Brain Injury and Recovery: Theoretical and Controversial Issues
This is the most likely cause of the symptoms of dementia described above. Having a support system in place can stave off some of the isolation that Alice experienced. Your email address will not be published. The Learning Corp does not provide rehabilitation services and does not guarantee improvements in brain function. The Learning Corp provides tools for self-help and tools for patients to work with their clinicians.
Previous post Next post. The Learning Corp Dec 4, Alzheimer's. Related Articles. Dywan, J. R etest reliability in adolescents of a computerized neuropsychological battery used to assess recovery from concussion. ANAM is a computer-based battery of neuropsychological tests designed to assess concussion effects. Since the principle behind these computerized batteries is to assess athletes before injury and after injury to determine the level of deficit and whether the individual is safe to return to play, it is critical that such batteries have excellent retest reliability.
Participants were assessed twice, using the same computers, at the same time of day, with seven days between administrations. Retest reliability of the ANAM was good, especially for the aggregate of throughput scores, reaching 0. Thus, the ANAM aggregated score appears to have robust reliability for cognitive measures involving memory and attention in adolescents. Fung, M. Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post-concussion syndrome: Implications for treatment.
Concussion is most commonly defined as a trauma induced alteration of mental status that may or may not involve loss of consciousness. Concussion produces a temporary alteration of the central regulatory systems that control, for example, the autonomic nervous system and circadian rhythms, as well as the auto-regulatory protection of the brain, which under normal conditions maintains a constant state of cerebral blood flow. The authors propose that PCS represents a condition whereby the regulatory and auto-regulatory mechanisms of the brain do not naturally return to normal.
They further propose that this physiologic dysfunction may be reduced or alleviated by individualized controlled sub-symptom threshold aerobic exercise rehabilitation. The implications of this theory of concussion and PCS for treatment and further research are discussed. Gilchrist, J. Nonfatal traumatic brain injuries from sports and recreation activities - United States, The findings indicate that an estimated , patients with nonfatal SR-related TBIs were treated in EDs each year for the period to Overall, males accounted for about The highest rates of SR-related TBI ED visits for both males and females occurred among those aged 10 to 14 years, followed by those aged 15 to 19 years.
Activities associated with the greatest number of TBI-related ED visits included bicycling, football, playground activities, basketball, and riding all-terrain vehicles. Leddy, J. Special issue: Sports and concussion. Topics include: the effects of explanatory style on concussion outcomes in sports, use of computer-based testing of youth hockey players with concussions, concussion sideline management intervention for rugby union leads to reduced concussion claims, use of ICECI and ICD E-coding structures to evaluate causes of head injury and concussion from sport and recreation participation in a school population, regulatory and auto-regulatory physiological dysfunction as a primary characteristic of post-concussion syndrome, the relation between post-concussion symptoms and neurocognitive performance in concussed athletes, contributions of functional magnetic resonance imaging to sport concussion evaluation, post-concussion syndrome ebb and flow, and retest reliability of a computerized neuropsychological battery to assess recovery from concussion in adolescents.
Individual articles may be available for document delivery; see accession number J through J TBI Updates, 4 3. In this issue: 1 exercise after TBI, 2 research corner, 3 conference on vocational outcomes, and 4 sports concussion. TBI Updates, 2 1. In this issue: 1 sports and concussions; 2 constraint induced therapy for upper extremity motor function at the University of Alabama, Birmingham; 3 housing resources; 4 recent staff presentations; 5 recent staff publications; and 6 updates on current TBI studies.
Browndyke, J. Applications of computer-based neuropsychological assessment. Journal of Head Trauma Rehabilitation, 17 5 , Outlines benefits and limitations of computer-based service delivery. Bennett, T. The management and evaluation of sports-related mild traumatic brain injuries in student athletes.
Journal of Cognitive Rehabilitation, 19 2 , The guidelines for grading concussions and general guidelines for return to competition following sports related and non-sports related mild TBI are listed. Evaluation of persisting cognitive difficulties in sports related TBI is described. A neuropsychological testing battery for sports-related TBI in the student athlete is suggested. Aldred, H. Sports injuries sourcebook. Health Reference Series, First Edition. Details are provided about causes, treatment and rehabilitation of these injuries.
