no global or local efficiency differences were observed between mild traumatic brain injury history and lifetime incidence groups. Brain networks with greater assortativity have more resilient, interconnected hubs, while those with lower assortativity indicate widely distributed, vulnerable hubs. Greater lifetime mild traumatic brain injury incidence predicted lower assortativity in our study sample. Less resilient brain networks may represent a lack of physiological recovery in mild traumatic brain injury patients, who otherwise demonstrate clinical recovery, more vulnerability to future brain injury and increased risk for accelerated age-related neurodegenerative changes. Future longitudinal studies should investigate whether decreased brain network resilience may be a predictor for long-term neurological dysfunction.
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Affiliation(s)
- Jacob R Powell
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Joseph B Hopfinger
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kelly S Giovanello
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Samuel R Walton
- Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Stephen M DeLellis
- Fort Liberty Research Institute, The Geneva Foundation, Tacoma, WA 98402, USA
| | - Shawn F Kane
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gary E Means
- United States Army Special Operations Command, Fort Liberty, NC 28303, USA
| | - Jason P Mihalik
- Correspondence to: Jason P. Mihalik Matthew Gfeller Center, Department of Exercise and Sport Science The University of North Carolina at Chapel Hill, 2201 Stallings-Evans Sports Medicine Center Campus Box 8700, Chapel Hill, NC 27599, USA E-mail:
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13
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Echemendia RJ, Burma JS, Bruce JM, Davis GA, Giza CC, Guskiewicz KM, Naidu D, Black AM, Broglio S, Kemp S, Patricios JS, Putukian M, Zemek R, Arango-Lasprilla JC, Bailey CM, Brett BL, Didehbani N, Gioia G, Herring SA, Howell D, Master CL, Valovich McLeod TC, Meehan WP, Premji Z, Salmon D, van Ierssel J, Bhathela N, Makdissi M, Walton SR, Kissick J, Pardini J, Schneider KJ. Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review. Br J Sports Med 2023; 57:722-735. [PMID: 37316213 DOI: 10.1136/bjsports-2022-106661] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6). DATA SOURCES Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation. ELIGIBILITY CRITERIA (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC. DATA EXTRACTION Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool. RESULTS Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children. CONCLUSION Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes. PROSPERO REGISTRATION NUMBER CRD42020154787.
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Affiliation(s)
- Ruben J Echemendia
- Concussion Care Clinic, University Orthopedics, State College, Pennsylvania, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Simon Kemp
- Sports Medicine, Rugby Football Union, London, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christopher M Bailey
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Gerry Gioia
- Depts of Pediatrics and Psychiatry & Behavioral Sciences, Children's National Health System, Washington, District of Columbia, USA
| | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - David Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Neil Bhathela
- UCLA Health Steve Tisch BrainSPORT Program, Los Angeles, California, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, School of Medicine, Richmond, Virginia, USA
| | - James Kissick
- Dept of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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14
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Kuenze C, Pietrosimone B, Currie KD, Walton SR, Kerr ZY, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia RJ, McCrea M, Guskiewicz KM, Meehan WP. Joint Injury, Osteoarthritis, and Cardiovascular Disease Risk Factors in Former National Football League Athletes: An NFL-LONG Study. J Athl Train 2023; 58:528-535. [PMID: 36645831 PMCID: PMC10496448 DOI: 10.4085/1062-6050-0437.22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Individuals with lower extremity osteoarthritis (OA) have a 25% greater risk of cardiovascular disease (CVD) than those without OA. The prevalence of traumatic joint injuries among National Football League (NFL) players exposes these athletes to an elevated risk for OA and potentially a greater risk of cardiovascular risk factors (CRFs) and CVD. OBJECTIVES To examine the associations between a history of lower extremity joint injury, lower extremity OA, and the prevalence of CRFs and CVD among former NFL athletes. DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS Former NFL players completed a comprehensive health questionnaire that was used in an ongoing study, the Neurologic Function Across the Lifespan: A Prospective, Longitudinal, and Translational Study for Former NFL Players (NFL-LONG). A subsample of 1738 former players reported lifetime medical diagnoses including CVD or CRFs. MAIN OUTCOME MEASURE(S) Crude and adjusted prevalence ratios (PRsadj) characterized the associations between CVD or CRFs and injury, OA diagnosis, or both among athletes who reported (1) no history of lower extremity joint injury or surgery and no diagnosed OA, (2) a history of lower extremity joint injury or surgery and no diagnosed OA, and (3) a history of lower extremity joint injury or surgery and diagnosed OA. RESULTS Neither a history of lower extremity joint injury (PRadj = 1.34; 95% CI = 0.86, 2.07) nor a history of lower extremity joint injury and diagnosed OA (PRadj = 1.41; 95% CI = 0.89, 2.25) was significantly associated with CVD. However, CRFs were 30% and 53% more prevalent in former players with lower extremity joint injury and no diagnosed OA (PRadj = 1.30; 95% CI = 1.12, 1.50) and those with lower extremity joint injury and diagnosed OA (PRadj = 1.53; 95% CI = 1.31, 1.78), respectively, versus athletes with no history of either condition. CONCLUSIONS The prevalence of CRFs was highest among former NFL athletes with a history of lower extremity joint injury and diagnosed OA. These findings provide insight regarding the potential pathways to chronic diseases that may be initiated by joint injury early in life.
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Affiliation(s)
| | - Brian Pietrosimone
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | | | - Samuel R. Walton
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Y. Kerr
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | | | - Avinash Chandran
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - J. D. DeFreese
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
| | | | - Ruben J. Echemendia
- University of Missouri–Kansas City
- University Orthopedics Center Concussion Clinic, State College, PA
| | | | - Kevin M. Guskiewicz
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill
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15
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Echemendia RJ, Brett BL, Broglio S, Davis GA, Giza CC, Guskiewicz KM, Harmon KG, Herring S, Howell DR, Master C, McCrea M, Naidu D, Patricios JS, Putukian M, Walton SR, Schneider KJ, Burma JS, Bruce JM. Sport concussion assessment tool™ - 6 (SCAT6). Br J Sports Med 2023; 57:622-631. [PMID: 37316203 DOI: 10.1136/bjsports-2023-107036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Miami, Florida, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Sports Medicine Research laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Stanley Herring
- Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - David R Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Christina Master
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Margot Putukian
- Chief Medical Officer, Major League Soccer, New York, New York, USA
- Princeton, New Jersey, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
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16
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Echemendia RJ, Ahmed OH, Bailey CM, Bruce JM, Burma JS, Davis GA, Gioia G, Howell D, Fuller GW, Master CL, van Ierssel J, Pardini J, Schneider KJ, Walton SR, Zemek R, Patricios J. Introducing the Concussion Recognition Tool 6 (CRT6). Br J Sports Med 2023; 57:689-691. [PMID: 37316214 DOI: 10.1136/bjsports-2023-106851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Ruben J Echemendia
- Department of Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Behavioral Associates, Port Matilda, PA, USA
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Christopher M Bailey
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansa City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Gerry Gioia
- Children's National Health System, Washington, DC, USA
| | - David Howell
- Department of Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Christina L Master
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Orthopedics and Sports Medicine, The Children's Hospital of Pennsylvania, Philadelphia, PA, USA
| | | | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Banner - University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Roger Zemek
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jon Patricios
- Faculty of Health Sciences, Wits Sport and Health (WiSH), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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17
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Davis GA, Echemendia RJ, Ahmed OH, Anderson V, Blauwet C, Brett BL, Broglio S, Bruce JM, Burma JS, Gioia G, Giza CC, Guskiewicz KM, Harmon KG, Herring SA, Makdissi M, Master CL, McCrea M, Meehan WP, Naidu D, Patricios JS, Purcell LK, Putukian M, Schneider KJ, Valovich McLeod TC, Walton SR, Yeates KO, Zemek R. Child SCAT6. Br J Sports Med 2023; 57:636-647. [PMID: 37316212 DOI: 10.1136/bjsports-2023-106982] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Port Matilda, Pennsylvania, USA
