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Mathew AS, Caze T, Price AM, Vasquez D, Abt JP, Burkhart SO. Association between days for concussion recovery and initial specialty clinic evaluation within 48 hours. BMC Sports Sci Med Rehabil 2024; 16:75. [PMID: 38566116 PMCID: PMC10986090 DOI: 10.1186/s13102-024-00866-w] [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: 11/15/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Researchers have highlighted the importance of early access to concussion care within one week of injury in reducing recovery times. However, a persisting question for concussion researchers is "just how early is important?" The purpose of this study was to examine differences in recovery time as predicted by the number of days elapsed since injury (DSI) to initial evaluation among patients who had access to a specialty concussion clinic within seven days. We hypothesized that DSI group membership, even within seven days, would significantly predict risk of protracted recovery (i.e., beyond 21 days). METHODS In this archival study, retrospective data were gathered from electronic medical records between September 2020 to March 2022. Records of participants between ages 12-18, those diagnosed with a sports-related concussion based on initial clinic visit diagnosis by a medical provider and those who established care within seven days of injury at a large pediatric specialty concussion clinic were examined. Participants were divided into three DSI groups (patients seen in < 48 h: "acute", patients seen between 49 h < and < 96 h: "sub-acute", and patients seen between 97 < and < 168 h: "post-acute"). A general linear model was constructed to examine relationships between relevant concussion factors (e.g., Post Concussion Scale Score, neurodevelopmental history, psychiatric history, concussion history, migraine history, overall VOMS change score, cognitive testing, sex, age, race, and ethnicity) that were either significant in the preliminary analysis or in clinical judgement and recovery time. Adjusted odds ratios (OR) were derived from a binary logistic regression model, in which recovery time was normal (≤ 21 recovery days) or protracted (> 21 recovery days). RESULTS A total of 856 participants were eligible. Adolescents in the acute group (M = 15.12, SD = 8.04) had shorter recovery times in days compared to those in the sub-acute (M = 17.98, SD = 10.18) and post-acute (M = 21.12, SD = 10.12; F = 26.00, p < .001) groups. Further, participants in the acute (OR = 4.16) and sub-acute (OR = 1.37) groups who accessed specialty concussion clinics within 48 h were 4 times more likely to have a normal recovery and recovered approximately 6 days faster than the post-acute care group. CONCLUSIONS Earlier concussion care access predicted recovery times and was associated with lower risk for protracted recovery.
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Affiliation(s)
- Abel S Mathew
- Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, TX, USA.
- Present Address: Children's Health Andrews Institute for Orthopaedics and Sports Medicine, 7211 Preston Rd., Plano, TX, 75024, USA.
| | - Todd Caze
- Caze Concussion Institute, Omaha, NE, USA
| | - August M Price
- Bellapianta Orthopaedics and Sports Medicine, Montclair, NJ, USA
| | - Desi Vasquez
- Texas A&M International University, Laredo, TX, USA
| | - John P Abt
- Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, TX, USA
| | - Scott O Burkhart
- Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, TX, USA
- University of Texas Southwestern-Psychiatry, Dallas, TX, USA
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Arvin N, Price AM, Seagraves B, Knell G, Burkhart SO. A-03 Physical Therapy Compared to a Home Exercise Program for Protracted Pediatric Sport-Related Concussion Rehabilitation. Arch Clin Neuropsychol 2022. [DOI: 10.1093/arclin/acac32.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose: The purpose of this study was to compare the recovery time in days between protracted recovery (greater than or equal to 28 days since injury) patients who were prescribed physical therapy and those who were prescribed a home exercise program. We hypothesized that physical therapy would be associated with shorter recovery times relative to the home exercise program. Methods: The 159 participants (aged 8–18) were drawn from an ongoing study. This study was a retrospective cohort design of sports-related concussion patients with a protracted recovery who presented to an outpatient specialty concussion clinic between 2018 and 2021, with data collected from electronic medical records. Both prescribed physical therapy (PPT) and home exercise program (HEP) patients were provided vestibular/ocular motor rehabilitation exercises to be completed at home three times per day. PPT participants must have completed at least three PPT sessions, or they were excluded from the study. Multi-variable zero-truncated negative binomial regressions were used to evaluate associations between groups. Results: Among the 48 (30.2%) PPT and 111 (69.8%) HEP participants, the majority were female (57.9%), age was 15.3 ± 1.4 (PPT) and 14.2 ± 2.8 (HEP), and days to clinic was a median 6.0 (IQR = 3.0–27.0; PPT) and 7.0 (IQR = 3.0–23.0; HEP). After adjusting for demographic (age, sex) and clinical measures (concussion history, convergence, VOMS score, and days to clinic), PPT was associated with an additional 1.21 days (95% CI: 1.06, 1.39) than HEP. Conclusions: We unexpectedly found that PPT was not associated with a shorter recovery time relative to HEP. Future research should explore this hypothesis while aiming to evaluate the effect of PPT versus HEP using a randomized design.