Injury prevention covers tips for specific sports, describes safety precautions in a variety of sporting activities, particularly those with a high risk of injury. These include football, basketball, baseball, softball, bicycling, skateboarding, in-line skating, scuba diving, soccer, and skiing. Treatment and rehabilitation provides information on aspects of recovering from an injury, especially those related to non-prescription pain relief, over-the-counter injury treatments, overcoming depression in recovery, and a guide to research and advances in sports medicine.
Information is provided about special concerns for children, young girls in athletic training programs, senior athletes, and women athletes. A directory of resources for further information is included. Barber-Foss, K. Traumatic brain injury in high school athletes. National estimates were made based on the MTBI frequencies found in the study. Branche, C. Journal of Head Trauma Rehabilitation, 13 2 , Data indicate that approximately , people a year experience sports-related TBI in the United States.
The authors discuss changes that could be made in surveillance to improve data collection. They also discuss sports injury mortality, risk factors, and possible interventions. This program was developed to assist in the assessment of injuries of an athlete on the playing field.
The manual is organized into 11 chapters: introduction, head and neck injury management for coaches, side line mental testing, equipment list, the football helmet, references, what athletes and families should know, TBI, emergency room forms, resources, and supplementary articles. Alla, S. British Journal of Sports Medicine, 46 8 , McCrory, P. Sports concussion and the risk of chronic neurological impairment.
Clinical Journal of Sport Medicine, 21 1 , At this time, the scientific evidence to support these views is limited, with only a handful of cases thus far reported. Based on the literature on this topic that extends back over 50 years, it is clear that only a small percentage of athletes suffer such sequelae presumably due to recurrent concussive or sub-concussive head impacts. At this stage, determining which athletes are at future risk is not possible; however, following existing concussion guidelines e. Boutin, D. Neurophysiological assessment prior to and following sports-related concussion during childhood: A case study.
Neurocase, 14 3 , An 8-year-old girl suffered a concussion while playing soccer. Visual evoked potentials VEPs were recorded at 7 weeks pre-injury and 24 hours, 7, 22, 32 and 55 weeks post-injury. A neuropsychological assessment performed at 24 hours post-injury reveals cognitive impairments, mainly attentional, that resolved within 22 weeks. VEPs and spectral analyses confirm the presence of cortical impairments up to one year post-injury, especially affecting vigilance and attention, which were reflected in school performance.
Kim, P. Neurological Surgery, 36 11 , No abstract is available. Bleiberg, J. Review of sports-related concussion: Potential for application in military settings. Discusses the incidence, definition, and diagnosis of concussion; concussion grading scales; sideline evaluation tools; neuropsychological assessment; return-to-action criteria; and complications of concussion.
Chinn, N. Community College Journal of Research and Practice, 37 6 , There are significant implications for the concussed student-athlete both in returning to the playing field and the classroom. Although practices are now in place to improve identification and management of concussions in professional sports, little is known about how it is managed in community colleges.
It also sought to understand the training, cultural pressures, and resources that may impact the degree to which community college athletic trainers implement these guidelines. Journal of School Health, 82 5 , It is important that persons involved in youth sports, particularly coaches, be made aware and educated on the signs and symptoms of concussion. A total of youth sport coaches completed the survey, for a response rate of Seventy-seven percent of youth sports coaches reported being better able to identify athletes who may have a concussion, with 50 percent reported having learned something new about concussion after reviewing the materials.
Sixty-three percent of youth sport coaches viewed concussions as being more serious, while 72 percent of coaches reporting that they are now educating others on concussion. Johnson, L. Return to play guidelines cannot solve the football-related concussion problem. Journal of School Health, 82 4 , Return to play guidelines RTPs have emerged as the preferred approach for addressing the problem of sport-related concussion in youth athletes.
Methods: This article reviews evidence of the risks and effects of football-related concussion and sub-concussive brain trauma, as well as the effectiveness of RTPs as a preventative measure. Results: Sport-related concussion is a significant problem among student athletes. Student athletes are more vulnerable to concussion, and at risk of neurocognitive deficits lasting a year or more, with serious effects on academic and athletic performance. RTPs do little to address the problem of sport-related concussion or the chronic damage caused by sub-concussive brain trauma.