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
| | - Vicki Anderson
- Child Neuropsychology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Psychology, University of Melbourne, Parkville, Victoria, Australia
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation/Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gerry Gioia
- Children's National Health System, Washington, District of Columbia, USA
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics / Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Christina L Master
- Orthopedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Laura K Purcell
- The Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | | | - Roger Zemek
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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18
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Echemendia RJ, Ahmed OH, Bailey CM, Bruce JM, Burma JS, Davis GA, Gioia G, Howell DR, Fuller GW, Master CL, van Ierssel J, Pardini J, Schneider KJ, Walton SR, Zemek R, Patricios JS. The Concussion Recognition Tool 6 (CRT6). Br J Sports Med 2023; 57:692-694. [PMID: 37316201 DOI: 10.1136/bjsports-2023-107021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Port Matilda, Pennsylvania, USA
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
| | - Christopher M Bailey
- University Hospitals, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Gerry Gioia
- Children's National Health System, Washington, District of Columbia, USA
| | - David R Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christina L Master
- Departments of Pediatrics and Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Banner - University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Roger Zemek
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
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19
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Davis GA, Echemendia RJ, Ahmed OH, Anderson V, Blauwet C, Brett BL, Broglio S, Bruce JM, Burma JS, Gioia GA, Giza CC, Guskiewicz KM, Harmon KG, Herring S, Makdissi M, Master CL, McCrea M, Valovich McLeod TC, Meehan WP, Naidu D, Patricios J, Purcell LK, Putukian M, Schneider KJ, Walton SR, Yeates KO, Zemek R. Introducing the Child Sport Concussion Assessment Tool 6 (Child SCAT6). Br J Sports Med 2023; 57:632-635. [PMID: 37316202 DOI: 10.1136/bjsports-2023-106853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Neurosurgery, Cabrini Health, Malvern, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Kansas City, Missouri, USA
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Vicki Anderson
- Psychology, University of Melbourne, Parkville, Victoria, Australia
- Brain and Mind, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - C Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gerard A Gioia
- Children's National Health System, Washington, District of Columbia, USA
- School of Medicine, George Washington University, Washington, DC, USA
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Sports Medicine Research Laboratory, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Stanley Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Christina L Master
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine, A.T. Still University, Mesa, Arizona, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jon Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | | | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | | | - Roger Zemek
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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20
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Echemendia RJ, Brett BL, Broglio S, Davis GA, Giza CC, Guskiewicz KM, Harmon KG, Herring S, Howell DR, Master CL, Valovich McLeod TC, McCrea M, Naidu D, Patricios J, Putukian M, Walton SR, Schneider KJ, Burma JS, Bruce JM. Introducing the Sport Concussion Assessment Tool 6 (SCAT6). Br J Sports Med 2023; 57:619-621. [PMID: 37316207 DOI: 10.1136/bjsports-2023-106849] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Ruben J Echemendia
- Psychology, University of Missouri, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven Broglio
- Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Sports Medicine Research Laboratory, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Stanley Herring
- Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - David R Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Christina L Master
- Division of Orthopedics and Sports Medicine, The Children's Hosputal of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jon Patricios
- Wits Sport and Health (WISH), School of Clinical Medicine, Faculty of Health Sciences, University of Witwaterstrand, Johannesburg, South Africa
| | - Margot Putukian
- Athletic Medicine, Princeton University, Princeton, New Jersey, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri, USA
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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MacGregor AJ, Casachahua JD, Walton SR, Harbertson J, Jurick SM, Dougherty AL, McCabe CT, Watrous JR, Fraser JJ. Deployment-related concussion and long-term health-related quality of life among US military personnel. Qual Life Res 2023:10.1007/s11136-023-03367-4. [PMID: 36897531 DOI: 10.1007/s11136-023-03367-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To examine the relationship between deployment-related concussion and long-term health-related quality of life (HRQoL) among injured US military personnel. METHODS The study sample included 810 service members with deployment-related injuries between 2008 and 2012 who responded to a web-based longitudinal health survey. Participants were categorized into three injury groups: concussion with loss of consciousness (LOC; n = 247), concussion without LOC (n = 317), or no concussion (n = 246). HRQoL was measured using the 36-Item Short Form Health Survey physical and mental component summary (PCS and MCS) scores. Current post-traumatic stress disorder (PTSD) and depression symptoms were examined. Multivariable linear regression models assessed the effects of concussion on PCS and MCS scores, while controlling for covariates. RESULTS A lower PCS score was observed in participants with concussion with LOC (B = - 2.65, p = 0.003) compared with those with no history of concussion. Symptoms of PTSD (PCS: B = - 4.84, p < 0.001; MCS: B = - 10.53, p < 0.001) and depression (PCS: B = - 2.85, p < 0.001; MCS: B = - 10.24, p < 0.001) were the strongest statistically significant predictors of lower HRQoL. CONCLUSION Concussion with LOC was significantly associated with lower HRQoL in the physical domain. These findings affirm that concussion management should integrate physical and psychological care to improve long-term HRQoL and warrant a more detailed examination of causal and mediating mechanisms. Future research should continue to incorporate patient-reported outcomes and long-term follow-up of military service members to further define the lifelong impact of deployment-related concussion.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
| | - John D Casachahua
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Samuel R Walton
- Virginia Commonwealth University School of Medicine, Department of Physical Medicine and Rehabilitation, Richmond, VA, USA
| | - Judith Harbertson
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Sarah M Jurick
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Cameron T McCabe
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Jessica R Watrous
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - John J Fraser
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA
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23
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Brett BL, Aggarwal NT, Chandran A, Kerr ZY, Walton SR, DeFreese JD, Guskiewicz KM, Echemendia RJ, Meehan WP, McCrea MA, Mannix R. Incorporation of concussion history as part of the LIfestyle for BRAin Health (LIBRA) modifiable factors risk score and associations with cognition in older former National Football League players. Alzheimers Dement 2023. [PMID: 36708229 PMCID: PMC10374874 DOI: 10.1002/alz.12929] [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] [Received: 08/14/2022] [Revised: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Investigate associations between the LIfestyle for BRAin Health (LIBRA) risk score with odds of mild cognitive impairment (MCI) diagnosis and cognitive function, incorporating concussion history. METHODS Former National Football League (NFL) players (N = 1050; mean age = 64.8 ± 9.0-years) completed initial testing for integration of concussion history into LIBRA scores (i.e., modified-LIBRA) and completed the Brief Test of Adult Cognition by Telephone (BTACT). Modified-LIBRA score (including concussion history) associations with odds of MCI and cognitive dysfunction were assessed via logistic and linear regression. RESULTS The highest quartile LIBRA scores were six times more likely to have a diagnosis of MCI compared to the lowest quartile (OR = 6.27[3.61, 10.91], p < 0.001). Modified-LIBRA scores significantly improved model fit for odds of MCI above original LIBRA scores (χ2 (1) = 7.76, p = 0.005) and accounted for a greater fraction of variance in executive function (ΔR2 = 0.02, p = 0.003) and episodic memory (ΔR2 = 0.02, p = 0.002). CONCLUSIONS Modified-LIBRA score, incorporating concussion history, may help monitoring risk status in former contact sport athletes, by targeting modifiable, lifestyle-related risk factors.