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Boucher SJ, Jones CA, Price AM, Ellis C, Abt J, Burkhart SO. A-05 Retrospective Comparison of Concussion Recovery Between School and All Star Cheerleaders. Arch Clin Neuropsychol 2022. [DOI: 10.1093/arclin/acac32.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose: Though often categorized together, All Star and school cheerleading are vastly different in concussion risk due to competitiveness and skill difficulty. The purpose of the current study was to compare concussion rate and recovery in school and All Star cheerleaders diagnosed with sports-related concussions (SRC). Methods: This study was a retrospective comparison of cheerleaders (aged 8–18 years) who were evaluated in a specialty concussion clinic and diagnosed with SRC from 2020–2022. A total of 64 female cheerleaders were included (33 school and 31 All Star). We compared days to clinic, prior history of concussion, Post-Concussion Symptom Scale (PCSS) total score, symptom provocation on the Vestibular Ocular Motor Screen, and recovery time in days for each group. Results: Reports of at least one prior concussion were higher in All Star cheerleaders (61%) compared to school cheerleaders (39%). Initial evaluation occurred an average of 4.0 ± 5.8 days post injury for All Star cheerleaders, with recovery occurring in 23.6 ± 17.4 days compared to school cheerleaders who were evaluated for initial evaluation an average of 4.2 ± 4.3 days post injury and recovered in 27.6 ± 19.7 days (P > 0.05). All Star cheerleaders experienced greater symptom provocation (P = 0.05) on horizontal vestibular-ocular reflex compared to school cheerleaders. There was no difference in symptom reporting on the PCSS (P = 0.23). Conclusions: Higher rates of prior concussion were reported in All Star cheerleaders. This may be a function of the more difficult skills being performed. Future research should investigate the impact of skill level and mechanism of injury on SRCs in All Star Cheerleading.
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Price AM, Jones CA, Boucher SJ, Ellis CS, Burkhart SO. A-36 Tracking Compliance To A Home Exercise Program For Concussion Using Ecological Momentary Assessment: A Pilot Study. Arch Clin Neuropsychol 2022. [DOI: 10.1093/arclin/acac32.36] [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: 11/13/2022] Open
Abstract
Abstract
Purpose: The management of pediatric concussions creates a clinical challenge due to unknown patient compliance with prescribed therapies and interventions. The purpose of this pilot study was to describe the logistical use of ecological momentary assessment (EMA) to track compliance to a physical therapy facilitated vestibular/ocular motor home exercise program (HEP) in patients diagnosed with concussion. Methods: A convenience sample of 20 concussed patients (aged 13–18 years [mdn = 14.5, IQR = 14.0–16.8]) was included in this initial pilot study. All participants were evaluated within seven days of injury. Participants were instructed to complete one daily HEP compliance log until medical clearance on their parent or guardians’ mobile device using an EMA application. Results: Participants were evaluated a median 3.5 (IQR = 1.3–6.5) days post injury, recovered in a median 15.5 (IQR = 11.0–25.0) days, and completed a mean 5.85 (SD = 3.9) total EMA logs representing a 47% completion rate. Participants reported completing a mean 1.21 (SD = 0.77) HEPs per day with a range of 0.0 to 3.0. Self-reported HEP compliance did not significantly correlate with recovery time in days (P = 0.26). Conclusions: The overall response rate for EMA logs was 47% and participants reported completing 1.2 HEPs per day. Analysis of this preliminary data did not reveal a correlation between HEP compliance and recovery time in days. Participants reported the primary barrier to completing daily questionnaires was access to their parent or guardians’ mobile device at the time of the prompt. Overall, the data derived from EMA appears useful for tracking the progression of this heterogenous injury.