Conclusions: Emphasizing RTPs as the solution to the concussion problem in tackle football risks neglecting genuine reforms that would prevent concussions. More effective concussion prevention is needed. Eliminating tackling from school football for youth under the age of 16 is recommended to reduce concussions. Additional modifications to football are recommended to enhance safety and reduce brain trauma at all levels of play. Boyer, C.
Exceptional Parent, 41 3 , With sports also come bumps and bruises--and one type of injury requires much more than an ice pack or a band-aid. Head trauma is one of the most common injuries sustained by young athletes, with more than 60, concussions occurring each year in U. The consequences can include impaired intellectual abilities, severe neurological disorders and other long-term disabilities. This article provides some facts about concussion in sports. Brady, D. Sport-related concussions. Communique, 39 8 , The primary focus of much of SRC research pertains to the assessment, management, and return to play of the concussed athlete.
This article highlights some major issues of SRC along with some controversies that presently exist within the field. Readers are encouraged to discuss specific SRC concerns with qualified and knowledgeable healthcare providers who are familiar with the person suffering from a concussion. Reed, N. Despite these benefits, it exposes children and youth to the increased risk of injury. The profession of occupational therapy has yet to be widely recognized or utilized within the world of sport when rehabilitating athletes following a concussion.
However, the importance of an interdisciplinary approach to sport-related concussion management has been promoted internationally McCrory et al. The combinations of symptoms associated with sport-related concussion can have a significant impact on occupational performance, both on and off the playing field.
Occupational therapists can assume a variety of roles specific to the safe return of athletes to their meaningful daily occupations. This commentary aims to act as a starting point for exploration of sport-related concussion from an occupational perspective and to expand the scope of occupational therapy practice into the world of sport. Dissertation, University of California, Davis. The study also set out to gain understanding of why some athletic trainers comply with best practices in concussion management, such as performing baseline testing, while others do not. The first phase of the research was a population study, and consisted of one athletic trainer from each of the California Community Colleges that had a football program at the time of the study, which totaled seventy-two.
Telephone surveys were conducted with 64 of the 72 CCC athletic trainers. The second part of the research consisted of follow-up in-depth interviews with eight of the athletic trainers at their corresponding work sites. Quantitative data was analyzed utilizing descriptive statistics, correlations, and multiple regression utilizing SPSS. Qualitative data reflecting responses to research questions was systematically analyzed and synthesized into corresponding themes. The results of this research indicated that a large number of California Community College athletic trainers 71 percent of those surveyed are not currently conducting baseline testing.
Further, number of years practicing as an athletic trainer negatively correlated with frequency of obtaining cognitive baselines. At the sideline, the most commonly utilized method of assessment by surveyed subjects was a symptoms checklist. Methods of assessment for return to play also varied. Standardized methods of assessment were employed in making return to play decisions by 42 percent of subjects, and 10 percent utilized ImPact computerized software. Other reasons for conducting baseline testing included identifying baseline testing as a valuable tool for reducing further injury, viewing baseline testing as a method for reducing risk and liability, and experiencing a sense of responsibility in adhering to the NATA position statement on management of concussion.
Themes identified for not conducting baseline testing included time constraints, and viewing baseline testing as an unnecessary component of a concussion management program. Respondents reported on pressure to return an athlete to play, frequency of receiving concussion education and amount of workload. Results of these variables are discussed as they relate to concussion assessment and return to play practices. Finally, recommendations are offered that include the creation of a system-wide approach to concussion management that reflects best practices utilized in systems such as the NFL, as well as baseline testing of athletes in all contact sports at California Community Colleges.
Faure, C. American Secondary Education, 39 1 , With an estimated , sport-related concussions occurring annually in the United States and a public perception that bell ringers are not concussions, many head-injured children are being allowed to continue to play through their symptoms.