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Affiliation(s)
- Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | | | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc., State College, Pennsylvania, USA
| | - William P Meehan
- Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Rebekah Mannix
- Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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24
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Kossman MK, Walton SR, Boltz AJ, Collins CL, Lempke LB, Robison HJ, Chandran A. Major Activity Restriction Following Musculoskeletal Injury In Collegiate Basketball: Findings From The NCAA-ISP Between 2009/10-2018/19. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000883132.39514.3f] [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: 11/21/2022]
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25
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Nedimyer AK, Walton SR, Carneiro KA, Weight EA, Mihalik JP, Kerr ZY, DeFreese J, Chandran A. Physical Activity In Former Elite Women’s Soccer Athletes. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000877096.74849.fb] [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: 11/21/2022]
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26
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Kerr ZY, Chandran A, Brett BL, Walton SR, DeFreese JD, Mannix R, Echemendia RJ, McCrea MA, Guskiewicz KM, Meehan WP. The stability of self-reported professional football concussion history among former players: A longitudinal NFL-LONG study. Brain Inj 2022; 36:968-976. [PMID: 35971311 DOI: 10.1080/02699052.2022.2109739] [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: 11/02/2022]
Abstract
OBJECTIVES To examine the stability of former National Football League (NFL) players' recall of professional football concussion. METHODS Two-hundred-and-nine former NFL players (ceasing football participation before/in 2001) completed surveys in 2001, 2010, and 2019 and reported the number of concussions sustained during their professional careers (0, 1 … 10, >10). Participants were categorized into four 'recall stability' groups, based upon concussion recall [e.g., 'Same' (same number recalled), 'Increased' (more recalled than in prior time point)]. In 2019, participants completed measures of functioning (e.g., PROMIS Cognitive Function, Anxiety, Depression). Fleiss Kappa and generalized linear mixed models (GLMM)-based ordinal measures Kappa assessed stability across time points. 'Recall stability group' functioning scores were compared. RESULTS Overall, 45.9% recalled more concussions over time; 14.8% reported the same number. Fleiss Kappa and GLMM-based ordinal measures Kappa suggested fair (0.22, 95% CI: 0.26, 0.38) and moderate stability (0.41, 95% CI: 0.35, 0.46), respectively. Higher cognitive functioning (P = 0.002), lower anxiety (P = 0.003), and lower depression (P = 0.007) were observed in the 'Same' vs 'Increased' groups. CONCLUSIONS Despite subtle time-based variations in reporting, professional football concussion history recall was relatively stable. Better cognitive and psychological functioning was associated with greater stability in concussion recall.
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Affiliation(s)
- Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samuel R Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebekah Mannix
- Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, Columbia, Pennsylvania, USA.,Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Michael A McCrea
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William P Meehan
- Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts, USA
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27
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Castellano AK, Powell JR, Cools MJ, Walton SR, Barnett RR, DeLellis SM, Goldberg RL, Kane SF, Means GE, Zamora CA, Depenbrock PJ, Mihalik JP. Relationship between Anterior Pituitary Volume and IGF-1 Serum Levels in Soldiers with Mild Traumatic Brain Injury History. Med Sci Sports Exerc 2022; 54:1364-1370. [PMID: 35838301 PMCID: PMC9287595 DOI: 10.1249/mss.0000000000002892] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE A high mild traumatic brain injury (mTBI) incidence rate exists in military and sport. Hypopituitarism is an mTBI sequela; however, few studies have examined this phenomenon in those with an mTBI history. This cross-sectional study of Special Operations Forces combat soldiers aimed 1) to relate anterior pituitary gland volumes (actual and normalized) to insulin-like growth factor 1 (IGF-1) concentrations, 2) to examine the effect of mTBI history on anterior pituitary gland volumes (actual and normalized) and IGF-1 concentrations, and 3) to measure the odds of demonstrating lower anterior pituitary gland volumes (actual and normalized) or IGF-1 concentrations if self-reporting mTBI history. METHODS Anterior pituitary gland volumes were manually segmented from T1-weighted 3D brain MRI sequences; IGF-1 serum concentrations were quantified using commercial enzyme-linked immunosorbent assays. Correlations and linear regression were used to determine the association between IGF-1 serum concentration and anterior pituitary gland volume (n = 74). Independent samples t-tests were used to compare outcomes between mTBI groups and logistic regression models were fit to test the odds of demonstrating IGF-1 concentration or anterior pituitary volume less than sample median based on mTBI group (n = 54). RESULTS A significant linear relationship between the subjects' anterior pituitary gland volumes and IGF-1 concentrations (r72 = 0.35, P = 0.002) was observed. Soldiers with mTBI history had lower IGF-1 concentrations (P < 0.001) and lower anterior pituitary gland volumes (P = 0.037) and were at greater odds for IGF-1 serum concentrations less than the sample median (odds ratio = 5.73; 95% confidence interval = 1.77-18.55). CONCLUSIONS Anterior pituitary gland volume was associated with IGF-1 serum concentrations. Mild TBI history may be adversely associated with anterior pituitary gland volumes and IGF-1 concentrations. Longitudinal IGF-1 and anterior pituitary gland monitoring may be indicated in those who report one or more mTBI.
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Affiliation(s)
- Anna K. Castellano
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jacob R. Powell
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael J. Cools
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Samuel R. Walton
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Randaline R. Barnett
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Richard L. Goldberg
- Department of Applied Physical Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Shawn F. Kane
- Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gary E. Means
- United States Army Special Operations Command, Fort Bragg, NC
| | - Carlos A. Zamora
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jason P. Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Kerr ZY, Walton SR, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia RJ, McCrea MA, Guskiewicz KM, Meehan WP. Measurement implications on the association between self-reported concussion history and depression: An NFL-LONG study. Clin Neuropsychol 2022:1-18. [PMID: 35791900 DOI: 10.1080/13854046.2022.2094834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveThis study examined how associations of self-reported concussion history and depression vary based on different variable characterizations. Methods Former NFL players (n = 1,697) completed a General Health Survey, indicating the number of concussions they sustained during their football career and whether a physician had diagnosed them with depression, and the PROMIS 4-item Depression scale. Self-reported concussion history was characterized as: a 3-category variable (0, 1-2, 3+) with (1) indicator variables and (2) as an ordinal variable; a 5-category variable (0, 1-2, 3-5, 6-9, 10+) with (3) indicator variables and (4) as an ordinal variable; and (5) the original interval scale (0, 1, 2,…, 10, 10+). Depression was characterized as: (1) physician diagnosis (yes/no); and the PROMIS 4-item Depression scale treated as: (2) the original T-score variable and (3) using a cut-off of a T-score >60 versus ≤60. Regression models with various combinations of the characterizations, while adjusting for age, race/ethnicity, education, pain interference, and stress level, estimated prevalence ratios and mean differences for binary and continuous outcomes, respectively. Concussion history-related effect estimates were compared across all models. Results Self-reported concussion history emerged as a significant predictor of each depression measure. With a higher number of concussions reported, be it via the categories or the interval scale, stronger associations between self-reported concussion history and depression were observed. Conclusions The various approaches to characterize self-reported concussion history and depression provided evidence of significant associations between the two variables, with the degree of association varying based on characterization of each construct.