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Worts PR, Mason JR, Burkhart SO, Sanchez-Gonzalez MA, Kim JS. The acute, systemic effects of aerobic exercise in recently concussed adolescent student-athletes: preliminary findings. Eur J Appl Physiol 2022; 122:1441-1457. [PMID: 35303160 DOI: 10.1007/s00421-022-04932-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Examine the acute effects (pre-, during, post-intervention) of two different intensities of aerobic exercise or rest on autonomic, oculomotor, and vestibular function and symptom burden in patients with a recent sport-related concussion (SRC) and compare their responses to sex-matched, age-stratified, non-concussed (HEALTHY) student-athletes. METHODS Student-athletes between the ages of 13 and 18 that presented to the sports medicine clinic within Day 3-7 post-SRC and from local schools were recruited for a randomized controlled trial (RCT). The participants were administered the Vestibular/Ocular Motor Screening (VOMS), King-Devick (K-D), and Post-Concussion Symptom Scale (PCSS) before and after the intervention. Heart rate variability (HRV) and mean arterial pressure (MAP) were collected before, during, and after the intervention. The intervention was either a single, 20-min session of treadmill walking at 40% (40HR) or 60% of age-predicted max heart rate (60HR), or seated, rest (NOEX). RESULTS 30 participants completed the intervention with the SRC group treated 4.5 ± 1.3 days post-injury. Pre-exercise HRV and MAP were significantly different (p's < 0.001) during treatment but returned to pre-exercise values within 5 min of recovery in both the SRC and HEALTHY groups. Both the SRC and HEALTHY groups exhibited similar reductions pre- to post-intervention for symptom severity and count (p's < 0.05), three VOMS items (p's < 0.05) but not K-D time. CONCLUSIONS To date, this is the first adolescent RCT to report the acute, systemic effects of aerobic exercise on recently concussed adolescent athletes. The interventions appeared safe in SRC participants, were well-tolerated, and provided brief therapeutic benefit. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT03575455.
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Affiliation(s)
- P R Worts
- Tallahassee Orthopedic Clinic, Tallahassee, FL, USA. .,Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, USA. .,Institute of Sports Sciences and Medicine, Florida State University, Tallahassee, FL, USA.
| | - J R Mason
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - S O Burkhart
- Children's Health Andrews Institute, Plano, TX, USA.,Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | | | - J-S Kim
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, USA.,Institute of Sports Sciences and Medicine, Florida State University, Tallahassee, FL, USA
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Affiliation(s)
- Gregory Knell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Dallas
| | - Scott O Burkhart
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Children's Health System of Texas, Plano
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Chu Y, Knell G, Brayton RP, Burkhart SO, Jiang X, Shams S. Machine learning to predict sports-related concussion recovery using clinical data. Ann Phys Rehabil Med 2022; 65:101626. [PMID: 34986402 DOI: 10.1016/j.rehab.2021.101626] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/13/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Sport-related concussions (SRCs) are a concern for high school athletes. Understanding factors contributing to SRC recovery time may improve clinical management. However, the complexity of the many clinical measures of concussion data precludes many traditional methods. This study aimed to answer the question, what is the utility of modeling clinical concussion data using machine-learning algorithms for predicting SRC recovery time and protracted recovery? METHODS This was a retrospective case series of participants aged 8 to 18 years with a diagnosis of SRC. A 6-part measure was administered to assess pre-injury risk factors, initial injury severity, and post-concussion symptoms, including the Vestibular Ocular Motor Screening (VOMS) measure, King-Devick Test and C3 Logix Trails Test data. These measures were used to predict recovery time (days from injury to full medical clearance) and binary protracted recovery (recovery time > 21 days) according to several sex-stratified machine-learning models. The ability of the models to discriminate protracted recovery was compared to a human-driven model according to the area under the receiver operating characteristic curve (AUC). RESULTS For 293 males (mean age 14.0 years) and 362 females (mean age 13.7 years), the median (interquartile range) time to recover from an SRC was 26 (18-39) and 21 (14-31) days, respectively. Among 9 machine-learning models trained, the gradient boosting on decision-tree algorithms achieved the best performance to predict recovery time and protracted recovery in males and females. The models' performance improved when VOMS data were used in conjunction with the King-Devick Test and C3 Logix Trails Test data. For males and females, the AUC was 0.84 and 0.78 versus 0.74 and 0.73, respectively, for statistical models for predicting protracted recovery. CONCLUSIONS Machine-learning models were able to manage the complexity of the vestibular-ocular motor system data. These results demonstrate the clinical utility of machine-learning models to inform prognostic evaluation for SRC recovery time and protracted recovery.