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That decision puts those athletes at additional catastrophic risk. This article provides school leaders, parents and coaches with a snapshot of appropriate concussion management practices by presenting policy recommendations for establishing uniform guidelines consistent with the current published literature. It also provides recommendations to teachers for making classroom accommodations for athletes with concussions. The consequences of concussion can be catastrophic, especially since the symptoms are rarely visible and often overlooked. To ensure the safety of athletes in youth and interscholastic sports programs, having Certified Athletic Trainers ATCs on staff or having a physician available at practices and games to oversee concussion and other injury management, is the best-case scenario.
However, when an ATC or physician is not available, it is critical for coaches to be trained to identify and manage concussion. The purpose of this article is to review the need for and use of both subjective and objective concussion assessment. Since the responsibility for athletic health care often falls on the shoulders of sport administrators and coaches, injury identification training and immediate-care-management education are essential.
Klein, C. This study explores the success of the tool kit in changing knowledge, attitudes, and practices related to the prevention and management of concussions. Methods: A mail questionnaire was administered to all eligible high school coaches who received the tool kit. Follow-up focus groups were conducted for additional information. Both quantitative data from the surveys and qualitative data from the focus groups were analyzed to support the objectives of the study. Results: Respondents self-reported favorable changes in knowledge, attitudes, and practices toward the prevention and management of concussions.
Qualitative responses augmented the quantitative data. Conclusion: Barriers to concussion prevention and management are complex; however, these results highlight the role that coaches can play in school settings in establishing a safe environment for their athletes. Kohn, L. Government Accountability Office. Concussion is a brain injury that can affect memory, speech, and muscle coordination and can cause permanent disability or death. Concussion can be especially serious for children, who are more likely than adults both to sustain a concussion and to take longer to recover.
These factors may affect return-to-play decisions, which determine when it is safe for an athlete to participate in sports again. Government Accountability Office GAO was asked to testify on concussion incurred in high school sports. This statement focuses on 1 what is known about the nationwide occurrence of concussion; 2 federal concussion prevention programs; 3 the components of key state laws related to the management of concussion; and 4 the recommendations of voluntary nationwide concussion management guidelines.
To do this work, GAO conducted literature searches; reviewed injury databases, state laws, and documents from federal agencies and organizations that conduct work in high school athletics or sports medicine; and interviewed federal officials and experts who identified key state laws and nationwide guidelines and provided other information. GAO shared the information in this statement with the relevant federal agencies. Samuels, C. Efforts to prevent concussions target schools.
Education Week, 30 5 , 1, Concussions are caused by a jolt to the body or a blow to the head that causes the head to move rapidly back and forth. Concussion symptoms include dizziness, nausea, confusion, slurred speech, and memory problems. Their efforts coincided with legislation from the U.
De Souza, M. Miller, Merrill J. Melnick, and Leslie Heywood. At that time, it was clear that evidence-based research confirmed that regular physical activity and sport provides the critical foundation, in no small part, that allows girls and women to lead healthy, strong, and fulfilled lives. This expanded review of existing research and health information is co-authored by a team of experts from several related disciplines, including epidemiology, exercise physiology, kinesiology, psychology, and sociology.
Some key contributions of this new report include the following: 1 Research affirms, even more definitively than five years ago, that engagement in moderate and consistent levels of physical activity and sport for girls and women is essential to good health and well-being; 2 Although more research needs to be done, early studies examining the connections between physical activity and academic achievement show there is a positive relationship between the two in girls and women; 3 Females from lower economic backgrounds and females of color engage less in physical activity, have less access to sport and physical fitness programs, and suffer negative health consequences as a result; and 4 Emerging research in prevention and training practices show that gender-conscious approaches to physical training and conditioning for female athletes help to reduce the likelihood of anterior cruciate ligament ACL injuries and concussions.
For the executive summary, see ED DeSouza, M. Executive summary. For the main report, see ED Hayes, G. American Journal of Health Education, 38 2 , Each year in the United States, an estimated 1. From developing an expert panel and pretesting message concepts to pilot testing, promoting, and evaluating the final product, CDC has shown that this undertaking is highly effective. Results of the pilot study and promotion efforts show that the tool kit is well received by coaches and school officials and that it meets a critical health education need.