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Affiliation(s)
- Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel R. Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin L. Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebekah Mannix
- Brain Injury Center, Boston Children’s Hospital, Boston, MA, USA
| | - Ruben J. Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, PA, USA
- Psychology, University of Missouri Kansas City, Kansas City, MO, USA
| | - Michael A. McCrea
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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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 2022:483089. [PMID: 35724361 DOI: 10.4085/1062-6050-0097.22] [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] [Key Words] [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 healthcare practices and concussion knowledge are unestablished. 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) concussion assessment and management practices associations with years of clinical experience and highest degree attained. DESIGN Cross-sectional cohort. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS Licensed Irish (49.7%;n=91/183) and Canadian (10.1%;n=211/2,090) athletic therapists. MAIN OUTCOME MEASURES Athletic therapists completed an online survey assessing their demographics, concussion knowledge (symptom recognition, patient-clinician scenarios), annual concussions assessed, and assessment and return-to-play (RTP) measures using a modified, previously validated survey. Symptom recognition consisted of 20 (8 true, 12 false) signs and symptoms recognition questions scored as total correct. Descriptive statistics and odds ratios (OR) 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 as the most common method for determining RTP. Symptom recognition was 72.8±17.0% among Irish and 76.6±17.0% among Canadian athletic therapists. Irish (91.2%;n=52/57) and Canadian (95.3%;n=161/178) athletic therapists reported standardized sideline assessments as the most common concussion assessment method. Irish and Canadian athletic therapists' two-domain (Irish:38.6%[n=22/57]; Canadian:73.6%[n=131/178]) and three-domain (Irish:3.5%[n=2/57]; Canadian:19.7%[n=35/178]) minimum assessments (i.e. symptoms, balance, and/or neurocognitive) were not associated with education or clinical experience (p≥0.068), except for Canadian athletic therapists with Master's degrees having greater odds of completing two-domain assessments at initial evaluation than those with Bachelor's degrees (OR[95%CI]=1.8[1.41-1.95]). CONCLUSIONS Irish and Canadian athletic therapists demonstrated similar concussion knowledge to prior research; however, the majority did not fully adhere to international consensus concussion assessment guidelines as evidenced by low two- and three- domain assessment use. Athletic therapists should aim to implement multidimensional concussion assessments to ensure optimal healthcare practices and patient safety.
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Affiliation(s)
- Landon B Lempke
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, United States.,Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, United States.,Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, United States
| | - Glen Bergeron
- Department of Kinesiology and Applied Health, The University of Winnipeg, Winnipeg, Canada
| | - Siobhán O'Connor
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, United States
| | - Jacob E Resch
- Exercise and Sport Injury Laboratory, Department of Kinesiology, University of Virginia, Charlottesville, Virginia, United States
| | - Samuel R Walton
- Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, United States
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DeFreese JD, Walton SR, Kerr ZY, Brett BL, Chandran A, Mannix R, Campbell H, Echemendia RJ, McCrea MA, Meehan WP, Guskiewicz KM. Transition-Related Psychosocial Factors and Mental Health Outcomes in Former National Football League Players: An NFL-LONG Study. J Sport Exerc Psychol 2022; 44:169-176. [PMID: 35279017 DOI: 10.1123/jsep.2021-0218] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
Transition from professional sport to nonsport endeavors has implications for postcareer health and well-being of athletes. The purpose of the current study was to examine associations among transition-related psychosocial factors and current mental health outcomes in former National Football League (NFL) players. Participants were former NFL players (n = 1,784; mean age = 52.3 ± 16.3 years) who responded to a questionnaire assessing the nature of their discontinuation from professional football (i.e., any degree of voluntary choice vs. forced discontinuation), prediscontinuation transition planning (yes vs. no), and current symptoms of depression and anxiety. After adjusting for relevant covariates, having an involuntary discontinuation and no transition plan prior to discontinuation were associated with greater depressive and anxiety symptom severity. Autonomy in discontinuation and pretransition planning are important to former NFL football players' mental health. Increasing autonomy in the discontinuation decision and pretransition planning represent psychoeducational intervention targets for this population.
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Affiliation(s)
- J D DeFreese
- University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | - Samuel R Walton
- University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | | | | | - Avinash Chandran
- University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
- Datalys Center for Sports Injury Research and Prevention, Inc., University of North Carolina at Chapel Hill, Chapel Hill, NC,USA
| | | | | | - Ruben J Echemendia
- University of Missouri-Kansas City, Kansas City, MO,USA
- University Orthopedics Center Concussion Clinic, State College, PA,USA
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31
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Brett BL, Kerr ZY, Walton SR, Chandran A, Defreese JD, Mannix R, Echemendia RJ, Meehan WP, Guskiewicz KM, McCrea M. Longitudinal trajectory of depression symptom severity and the influence of concussion history and physical function over a 19-year period among former National Football League (NFL) players: an NFL-LONG Study. J Neurol Neurosurg Psychiatry 2022; 93:272-279. [PMID: 34663623 PMCID: PMC8854336 DOI: 10.1136/jnnp-2021-326602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/03/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study investigated the longitudinal course of depressive symptom severity over 19 years in former American football players and the influence of concussion history, contact sport participation and physical function on observed trajectories. METHODS Former American football players completed a general health questionnaire involving demographic information, medical/psychiatric history, concussion/football history and validated measures of depression and physical function at three time points (2001, 2010 and 2019). Parallel process latent growth curve modelling tested associations between concussion history, years of football participation, and overall and change in physical function on the overall level and trajectory of depressive symptoms. RESULTS Among the 333 participants (mean(SD) age, 48.95 (9.37) at enrolment), there was a statistically significant, but small increase in depressive symptom severity from 2001 (48.34 (7.75)) to 2019 (49.77 (9.52)), slope=0.079 (SE=0.11), p=0.007. Those with greater concussion history endorsed greater overall depressive symptom severity, B=1.38 (SE=0.33), p<0.001. Concussion history, B<0.001 (SE=0.02), p=0.997 and years of participation, B<0.001 (SE=0.01), p=0.980, were not associated with rate of change (slope factor) over 19 years. Greater decline in physical function, B=-0.71 (SE=0.16), p<0.001, was predictive of a faster growth rate (ie, steeper increase) of depression symptom endorsement over time. CONCLUSIONS Concussion history, not years of participation, was associated with greater depressive symptom severity. Neither factor was predictive of changes over a 19-year period. Decline in physical function was a significant predictor of a steeper trajectory of increased depressive symptoms, independent of concussion effects. This represents one viable target for preventative intervention to mitigate long-term neuropsychiatric difficulties associated with concussion across subsequent decades of life.
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Affiliation(s)
- Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel R Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, indianapolis, IN, USA
| | - J D Defreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, Pennsylvania, USA
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - William P Meehan
- Sports Medicine Division, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA
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Lempke LB, Kerr ZY, Melvin P, Walton SR, Wallace JS, Mannix RC, Meehan WP, Ward VL. Examining racial and ethnic disparities in adult emergency department patient visits for concussion in the United States. Front Neurol 2022; 13:988088. [PMID: 36247794 PMCID: PMC9563304 DOI: 10.3389/fneur.2022.988088] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022] Open
Abstract
Background Racial and ethnic differences in emergency department (ED) visits have been reported among adolescent patients but are unsubstantiated among adults. Therefore, our purpose in this study was to examine the relationship between race/ethnicity and adult ED visits for concussions, their injury mechanisms, and computed tomography (CT) scan use among a nationally representative sample. Methods We used the National Hospital Ambulatory Medical Care Survey database from 2010-2015 to examine 63,725 adult (20-45 years old) patient visits, representing an estimated 310.6 million visits presented to EDs. Of these visits, 884 (4.5 million national estimate) were diagnosed with a concussion. Visit records detailed patient information (age, sex, race/ethnicity, geographic region, primary payment type), ED visit diagnoses, injury mechanism (sport, motor vehicle, fall, struck by or against, "other"), and head CT scan use. The primary independent variable was race/ethnicity (non-Hispanic Asian, non-Hispanic Black or African American, Hispanic/Latinx, non-Hispanic multiracial or another, and non-Hispanic White). We used multivariable logistic and multinomial regression models with complex survey sampling design weighting to examine the relationship between concussion ED visits, injury mechanisms, and CT scan use separately by race/ethnicity while accounting for covariates. Results There were no associations between race/ethnicity and concussion diagnosis among adult ED visits after accounting for covariates. Relative to sports-related injuries, non-Hispanic Black or African American patient visits were associated with a motor vehicle (OR = 2.69, 95% CI: 1.06-6.86) and "other" injury mechanism (OR = 4.58, 95% CI: 1.34-15.69) compared to non-Hispanic White patients. Relative to sports-related injuries, non-Hispanic Asian, multiracial, or patients of another race had decreased odds of falls (OR = 0.20, 95% CI: 0.04-0.91) and "other" injuries (OR = 0.09, 95% CI: 0.01-0.55) compared to non-Hispanic White patients. The odds of a CT scan being performed were significantly lower among Hispanic/Latinx patient visits relative to non-Hispanic White patients (OR = 0.52, 95% CI: 0.30-0.91), while no other race/ethnicity comparisons differed. Conclusion Our findings indicate that the overarching concussion ED visit likelihood may not differ by race/ethnicity in adults, but the underlying mechanism causing the concussion and receiving a CT scan demonstrates considerable differences. Prospective future research is warranted to comprehensively understand and intervene in the complex, multi-level race/ethnicity relationships related to concussion health care to ensure equitable patient treatment.