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Affiliation(s)
- Yan Chu
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Gregory Knell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA; Children's Health and The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA; Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, TX, USA
| | - Riley P Brayton
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA; Children's Health and The University of Texas Health Science Center at Houston (UTHealth), Dallas, TX, USA; Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, TX, USA
| | - Scott O Burkhart
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, TX, USA
| | - Xiaoqian Jiang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Shayan Shams
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Department of Applied Data Science, San Jose State University, San Jose, CA, USA.
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Knell G, Caze T, Burkhart SO. Evaluation of the vestibular and ocular motor screening (VOMS) as a prognostic tool for protracted recovery following paediatric sports-related concussion. BMJ Open Sport Exerc Med 2021; 7:e000970. [PMID: 33868706 PMCID: PMC7996664 DOI: 10.1136/bmjsem-2020-000970] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To understand the relationship between initial vestibular and ocular motor screening (VOMS) and recovery time, and the utility of VOMS to screen for protracted recovery in youth/adolescent patients with sport-related concussion (SRC). Methods Participants (8–18 years) who were diagnosed with an SRC within 7 days of the injury were administered the VOMS test by certified medical personnel. Recovery time (days) and protracted recovery (>30 days) were the primary outcomes. Multivariable regression models were used to evaluate the association between VOMS symptom provocation and (1) recovery time (days) and (2) protracted recovery. Measures of VOMS validity, predictive ability and receiver operator curves were used to assess VOMS as a prognostic tool to accurately classify a normal/protracted recovery. Results After adjustment, any symptom provocation across all VOMS domains was associated (p<0.05) with greater recovery time, except the convergence test (p=0.08) in females. All VOMS test thresholds (≥1 to ≥10) in males and (≥1 to ≥5) in females were associated (p<0.05) with recovery time. However, the VOMS test performed poorly among males (receiver operating characteristic (ROC) area=0.66) and failed among females (ROC area=0.56) as a prognostic tool to identify those that will have a normal/protracted recovery. Conclusion In this sample, overall, the VOMS test was associated with recovery time (days); however, the VOMS was not a valid stand-alone prognostic tool to identify a delayed recovery, but may be useful in combination with other concussion symptomology assessments. Future studies should confirm these findings in larger samples while taking into consideration other comorbid factors that may influence recovery time.
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Affiliation(s)
- Gregory Knell
- Center for Pedatric Population Health, Children's Health System of Texas and University of Texas Health Science Center at Houston, Dallas, TX, USA.,Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Dallas, TX, USA.,Andrews Institute for Orthopaedics and Sports Medicine, Children's Health System of Texas, Plano, TX, USA
| | - Todd Caze
- Andrews Institute for Orthopaedics and Sports Medicine, Children's Health System of Texas, Plano, TX, USA.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Scott O Burkhart
- Andrews Institute for Orthopaedics and Sports Medicine, Children's Health System of Texas, Plano, TX, USA
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Millsaps B, Worts PR, Berg DC, Burkhart SO. Microhemorrhages in Professional Motocross Athletes: A Case Series. HCA Healthc J Med 2020; 1:269-277. [PMID: 37426606 PMCID: PMC10324744 DOI: 10.36518/2689-0216.1011] [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] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Introduction Motocross is a sport in which riders race 250-450 cc four-stroke dirt bikes and are potentially subjected to a high frequency of head injuries starting at a very young age. The objective of this case series is to present the findings following gradient echo T2-weighted MRI (SWI) upon clinical evaluation after a concussion in 4 young professional motocross racers. Clinical Findings Microhemorrhages were found in 2 of 4 riders. Areas of microhemorrhages were not aligned with a previously positive CT finding from a prior concussion in 1 rider. Conclusions Microhemorrhages were found in 2 young motocross riders following a gradient echo T2-weighted MRI upon a clinical evaluation after a concussion. Long-term consequences of these findings are not yet known, and longitudinal studies are needed to provide further understanding to improve concussion management in motocross athletes.