Vance, E. The science of hard knocks. Chronicle of Higher Education, 53 41 , A Football players still get the most knocks to the head. Women have managed to keep up with, and often surpass, men in sports-related concussions in the last few years. In basketball, women reported 24 percent more concussions than men did during games in the season. In soccer, women had concussions at almost twice the rate of men. A flurry of recent research about head injuries has called attention to the issue, but concussions remain a medical mystery.
Some medical experts fear that athletics trainers are overlooking many concussions and that coaches sometimes push to get players back into games before their head injuries have healed. Recent studies have shown that concussions are cumulative: once you have one concussion, you are more likely to have a second that is more severe.
As it stands, the only accepted treatment for a concussion is to rest the brain. That means no contact sports, no exercise, and no strenuous thinking, all of which creates a challenge for college athletes. Experts say that taking an important exam or memorizing the periodic table will not cause additional damage, but it will likely slow the recovery. Robert Cantu says treating an injury that cannot be directly observed is tricky, especially in a young brain, which is not fully developed until about age 22 and so takes longer to mend.
He and other medical experts stress the importance of rest. However, National Collegiate Athletic Association NCAA guidelines leave it up to the individual trainer, suggesting that the player have no symptoms and return gradually. Perhaps the biggest unknown with concussions is whether they affect long-term health. Although some medical experts say it is too early to link concussions with long-term health problems, most people who study brain injuries do not doubt that concussions can have some lasting effect on athletes.
What effects they have and who is at risk remain unclear. Bizzochi, J. Video gaming promotes concussion knowledge acquisition in youth hockey players. Journal of Adolescence, 29 3 , The goal of this research was to develop a video game wherein the educational aspect was implicitly embedded in the video game, such that the gaming activity remained interesting and relevant. Results demonstrated that participants playing the experimental version of the video game scored significantly higher on a concussion symptoms questionnaire, in a significantly faster time, than participants playing the control version of the game.
Most participants indicated that they enjoyed the game and would play it again. These results suggest that educational material can be conveyed successfully and in an appealing manner via video game play. Centers for Disease Control and Prevention Guide for Coaches. It focuses on the fact that coaches can play a key role in preventing concussions and managing them properly when they occur.
Battin, B. Second-impact syndrome. Journal of School Nursing, 20 5 , Students who experience multiple brain injuries within a short period of time hours, days, or weeks may suffer catastrophic or fatal reactions related to SIS. Adolescents are particularly susceptible to the dangers of SIS, and current return-to-play guidelines may be too lenient to protect a student from SIS. Any student with signs of a concussion should receive medical evaluation and not be allowed to return to play in the current game or practice.
The role of the school nurse includes being knowledgeable about management of head injuries and return-to-play guidelines, providing follow-up for athletes who have concussions, and providing education on prevention and management of head injuries. Aubry, M. Physician and Sportsmedicine, 30 2 , They addressed such issues as epidemiology, basic and clinical science, grading systems, cognitive assessment, new research methods, protective equipment, management, prevention, and long-term outcome.
The results of their work is summarized in this agreement statement. Anderson, S. Journal of Athletic Training, 36 3 , It can be used during initial sideline examinations as well as during subsequent follow-up examinations. Garrett, W. Cognitive deficits may occur for many reasons. Heading cannot be blamed when details of the actual event and impact are unknown. Concussions are the most common head injury in soccer and a factor in cognitive deficits and are probably the mechanism of the reported dysfunction. Mueller, F.
Catastrophic head injuries in high school and collegiate sports. Data from a national surveillance system indicated that a football-related fatality occurred every year except one from , mainly related to head injuries. From , 69 football head-related injuries resulted in permanent disability. Deaths and permanent disability injuries also occurred in other sports.
Twelfth Edition. The third section on special populations covers participation by impaired and pregnant student-athletes and student-athletes with sickle cell trait. The final section on equipment covers protective equipment; eye safety; use of the trampoline and minitramp; mouth guards; use of the head as a weapon in football and other contact sports; and guidelines for fitting and removing helmets.