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Affiliation(s)
- Landon B Lempke
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.,The Micheli Center for Sports Injury Prevention, Waltham, MA, United States.,Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrice Melvin
- Office of Health Equity and Inclusion, The Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States
| | - Samuel R Walton
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica S Wallace
- Department of Health Science, University of Alabama, Tuscaloosa, AL, United States
| | - Rebekah C Mannix
- Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, MA, United States.,Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
| | - William P Meehan
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.,The Micheli Center for Sports Injury Prevention, Waltham, MA, United States.,Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, MA, United States.,Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Valerie L Ward
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States.,Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States.,Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States.,Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, United States
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Walton SR, Kerr ZY, Mannix R, Brett BL, Chandran A, DeFreese JD, McCrea MA, Guskiewicz KM, Meehan WP, Echemendia RJ. Subjective Concerns Regarding the Effects of Sport-Related Concussion on Long-Term Brain Health among Former NFL Players: An NFL-LONG Study. Sports Med 2021; 52:1189-1203. [PMID: 34773581 DOI: 10.1007/s40279-021-01589-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Potential links between a history of sport-related concussions and later-life neurobiological and psychological brain health have been studied in former collision-sport athletes. However, empirical studies of how former athletes perceive the future of their brain health as a result of these injuries are missing. OBJECTIVES We aimed to (1) identify the extent to which former National Football League players currently have concerns about their long-term psychological and cognitive functioning as a result of concussions sustained while playing football; (2) examine whether current concerns are different than concerns they had while playing football; (3) examine the relationship between current brain health concerns and self-reported concussion history (SR-CHx); and (4) explore other important factors associated with these concerns. METHODS In this cross-sectional study, former National Football League players with a SR-CHx of one or more concussions (n = 1514; aged mean [standard deviation] = 52.3 [15.7] years) completed a general health questionnaire. Participants reported their lifetime concussion history, as well as both their current concerns and concerns while playing football (i.e., retrospective concerns) regarding the long-term effects of concussions on their memory, thinking skills, and risk of developing chronic traumatic encephalopathy. Current and retrospective concerns were self-reported on a five-point Likert scale. Four concussion history categories were created based on SR-CHx: 1-2 (n = 309); 3-5 (n = 413); 6-9 (n = 356); and 10 + (n = 436) lifetime concussions. Proportions of participants reporting each level of current and retrospective concerns were examined to identify whether concerns presently exist in these former players, and whether their current concerns are different than retrospective concerns. Next, we explored associations between current concerns and SR-CHx. RESULTS More than one-third of participants reported being currently "extremely concerned" about memory problems (36.9%), thinking skills (37.8%), and developing chronic traumatic encephalopathy (39.5%). In contrast, when asked about concerns while playing, most reported being "not at all concerned" regarding memory = 61.2%, thinking skills = 56.1%, and developing chronic traumatic encephalopathy = 71.2%. Of those who retrospectively endorsed being "not at all" or "slightly" concerned regarding memory (n = 1159/1514), thinking skills (n = 1080/1514), and developing chronic traumatic encephalopathy (n = 1219/1514), approximately half reported being currently "moderately" or "extremely" concerned about those same issues (n = 586/1159; n = 534/1080; n = 619/1219, respectively). Current concerns regarding memory (χ216 = 316.61; p < 0.001; V = 0.264), thinking skills (χ216 = 333.17; p < 0.001; V = 0.271), and developing chronic traumatic encephalopathy (χ216 = 280.85; p < 0.001; V = 0.249) were significantly related to SR-CHx, with more concussions being associated with greater current concerns. CONCLUSIONS Former National Football League players reported significant concerns regarding the potential effects of their prior concussions on long-term brain health, and these concerns are more prevalent now than when they were playing football. Cognitive and mental health concerns are readily identifiable targets for clinical intervention. Clinicians working with former players may wish to explore the extent to which individual players experience these concerns, the nature and depth of these concerns, and the impact of these concerns on the player's functioning and well-being.
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Affiliation(s)
- Samuel R Walton
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zachary Y Kerr
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebekah Mannix
- Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Avinash Chandran
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Jonathan D DeFreese
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin M Guskiewicz
- Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William P Meehan
- Micheli Center for Sports Injury Prevention and Boston Children's Hospital, Waltham, MA, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri, Kansas City, Kansas City, MO, USA.
- University Orthopedics Center Concussion Clinic, 101 Regent Ct., State College, PA, 16801, USA.
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Walton SR, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia RJ, Meehan WP, McCrea M, Guskiewicz KM, Kerr ZY. Mild Cognitive Impairment and Dementia Reported by Former Professional Football Players over 50 Years of Age: An NFL-LONG Study. Med Sci Sports Exerc 2021; 54:424-431. [PMID: 34593716 DOI: 10.1249/mss.0000000000002802] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate prevalences of MCI and dementia diagnoses in former National Football League (NFL) players ≥50 years old and examine the relationships among these diagnoses and an array of predictors of long-term brain health. METHODS A cross-section of former NFL players (n = 922; aged [mean ± SD] 64.8 ± 8.9 years) completed a questionnaire. Prevalences of self-reported medical diagnoses of MCI and dementia were reported alongside U.S. population estimates across 5-year age intervals (e.g., 60-64 years). Prevalence ratios (PRs) were calculated for multiple predictors of long-term brain health. RESULTS Overall, MCI and dementia prevalences were n = 219(23.8%) and n = 82(8.9%), respectively. Each diagnosis was more prevalent in former NFL players across age groups than U.S. norms, with greater disparities at relatively younger ages (e.g., 65-69) compared with older ages. Greater prevalences of MCI and dementia were associated with: self-reported concussion history (10+ vs. 0; PRadjusted[95%CI] = 1.66[1.02-2.71] and 2.61[1.01-6.71], respectively); recent pain intensity (PRadjusted[95%CI] = 1.13[1.07-1.20] and 1.15[1.03-1.28]); and diagnoses of depression (PRadjusted[95%CI] = 2.70[1.92-3.81] and 3.22[1.69-6.14]), anxiety (PRadjusted[95%CI] = 1.96[1.26-3.07] and 3.14[1.47-6.74]), or both (PRadjusted[95%CI] = 3.11[2.38-4.08] and 4.43[2.71-7.25]). Higher MCI prevalence was related to sleep apnea (PRadjusted[95%CI] = 1.30[1.06-1.60]); higher dementia prevalence was associated with age (5-year interval, PRadjusted[95%CI] = 1.42[1.26-1.60]) and race (non-White vs. White, PRadjusted[95%CI] = 1.64[1.07-2.53]). CONCLUSIONS Self-reported MCI and dementia prevalences were higher in former NFL players than national estimates and were associated with numerous personal factors, including mood-related disorders and a high number of self-reported concussions. Predictors of higher MCI and dementia prevalence may be modifiable and warrant consideration by clinicians and researchers as potential targets to mitigate the onset of these conditions.