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Affiliation(s)
- Brianna Millsaps
- UCF College of Medicine/HCA Healthcare GME Consortium Family Medicine Residency Program, Gainesville, FL
| | - Philip R. Worts
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL
- Tallahassee Orthopedic Clinic, Tallahassee, FL
| | | | - Scott O. Burkhart
- Department of Orthopedics and Sports Medicine, Children’s Health Andrews Institute, Dallas, TX
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Caze Ii T, Knell GP, Abt J, Burkhart SO. Management and Treatment of Concussions via Tele-Concussion in a Pediatric Setting: Methodological Approach and Descriptive Analysis. JMIR Pediatr Parent 2020; 3:e19924. [PMID: 32634106 PMCID: PMC7434418 DOI: 10.2196/19924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Approximately 2 million children in the United States sustain a concussion annually, resulting in an economic impact as high as US $20 billion. Patients who receive treatment at concussion specialty clinics, versus primary care, experience faster recovery, thereby reducing patient burden and subsequent medical-related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits. This is particularly relevant in light of the severe acute respiratory syndrome coronavirus 2 pandemic and subsequent guidance to eliminate all non-medically necessary in-clinic visits. Telehealth has been used to effectively deliver in-clinic care across several disciplines including psychiatry, psychology, and neuropsychology. However, a model of telehealth delivered concussion assessment, treatment, and management has not been established. OBJECTIVE The purposes of this paper are to describe a pediatric concussion specialty clinic's experiences in delivering telehealth concussion services and to provide preliminary descriptive data on a sample of pediatric telehealth patients with concussions. METHODS The specialty pediatric concussion clinic described here began providing telehealth services in 2019 and is part of the largest and fastest-growing telehealth hospital network in the United States. The clinical care process will be described, including accessing the telehealth platform, assessment during the initial appointment, injury management including communication with relevant patient stakeholders (eg, parent or guardians, athletic trainers), dissemination of rehabilitation exercises, and nature of follow-up visits. Descriptive data will include patient demographics, the radius of care, the time between the date of injury and initial visit, the average number of follow-up visits, and days until medically cleared for return-to-learn and return-to-play. RESULTS The analytic sample included 18 patients with concussions who were seen for all of their visits via telehealth between August 2019 and April 2020. The mean age of the sample was 14.5 (SD 2.5) years. The radius of care was a median of 17 (IQR 11.0-31.0) miles from the clinic with a median time between injury and the first visit of 21 (IQR 6.0-41.5) days. The mean number of visits was 2.2 (SD 0.8) with a median days between visits of 5.4 (IQR 3.0-9.3) to manage and treat the concussion. Of the 18 patients, 55.6% (n=10) were medically cleared for return-to-learn or -play in a median of 15.5 (IQR 11.0-29.0) days. CONCLUSIONS Limited access to health care is a well-understood barrier for receiving quality care. Subsequently, there are increasing demands for flexibility in delivering concussion services remotely and in-clinic. This is the first paper to provide a clinically relevant framework for the assessment, management, and treatment of acute concussion via telehealth in a pediatric population.