Appended is a NCAA injury surveillance system summary. Hutchinson, M. Cheerleading injuries. Patterns, prevention, case reports. Physician and Sportsmedicine, 25 9 , , , Two case reports are presented that illustrate acute injuries typical of cheerleading. Prevention recommendations are offered related to supervising, screening, limiting stunts, optimizing the environment and equipment, and preparing for emergencies. Fields, K.
Head injuries in soccer. Physician and Sportsmedicine, 17 1 , 69, The American Journal of Sports Medicine, 34 10 , Neurocognitive testing is important given the potential unreliability of athlete self-report after injury. Post-injury neurocognitive performance Immediate Post-concussion Assessment and Cognitive Testing and symptom post-concussion symptom scores were compared with pre-injury baseline scores and with those of an age- and education-matched non-injured athlete control group.
RESULTS: Sixty-four percent of concussed athletes reported a significant increase in symptoms, as judged by post-concussion symptom scores, compared with pre-injury baseline at two days after injury. Eighty-three percent of the concussed sample demonstrated significantly poorer neurocognitive test results relative to their own baseline performance. The addition of neurocognitive testing resulted in a net increase in sensitivity of 19 percent.
Ninety-three percent of the sample had either abnormal neurocognitive test results or a significant increase in symptoms, relative to their own baseline; 30 percent of a control group demonstrated either abnormalities in neurocognitive testing or elevated symptoms, as judged by post-concussion symptom scores. For the concussed group, use of symptom and neurocognitive test results resulted in an increased yield of 29 percent overreliance on symptoms alone.
In contrast, 0 percent of the control group had both symptoms and abnormal neurocognitive testing. Neurocognitive testing increases diagnostic accuracy when used in conjunction with self-reported symptoms. Bennell, K. Computerized cognitive assessment of concussed Australian Rules footballers. British Journal of Sports Medicine, 35 5 , It has been proposed that computerized cognitive tests have many advantages over such conventional tests, but their role in this domain is yet to be established.
To investigate the role of computerized cognitive tests in the assessment and follow up of sports related concussions. Tests were repeated in players who had sustained a concussive injury. A group of non-injured players were used as matched controls. However, analysis of the SRT data showed an increase in response variability and latency after concussion in the injured athletes. Athens, J. Symptom response following acute bouts of exercise in concussed and non-concussed individuals — A systematic narrative review.
Physical Therapy in Sport, 14 4 , Concussion-like symptoms have been shown to be influenced by prior participation in physical activity; however, the potential contribution of acute exercise on symptoms is not well understood. OBJECTIVE: The purpose of this study was to systematically review the literature in order to further understand the acute effects of exercise on documented self-reported symptoms in both concussed and non-concussed individuals.
METHODS: Nine electronic databases were systematically searched using keywords and MeSH terms that included; self-reported symptoms, sports-related concussion, brain concussion, exercise and athletic injuries. In addition, an extensive search of the grey literature was conducted. RESULTS: Of the articles retrieved, only five met the inclusion criteria comprising a total of concussed and non-concussed participants.
In general, the mean symptom scores increased from pre-exercise to post-exercise levels immediately following acute bouts of exercise in both concussed and non-concussed individuals. Thus, the application to real world situation is still to be established. Garza, D. British Journal of Sports Medicine, 46 3 , Almost 40 percent were randomized controlled trials and The focus of the study was protective equipment in 41 percent, training in Equipment research studied stability devices Training studies often used a combination of interventions e.
Almost 70 percent of the studies examined lower extremity injuries, and a majority of these were joint non-bone -ligament injuries. Contact sports were most frequently studied Of these, the majority investigated equipment or training interventions whereas only 4 percent focused on changes to the rules and regulations that govern sport.
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The focus of intervention research is on acute injuries in collision and contact sports whereas only 20 percent of the studies focused on non-contact sports. Balcer, L. The King-Devick test as a concussion screening tool administered by sports parents. The King-Devick K-D test captures impairment of eye movements and other correlates of suboptimal brain function. We investigated the K-D test as a screening for concussion when administered by layperson sports parents in a cohort of amateur boxers.