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Affiliation(s)
- Samuel R Walton
- Department of Exercise and Sport Science and Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC Department of Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, WI Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN Division of Emergency Medicine, Boston Children's Hospital, Boston, MA Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA Department of Psychology, University of Missouri - Kansas City, Kansas City, MO University Orthopedics Center Concussion Care Clinic, State College, PA Sports Medicine Division, Boston Children's Hospital, Boston, MA The Micheli Center for Sports Injury Prevention, Boston, MA Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
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Thompson XD, Erdman NK, Walton SR, Broshek DK, Resch JE. Reevaluating clinical assessment outcomes after unrestricted return to play following sport-related concussion. Brain Inj 2021; 35:1577-1584. [PMID: 34543089 DOI: 10.1080/02699052.2021.1975818] [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: 10/20/2022]
Abstract
PRIMARY OBJECTIVE The objective of this study was to examine neurocognition, postural control, and symptomology at multiple timepoints following concussion. We hypothesized that collegiate athletes would perform similar to or better than their baseline in terms of each outcome at both timepoints. RESEARCH DESIGN This was a retrospective study of 71 collegiate athletes (18.3 ± 0.89 years old; 182.2 ± 10.05 cm; 84.2 ± 20.07 kg) to observe changes in outcomes from a previously established clinical protocol. METHODS AND PROCEDURES Participants were administered ImPACT™, the Sensory Organization Test (SOT), and the revised head injury scale (HIS-r) prior to their seasons (baseline); upon reporting symptom-free following concussion (post-injury); and approximately 8-months after return-to-play to establish a new baseline. MAIN OUTCOMES AND RESULTS There were no changes in ImPACT scores or HIS-r reporting over time. ImPACT total symptom score (TSS) decreased over time (p = .002, ηp2 = 0.08). Significant main effects occurred for the SOT equilibrium score (p < .01, ηp2 = 0.34) and Vestibular sensory ratio (p < .001, ηp2 = 0.22). CONCLUSIONS Our data suggest no decline in neurocognition, balance, or symptom burden approximately eight months post-injury. As clinicians continue to explore "best practices" for concussion management and potential long-term implications of these injuries it is important to monitor outcome measures longitudinally.
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Affiliation(s)
- Xavier D Thompson
- UVA Department of Kinesiology, The University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas K Erdman
- Postdoctoral Research Fellow, George Mason University Sports Medicine, Research and Testing Lab, Fairfax, Virginia, USA
| | - Samuel R Walton
- Postdoctoral Research Associate, UNC Center for the Study of Retired Athletes & Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Chapel Hill, North Carolina, USA
| | - Donna K Broshek
- UVA Department of Psychiatry and Neurobehavioral Sciences, UVA Health, Charlottesville, Virginia, USA
| | - Jacob E Resch
- UVA Department of Kinesiology, The University of Virginia, Charlottesville, Virginia, USA
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Powell JR, Barczak-Scarboro N, Walton SR, Giovanello K, Barnett R, Piazza M, Bailar-Heath MB, Burke R, DeLellis S, Kane S, Lynch J, Means G, Depenbrock P, Mihalik J. Associations Among Subcortical Volumes With Mental Health In Special Operations Forces Combat Service Members. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000763096.63297.85] [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: 11/21/2022]
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Walton SR, Brett BL, Kerr ZY, DeFreese JD, Chandran A, Mannix R, Echemendia RJ, Meehan WP, McCrea MA, Guskiewicz KM. Changes In Health Over 18-years And In Relation To Concussion History In Former NFL Players. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000763164.55790.12] [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: 11/21/2022]
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Barczak-Scarboro NE, Powell JR, Walton SR, Giovanello KS, Barnett R, Piazza M, Bailar-Heath M, Burke R, DeLellis SM, Kane SF, Lynch JH, Means GE, Depenbrock PJ, Mihalik JP. Cortical Volumes Did Not Associate With Mental Health Symptoms In Special Operations Forces Service Members. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000762700.44767.1a] [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: 11/21/2022]
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Kerr ZY, Walton SR, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia R, Meehan WP, McCrea MW, Guskiewicz KM. Depression And Concussion History Among Former NFL Players Aged Over 50 Years: An NFL-LONG Study. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000761368.63267.bf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Walton SR, Broshek DK, Kranz S, Malin SK, Hertel J, Resch JE. Mood, Psychological, and Behavioral Factors of Health-Related Quality of Life Throughout Recovery From Sport Concussion. J Head Trauma Rehabil 2021; 36:128-136. [PMID: 32769824 DOI: 10.1097/htr.0000000000000604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To measure alterations in mood, psychological, and behavioral factors in collegiate athletes throughout recovery from sport concussion (SC) compared with matched controls. SETTING University research laboratory. PARTICIPANTS Twenty (55% female) division I collegiate athletes with SC (19.3 ± 1.08 years old, 1.77 ± 0.11 m, 79.6 ± 23.37 kg) and 20 (55% female) uninjured matched controls (20.8 ± 2.17 years old, 1.77 ± 0.10 m, 81.9 ± 23.45 kg). DESIGN Longitudinal case control. MAIN MEASURES Self-reported concussion-related symptoms, anxiety, resilience, stigma, sleep disturbance, fatigue, and appetite were assessed at 3 time points in the SC group: T1 (≤72 hours of SC), T2 (7 days after T1), and TF (after symptom resolution). Control participants were evaluated at similar intervals. Group and group-by-sex differences were assessed using repeated-measures analyses of variance. Post hoc analyses were performed with Tukey's honestly significant difference (HSD) and paired-sample t tests. RESULTS The SC group had greater sleep disturbance than controls at T1 (P = .001; d = 1.21) and endorsed greater stigma at all time points (P ≤ .03; d ≥ 0.80). Stigma (F(2) = 3.68; P = 0.03; η2p = 0.12), sleep disturbance (F(2) = 5.27; P = .008; η2p = 0.15), and fatigue (F(2) = 3.46; P = .04; η2p = 0.11) improved throughout recovery in those with SC only. No differences were observed between males and females (P > .05). CONCLUSION Sleep disturbance and stigma were negatively affected by SC, highlighting potential areas for clinical interventions to maximize recovery in males and females.
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Affiliation(s)
- Samuel R Walton
- Exercise and Sport Science Work, University of North Carolina at Chapel Hill
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Brett BL, Walton SR, Kerr ZY, Nelson LD, Chandran A, Defreese JD, Echemendia RJ, Guskiewicz KM, Meehan Iii WP, McCrea MA. Distinct latent profiles based on neurobehavioural, physical and psychosocial functioning of former National Football League (NFL) players: an NFL-LONG Study. J Neurol Neurosurg Psychiatry 2021; 92:282-290. [PMID: 33483350 DOI: 10.1136/jnnp-2020-324244] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 06/14/2020] [Revised: 07/30/2020] [Accepted: 09/22/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify subgroups of former National Football League (NFL) players using latent profile analysis (LPA) and examine their associations with total years of participation (TYP) and self-reported lifetime sport-related concussion history (SR-CHx). METHODS Former NFL players (N=686) aged 50-70 years, with an average 18.0 TYP (±4.5) completed a questionnaire. SR-CHx distributions included: low (0-3; n=221); intermediate (4-8; n=209) and high (9+; n=256). LPA measures included: Quality of Life in Neurological Disorders Emotional-Behavioral Dyscontrol, Patient Reported Outcomes Measurement Information System Cognitive Function, Emotional Support, Self-Efficacy, Meaning and Purpose, Physical Function, Pain Interference, Participation in Social Roles and Activities, Anxiety, Depression, Fatigue, and Sleep Disturbance. Demographic, medical/psychiatric history, current psychosocial stressors, TYP and SR-CHx were compared across latent profiles (LPs). RESULTS A five profile solution emerged: (LP1) global higher functioning (GHF; 26.5%); (LP2) average functioning (10.2%); (LP3) mild somatic (pain and physical functioning) concerns (22.0%); (LP4) somatic and cognitive difficulties with mild anxiety (SCA; 27.5%); LP5) global impaired functioning (GIF; 13.8%). The GIF and SCA groups reported the largest number ofe- medical/psychiatric conditions and higher psychosocial stressor levels. SR-CHx was associated with profile group (χ2(8)=100.38, p<0.001); with a higher proportion of GIF (72.6%) and SCA (43.1%) groups reporting being in the high SR-CHx category, compared with GHF (23.1%), average (31.4%) and somatic (27.8%) groups. TYP was not significantly associated with group (p=0.06), with greater TYP reported by the GHF group. CONCLUSIONS Five distinct profiles of self-reported functioning were identified among former NFL players. Several comorbid factors (ie, medical/psychiatric diagnoses and psychosocial stressors) and SR-CHx were associated with greater neurobehavioural and psychosocial dysfunction.