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Affiliation(s)
- Todd Caze Ii
- Children's Health Andrew's Insitute, Plano, TX, United States.,University of Texas-Southwestern Medical Center, Dallas, TX, United States
| | - Gregory P Knell
- Children's Health Andrew's Insitute, Plano, TX, United States.,Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - John Abt
- Children's Health Andrew's Insitute, Plano, TX, United States
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Knell G, Burkhart SO, Caze TJ, Polousky JD, Kohl HW, Messiah SE. Association Between Concussion History and Factors Relating to Cognitive, Behavioral, and Emotional Health Among American High School Athletes: A Cross-sectional Analysis. Am J Sports Med 2020; 48:2534-2543. [PMID: 32692937 DOI: 10.1177/0363546520938776] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The cognitive, behavioral, and emotional deficits that may be associated with sports-related concussions among adolescents are unclear. PURPOSE To examine the association between reported concussion history and factors relating to cognitive, behavioral, and emotional health among a population-based sample of US high school-aged adolescents. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Participants included a representative sample of US high school student-athletes who reported a concussion history (in the past 12 months) and relevant behaviors/outcomes within 3 domains: cognitive (academics, difficulty concentrating), behavioral (drinking and driving, carrying a weapon, physically fighting, tobacco use, marijuana use, binge drinking), and emotional (symptoms of depression, suicidal thoughts/actions). The adjusted relative odds of experiencing 0 and at least 1, 2, 3, or ≥4 concussions were modeled while mutually adjusting for the behaviors of interest in addition to age, race/ethnicity, and sleep problems. Data were reported in sex stratum. RESULTS A total of 13,268 participants were included in the unweighted data set. Overall, 14.5% (95% CI, 12.9%-16.2%) of female and 18.1% (95% CI, 16.4%-19.8%) of male student-athletes had at least 1 concussion in the past 12 months. As compared with those who reported not engaging in any of the behaviors deleterious to health or having had any of the negative health outcomes (composite score of 0), female athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 1.94 (95% CI, 1.55-2.43), 3.13 (95% CI, 2.30-4.33), and 6.05 (95% CI, 3.75-9.75) times more likely to have a recent history of concussions after accounting for relevant factors. As compared with those having a composite score of 0, male athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 2.03 (95% CI, 1.58-2.59), 3.80 (95% CI, 2.71-5.34), and 8.23 (95% CI, 4.91-13.77) times more likely to have a recent history of concussions after accounting for relevant factors. CONCLUSION Self-reported concussions among US high school athletes is related to several deleterious health behaviors and outcomes. These associations should be confirmed in longitudinal analyses.
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Affiliation(s)
- Gregory Knell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Scott O Burkhart
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Todd J Caze
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Peter O'Donnell Jr Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John D Polousky
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Harold W Kohl
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, Austin, Texas, USA.,Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Sarah E Messiah
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Center for Pediatric Population Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
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Worts PR, Mason JR, Kontos AP, Schatz P, Burkhart SO. Oculomotor Fatigue Is Present In Some Adolescent Student-athletes Following Sport-related Concussion. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676972.43644.8e] [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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Worts PR, Sanchez-Gonzalez M, Ormsbee MJ, Panton LB, Levenson CW, Burkhart SO, Kim JS. Cardiovascular Autonomic Changes Following a Bout of Low-intensity Exercise in Recently Concussed and Healthy Athletes. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562712.20936.37] [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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Worts PR, Burkhart SO, Kim JS. A Physiologically Based Approach to Prescribing Exercise Following a Sport-Related Concussion. Sports Med 2019; 49:683-706. [DOI: 10.1007/s40279-019-01065-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Worts PR, Schatz P, Burkhart SO. Test Performance and Test-Retest Reliability of the Vestibular/Ocular Motor Screening and King-Devick Test in Adolescent Athletes During a Competitive Sport Season: Response. Am J Sports Med 2019; 47:NP13-NP14. [PMID: 30781980 DOI: 10.1177/0363546518817763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Worts PR, Burkhart SO. Test Performance and Test-Retest Reliability of the Vestibular/Ocular Motor Screening and King-Devick Test in Adolescent Athletes During a Competitive Sport Season: Response. Am J Sports Med 2019; 47:NP16-NP18. [PMID: 30781979 DOI: 10.1177/0363546518819445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Worts PR, Schatz P, Burkhart SO. Test Performance and Test-Retest Reliability of the Vestibular/Ocular Motor Screening and King-Devick Test in Adolescent Athletes During a Competitive Sport Season. Am J Sports Med 2018; 46:2004-2010. [PMID: 29741916 DOI: 10.1177/0363546518768750] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Vestibular/Ocular Motor Screening (VOMS) and King-Devick (K-D) test are tools designed to assess ocular or vestibular function after a sport-related concussion. PURPOSE To determine the test-retest reliability and rate of false-positive results of the VOMS and K-D test in a healthy athlete sample. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Forty-five healthy high school student-athletes (mean age, 16.11 ± 1.43 years) completed self-reported demographics and medical history and were administered the VOMS and K-D test during rest on day 1 (baseline). The VOMS and K-D test were administered again once during rest (prepractice) and once within 5 minutes of removal from sport practice on day 2 (removal). The Borg rating of perceived exertion scale was administered at removal. Intraclass correlation coefficients were used to determine test-retest reliability on the K-D test and the average near point of convergence (NPC) distance on the VOMS. Level of agreement was used to examine VOMS symptom provocation over the 3 administration times. Multivariate base rates were used to determine the rate of false-positive results when simultaneously considering multiple clinical cutoffs. RESULTS Test-retest reliability of total time on the K-D test (0.91 [95% CI, 0.86-0.95]) and NPC distance (0.91 [95% CI, 0.85-0.95]) was high across the 3 administration times. Level of agreement ranged from 48.9% to 88.9% across all 3 times for the VOMS items. Using established clinical cutoffs, false-positive results occurred in 2% of the sample using the VOMS at removal and 36% using the K-D test. CONCLUSION The VOMS displayed a false-positive rate of 2% in this high school student-athlete cohort. The K-D test's false-positive rate was 36% while maintaining a high level of test-retest reliability (0.91). Results from this study support future investigation of VOMS administration in an acutely injured high school athletic sample. Going forward, the VOMS may be more stable than other neurological and symptom report screening measures and less vulnerable to false-positive results than the K-D test.
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Affiliation(s)
- Phillip R Worts
- Department of Nutrition, Food and Exercise Sciences, College of Human Sciences, Florida State University, Tallahassee, Florida, USA.,Tallahassee Orthopedic Clinic, Tallahassee, Florida, USA
| | - Philip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania, USA
| | - Scott O Burkhart
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA
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Worts PR, Burkhart SO, Daniel Petty S, Panton LB, Ormsbee MJ, Levenson CW, Kim JS. Safety Of Sub-maximal Aerobic Exercise During The Sub-acute Phase Of Recovery Following Sport-related Concussion. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538768.40012.0c] [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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Worts PR, Schatz P, Boutzoukas EM, Burkhart SO. Utility of the Vestibular/Ocular Motor Screening (VOMS) Tool During High School Sport Participation. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518018.39207.12] [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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Worts PR, Boutzoukas EM, Burkhart SO, Ormsbee MJ, Panton LB, Kim JS. Changes in Oculomotor Function with Exercise in High School Student-Athletes. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000487962.33111.f4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Henry LC, Burkhart SO, Elbin RJ, Agarwal V, Kontos AP. Traumatic axonal injury and persistent emotional lability in an adolescent following moderate traumatic brain injury: A case study. J Clin Exp Neuropsychol 2015; 37:439-54. [PMID: 26000663 DOI: 10.1080/13803395.2015.1025708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/10/2023]
Abstract
A 15-year-old male was treated secondary to sustaining a moderate traumatic brain injury (moderate TBI). Symptom self-report, and computerized and paper-and-pencil-based neurocognitive, vestibular/ocular motor, and imaging data were used throughout to document impairment and recovery. The patient demonstrated persistent emotional lability concurrent with vestibular impairment. In addition to clinical evaluation and management, the patient also underwent susceptibility-weighted imaging, which revealed axonal shearing across the corpus callosum and areas innervating the prefrontal cortex. Paper-and-pencil neurocognitive measures revealed persisting deficits, despite normal-appearing computerized test results. Implications of this case underline the importance of an integrative evaluation process including clinical interview, neurocognitive and vestibular/ocular physical therapy, and advanced neuroimaging, especially in cases with atypical presentation.
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Affiliation(s)
- Luke C Henry
- a UPMC Sports Medicine Concussion Program/Department of Orthopaedic Surgery , University of Pittsburgh , Pittsburgh , PA , USA
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Worts PR, Burkhart SO, Ormsbee MJ, Davis AW, Kim JS. Assessment Of Convergence Insufficiency Using Subjective And Objective Tests Following A Sport-Related Concussion. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000476418.07239.3d] [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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