Methods: The K-D test was administered pre-fight and post-fight by laypersons masked to the head trauma status of each athlete. Matches were watched over by a ringside physician and boxing trainer. Athletes with suspected head trauma received testing with the Military Acute Concussion Evaluation MACE by the ringside physician to determine concussion status.
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Athletes sustaining concussion were compared to the athletes screened using the K-D test. One boxer sustained a concussion as determined by the ringside physician. This boxer was accurately identified by the layperson K-D testers due to a worsening in K-D test compared to baseline 3. High levels of test-retest reliability were observed intra-class correlation coefficient 0. Additionally, 6 boxers who participated in multiple bouts showed no worsening of their K-D times further supporting that scores are not affected by the fatigue associated with sparring.
Conclusion: The K-D test is a rapid sideline screening tool for concussion that can be effectively administered by non-medically trained laypersons. Bazarian, J. British Journal of Sports Medicine, 48 2 , Brown, S. To address this variation, a multidisciplinary concussion program was established based on a uniform management protocol, with emphasis on community outreach via traditional media sources and the Internet. This retrospective study evaluates the impact of standardization of concussion care and resource utilization before and after standardization in a large regional pediatric hospital center.
Emergency department, sports medicine, and neurosurgery records were reviewed. Data collected included demographics, injury details, clinical course, Sports Concussion Assessment Tool-2 SCAT2 scores, imaging, discharge instructions, and referral for specialty care. The cohort was analyzed comparing patients evaluated before and after standardization of care.
Results Five hundred eighty-nine patients were identified, including before standardization and after standardization Establishment of a multidisciplinary clinic with a standardized protocol resulted in significantly decreased institutional resource utilization and more consistent concussion care for this growing patient population. Davis, G. This study aimed to assess whether key messages within these guidelines are reflected in the knowledge of coaches and sports trainers involved in community sport.
Knowledge scores were constructed from Likert scales and compared across football codes and respondent groups. There were no significant differences in either concussion symptoms or concussion management knowledge across codes or team roles. Over 90 percent of respondents correctly identified five of the eight key signs or symptoms of concussion.
Fewer than 50 percent recognized the increased risk of another concussion following an initial concussion. Most incorrectly believed or were uncertain that scans typically show damage to the brain after a concussion occurs. This needs to be redressed to maximize the safety of all of those involved in community sport. Dimou, S. Journal of Neurotrauma, Jan. For the most part, diagnosis of concussion is based on subjective clinical measures and thus is prone to under-reporting. In the current environment, where conventional imaging modalities, such as computed tomography and magnetic resonance imaging, are unable to elucidate the degree of white matter damage and neuro-metabolic change, a discussion of two advanced imaging techniques-diffusion tensor imaging DTI and magnetic resonance spectroscopy MRS -is undertaken with a view to highlighting their potential utility.
Our aim is to outline a variety of the approaches to concussion research that have been employed, with special attention given to the clinical considerations and acute complications attributed to concussive injury. DTI and MRS have been at the forefront of research as a result of their noninvasiveness and ease of acquisition, and hence it is thought that the use of these neuroimaging modalities has the potential to aid clinical decision making and management, including guiding return-to-play protocols.
Dougan, B. Pre-existing athlete characteristics, particularly age, sex and education, were demonstrated to be significant modifiers of neuropsychological outcomes within 10 days of a sports-related concussion. Implications for return-to-play decision-making and future research directions are discussed. Echlin, P. Hockey Concussion Education Project, Part 1. Susceptibility-weighted imaging study in male and female ice hockey players over a single season.
Journal of Neurosurgery, Feb. The authors use susceptibility-weighted imaging SWI to automatically detect small hypo-intensities that may be subtle signs of chronic and acute damage due to both sub-concussive and concussive injury. The goal was to investigate how the burden of these hypo-intensities changes over time, over a playing season, and post-concussion, in comparison with subjects who did not suffer a medically observed and diagnosed concussion. Methods Images were obtained in 45 university-level adult male and female ice hockey players before and after a single Canadian Interuniversity Sports season.