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Affiliation(s)
- Benjamin L Brett
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA .,Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samuel R Walton
- Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zachery Y Kerr
- Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lindsay D Nelson
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Avinash Chandran
- NCAA Injury Surveillance Program, Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - J D Defreese
- Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, State College, Pennsylvania, USA
| | - Kevin M Guskiewicz
- Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Michael A McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Walton SR, Kerr ZY, Brett BL, Chandran A, DeFreese JD, Smith-Ryan AE, Stoner L, Echemendia RJ, McCrea M, Meehan Iii WP, Guskiewicz KM. Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional-behavioural dyscontrol in former NFL players: an NFL-LONG Study. Br J Sports Med 2021; 55:683-690. [PMID: 33397673 DOI: 10.1136/bjsports-2020-103400] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the relationships among self-reported sport-related concussion (SRC) history and current health-promoting behaviours (exercise frequency, diet quality and sleep duration) with self-reported measures of brain health (cognitive function, symptoms of depression and anxiety and emotional-behavioural dyscontrol) in former NFL players. METHODS In this cross-sectional study, a questionnaire was sent to former NFL players. Respondents reported SRC history (categorical: 0; 1-2; 3-5; 6-9; 10+ concussions), number of moderate-to-vigorous aerobic and resistance exercise sessions per week, diet quality (Rapid Eating Assessment for Participants-Shortened) and average nightly sleep duration. Outcomes were Patient-Reported Outcomes Measurement Information System Cognitive Function, Depression, and Anxiety, and Neuro-QoL Emotional-Behavioral Dyscontrol domain T-scores. Multivariable linear regression models were fit for each outcome with SRC history, exercise frequency, diet quality and sleep duration as explanatory variables alongside select covariates. RESULTS Multivariable regression models (n=1784) explained approximately 33%-38% of the variance in each outcome. For all outcomes, SRC history (0.144≤|β|≤0.217) was associated with poorer functioning, while exercise frequency (0.064≤|β|≤0.088) and diet quality (0.057≤|β|≤0.086) were associated with better functioning. Sleeping under 6 hours per night (0.061≤|β|≤0.093) was associated with worse depressive symptoms, anxiety and emotional-behavioural dyscontrol. CONCLUSION Several variables appear to be associated with mood and perceived cognitive function in former NFL players. SRC history is non-modifiable in former athletes; however, the effects of increasing postplaying career exercise frequency, making dietary improvements, and obtaining adequate sleep represent important potential opportunities for preventative and therapeutic interventions.
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Affiliation(s)
- Samuel R Walton
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Y Kerr
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Benjamin L Brett
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Avinash Chandran
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- NCAA Injury Surveillance Program, Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - J D DeFreese
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abbie E Smith-Ryan
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lee Stoner
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Neuropsychology, University Orthopedics Center Concussion Clinic, State College, PA, USA
| | - Michael McCrea
- Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan Iii
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin M Guskiewicz
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Reynier KA, Alshareef A, Sanchez EJ, Shedd DF, Walton SR, Erdman NK, Newman BT, Giudice JS, Higgins MJ, Funk JR, Broshek DK, Druzgal TJ, Resch JE, Panzer MB. The Effect of Muscle Activation on Head Kinematics During Non-injurious Head Impacts in Human Subjects. Ann Biomed Eng 2020; 48:2751-2762. [PMID: 32929556 DOI: 10.1007/s10439-020-02609-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022]
Abstract
In this study, twenty volunteers were subjected to three, non-injurious lateral head impacts delivered by a 3.7 kg padded impactor at 2 m/s at varying levels of muscle activation (passive, co-contraction, and unilateral contraction). Electromyography was used to quantify muscle activation conditions, and resulting head kinematics were recorded using a custom-fit instrumented mouthpiece. A multi-modal battery of diagnostic tests (evaluated using neurocognitive, balance, symptomatic, and neuroimaging based assessments) was performed on each subject pre- and post-impact. The passive muscle condition resulted in the largest resultant head linear acceleration (12.1 ± 1.8 g) and angular velocity (7.3 ± 0.5 rad/s). Compared to the passive activation, increasing muscle activation decreased both peak resultant linear acceleration and angular velocity in the co-contracted (12.1 ± 1.5 g, 6.8 ± 0.7 rad/s) case and significantly decreased in the unilateral contraction (10.7 ± 1.7 g, 6.5 ± 0.7 rad/s) case. The duration of angular velocity was decreased with an increase in neck muscle activation. No diagnostic metric showed a statistically or clinically significant alteration between baseline and post-impact assessments, confirming these impacts were non-injurious. This study demonstrated that isometric neck muscle activation prior to impact can reduce resulting head kinematics. This study also provides the data necessary to validate computational models of head impact.
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Affiliation(s)
- Kristen A Reynier
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Ahmed Alshareef
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | | | - Daniel F Shedd
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Samuel R Walton
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Nicholas K Erdman
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Benjamin T Newman
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
| | - J Sebastian Giudice
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Michael J Higgins
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | | | - Donna K Broshek
- Neurocognitive Assessment Lab, University of Virginia, Charlottesville, VA, USA
| | - Thomas J Druzgal
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Matthew B Panzer
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA.
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Walton SR, Broshek DK, Freeman JR, Hertel J, Meyer JP, Erdman NK, Resch JE. Institutionally Based ImPACT Test® Normative Values May Differ from Manufacturer-Provided Normative Values. Arch Clin Neuropsychol 2020; 35:275-282. [PMID: 31711107 DOI: 10.1093/arclin/acz068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/30/2019] [Accepted: 10/15/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The necessity for pre-injury baseline computerized neurocognitive assessments versus comparing post-concussion outcomes to manufacturer-provided normative data is unclear. Manufacturer-provided norms may not be equivalent to institution-specific norms, which poses risks for misclassifying the presence of impairment when comparing individual post-concussion performance to manufacturer-provided norms. The objective of this cohort study was to compare institutionally derived normative data to manufacturer-provided normative values provided by ImPACT® Applications, Incorporated. METHOD National Collegiate Athletic Association Division 1 university student athletes (n = 952; aged 19.2 ± 1.4 years, 42.5% female) from one university participated in this study by completing pre-injury baseline Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) assessments. Participants were separated into 4 groups based on ImPACT's age and gender norms: males <18 years old (n = 186), females <18 years old (n = 165), males >19 years old (n = 361) or females >19 years old (n = 240). Comparisons were made between manufacturer-provided norms and institutionally derived normative data for each of ImPACT's clinical composite scores: Verbal (VEM) and Visual (VIM) Memory, Visual Motor Speed (VMS), and Reaction Time (RT). Outcome scores were compared for all groups using a Chi-squared goodness of fit analysis. RESULTS Institutionally derived normative data indicated above average performance for VEM, VIM, and VMS, and slightly below average performance for RT compared to the manufacturer-provided data (χ2 ≥ 20.867; p < 0.001). CONCLUSIONS Differences between manufacturer- and institution-based normative value distributions were observed. This has implications for an increased risk of misclassifying impairment following a concussion in lieu of comparison to baseline assessment and therefore supports the need to utilize baseline testing when feasible, or otherwise compare to institutionally derived norms rather than manufacturer-provided norms.
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Affiliation(s)
- Samuel R Walton
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Jason R Freeman
- Department of Athletics, Sports Psychology, University of Virginia, Charlottesville, VA 22903, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
| | - J Patrick Meyer
- Department of Leadership, Foundations and Policy, University of Virginia, Charlottesville, VA 22903, USA.,Northwest Evaluation Association, Portland, OR 97209, USA
| | - Nicholas K Erdman
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
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Walton SR, Brett BL, Chandran A, DeFreese JD, Giovanello KS, Nader A, Kerr ZY, McCrea M, Guskiewicz KM. Associations Of Concussion And Playing History With Clinical Outcomes In Young College Football Alumni. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000685936.03760.a0] [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: 11/21/2022]
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Walton SR, Malin SK, Kranz S, Broshek DK, Hertel J, Resch JE. Whole-Body Metabolism, Carbohydrate Utilization, and Caloric Energy Balance After Sport Concussion: A Pilot Study. Sports Health 2020; 12:382-389. [PMID: 32520660 DOI: 10.1177/1941738120923869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/17/2022] Open
Abstract
BACKGROUND Sport concussion (SC) causes an energy crisis in the brain by increasing energy demand, decreasing energy supply, and altering metabolic resources. Whole-body resting metabolic rate (RMR) is elevated after more severe brain injuries, but RMR changes are unknown after SC. The purpose of this study was to longitudinally examine energy-related changes in collegiate athletes after SC. HYPOTHESIS RMR and energy consumption will increase acutely after SC and will return to control levels with recovery. STUDY DESIGN Case-control study. LEVEL OF EVIDENCE Level 4. METHODS A total of 20 collegiate athletes with SC (mean age, 19.3 ± 1.08 years; mean height, 1.77 ± 0.11 m; mean weight, 79.6 ± 23.37 kg; 55% female) were compared with 20 matched controls (mean age, 20.8 ± 2.17 years; mean height, 1.77 ± 0.10 m; mean weight, 81.9 ± 23.45 kg; 55% female). RMR, percentage carbohydrate use (%CHO), and energy balance (EBal; ratio between caloric consumption and expenditure) were assessed 3 times: T1, ≤72 hours after SC; T2, 7 days after T1; and TF, after symptom resolution. A 2 × 2 × 3 (group × sex × time) multivariate analysis of variance assessed RMR, %CHO, and EBal. Changes in RMR, %CHO, and EBal (T1 to TF) were correlated with days to symptom-free and days to return to play in the concussed group. RESULTS Women reported being symptom-free (median, 6 days; range, 3-10 days) sooner than men (median, 11 days; range, 7-16 days). RMR and %CHO did not differ across time between groups or for group × sex interaction. SC participants had higher EBal than controls at T1 (P = 0.016) and T2 (P = 0.010). In men with SC, increasing %CHO over time correlated with days to symptom-free (r = 0.735 and P = 0.038, respectively) and days to return to play (r = 0.829 and P = 0.021, respectively). CONCLUSION Participants with SC were in energy surplus acutely after injury. Although women recovered more quickly than men, men had carbohydrate metabolism changes that correlated with recovery time. CLINICAL RELEVANCE This pilot study shows that male and female student-athletes may have differing physiologic responses to SC and that there may be a role for dietary intervention to improve clinical outcomes after SC.
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Affiliation(s)
- Samuel R Walton
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia.,Center for the Study of Retired Athletes and Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steven K Malin
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Sibylle Kranz
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
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Rosenblum DJ, Walton SR, Erdman NK, Broshek DK, Hart JM, Resch JE. If Not Now, When? An Absence of Neurocognitive and Postural Stability Deficits in Collegiate Athletes with One or More Concussions. J Neurotrauma 2020; 37:1211-1220. [PMID: 31910071 DOI: 10.1089/neu.2019.6813] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A history of concussion has been associated with decreased neurocognitive function and postural control. The purpose of our study was to compare neurocognitive function and postural control in collegiate athletes with and without varying histories of concussion. Collegiate athletes were divided into groups based on 0 (n = 129), 1 (n = 91), 2 (n = 52), and 3+ (n = 34) prior concussions. Participants in each group were carefully matched by sport, sex, height, weight, and age. Athletes were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT™) and the Sensory Organization Test (SOT) as part of a standard of care pre-season assessment. Group ImPACT (Verbal and Visual Memory, Visual Motor Speed, and Reaction Time) and SOT (Equilibrium Score and Somatosensory, Visual, and Vestibular sensory ratios) outcome scores were compared using one-way analyses of variance (ANOVAs). Coefficients of variation (CVs) were also calculated for each outcome score and were compared using two-sample tests with 95% confidence intervals (CIs). Participants with and without a history of concussion were not significantly different for any ImPACT or SOT outcome score (p's > 0.10). Groups (0, 1, 2, and 3+ previous concussions) were not different from each other for any ImPACT or SOT outcome score (p's ≥ 0.11). Likewise, the CVs associated with each ImPACT and SOT outcome score did not vary significantly between outcome scores for any group comparison (p ≥ 0.09). Our findings suggest that a history of one or more concussions does not influence neurocognitive performance or postural stability in collegiate athletes at their pre-season baseline assessment.
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Affiliation(s)
- Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Samuel R Walton
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas K Erdman
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Joeseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Carrington HW, Broshek DK, Erdman NK, Thompson XD, Walton SR, Resch JE. The Influence of Hormonal Contraceptives on Baseline ImPACT Performance. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.54] [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: 11/12/2022] Open
Abstract
Abstract
Purpose
Our study examined the influence of hormonal contraceptives (HC) on pre-injury (baseline) ImPACT performance in female collegiate athletes.
Methods
Participants in our cross-sectional study consisted of 304 NCAA Division I female athletes who self-reported taking (HC+ [n=154]) or not taking (HC- [n=154]) HC. HC+ participants were matched to HC- participants for height, weight, sport, and position. HC+ participants had an average age of 19.0±1.33 years, height of 170.5–8.70 cm, and mass of 64.2–10.58 kg. HC- participants had an average age of 19.0±1.24 years, height of 170.3–9.19 cm, and mass of 64.2–9.75 kg. Participants completed ImPACT as part of their preseason baseline assessment. Only participants with valid ImPACT assessments were included in our analyses. Chi-squared (χ2) tests were performed to compare groups in terms of medical history variables. Independent t-tests were used to compare groups in terms of demographic variables, self-reported hours of sleep, and ImPACT (Verbal and Visual Memory, Visual Motor Speed [VMS], Reaction Time [RT], and Total Symptom Severity [TSS]) outcome scores. Analyses were performed with α=0.05.
Results
No differences were observed between groups for demographic variables, hours of sleep, or medical history variables (p<0.05). For VMS, the HC- group (42.9+5.63) scored significantly worse (t[304]=2.17, p=0.03; d=0.25; 95% CI [0.1, 2.7]) than the HC+ group (44.3+5.67). For RT, the HC- group (0.55+0.06) performed significantly slower (t[304]=-2.02, p=0.05; d=0.23; 95% CI [-0.03, -0.0003]) than the HC+ group (0.54+0.05).
Conclusion
Our results suggest HCs may influence ImPACT performance in female collegiate athletes. Clinicians must consider the role of HCs when interpreting ImPACT outcome scores.
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Walton SR, Malin SK, Kranz S, Broshek DK, Hertel J, Resch JE. Effects of Concussion on Whole-Body Energy Metabolism and Caloric Intake: A Preliminary Investigation. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561640.70657.12] [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: 11/21/2022]
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