In addition, 11 subjects 5 men and 6 women underwent imaging at 72 hours, 2 weeks, and 2 months after concussion. To identify subtle changes in brain tissue and potential CMBs, non-vessel clusters of hypo-intensities on SWI were automatically identified, and a hypo-intensity burden index was calculated for all subjects at the beginning of the season BOS , the end of the season EOS , and at post-concussion time points where applicable.
Results A statistically significant increase in the hypo-intensity burden, relative to the BOS, was observed for male subjects with concussions at the 2-week post-concussion time point. A smaller, non-significant rise in the burden for female subjects with concussions was also observed within the same time period.
There were no significant changes in burden for non-concussed subjects of either sex between the BOS and EOS time points. However, there was a statistically significant difference in the burden between male and female subjects in the non-concussed group at both the BOS and EOS time points, with males having a higher burden. The hypointensity burden metric proposed here shows statistically significant changes over time in the male subjects.
A smaller, non-significant increase in the burden metric was observed in the female subjects. Kay, M. Positive and negative factors that influence concussion reporting among secondary school athletes. Journal of Sport Rehabilitation, Jan. It has been reported that up to 3. One significant issue with identifying concussions is that a clinical diagnosis is based on the presence of signs and symptoms, which are self-reported by the patient. In the adolescent population, injury to the brain is possible with even the slightest insult, which can affect recovery and predispose them to subsequent concussions.
Recent legislative efforts have included athlete education as a means to improve concussion reporting. More specifically, 49 of the 50 states have implemented concussion legislation3 that includes some type of concussion education protocol, but there is still little evidence to suggest that enhanced knowledge levels result in behavior changes, including improved concussion reporting practices. It is unclear as to what factors make an adolescent athlete more or less likely to report the symptoms of a concussion. Marion, D. Journal of Neurotrauma, 31 2 , This concern has led to significant confusion among primary care providers and athletic trainers about how to best identify those athletes at risk and how to treat those with concussion.
The goal of each group was to clearly define current best practices for the definition, diagnosis, and acute and post-acute management of sports-related concussion, including specific recommendations for return to play. In this article, we compare the recommendations of each of the three groups, and highlight those topics for which there is consensus regarding the definition of concussion, diagnosis, and acute care of athletes suspected of having a concussion, as well as return-to-play recommendations.
Sports-related concussion: Anonymous survey of a collegiate cohort. Among athletes who responded to the survey, 43 percent of those with a history of concussion reported that they had knowingly hidden symptoms of a concussion to stay in a game, and 22 percent of athletes overall indicated that they would be unlikely or very unlikely to report concussion symptoms to a coach or athletic trainer in the future. These data suggest that there may be a substantial degree of underreporting of concussion among collegiate athletes, despite most acknowledging that they have been formally educated about the risks of concussion.
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Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes. METHODS: This study was a retrospective review of athletes aged 9 to 17 years who were referred for evaluation of a sports-related concussion over a month period. Athletes with learning disabilities were excluded from the study and data analysis. Age, height, and weight were recorded for each subject.
Each subject also reported their initial degree of confusion, amnesia, or loss of consciousness, and whether a helmet was worn when the injury was sustained. A item post-concussion symptom score SS scale was completed by both groups on initial assessment SS1 and follow-up visit SS2. A similar analysis was also performed for effects of sex on SS1 and SSR in patients who were not wearing a helmet.
Males, regardless of day of presentation, had a lower SS1 evaluation than females Males without helmets did not differ from females without helmets, but this was not significantly different The overall mean SSR was There were no significant differences in degree of loss of consciousness, amnesia, confusion, or age between the sexes or groups.
With SSR being similar between sexes, the current data suggest that young, female athletes may take longer to become symptom free following sports-related concussion. This information may be an important factor in returning a young athlete to sport after sports-related concussion. Brody, D. The Journal of Clinical Psychiatry, 74 2 , , quiz Also known as mild traumatic brain injury mTBI , concussions often occur, and often multiple times, in both military and sports settings.
Brain injuries can seriously and negatively impact patients, leading to changes in personality, sleep problems, and cognitive impairments and can increase the risk for suicide, posttraumatic stress disorder, depression, and anxiety. Currently, symptom management and education are the best strategies to help those who have received multiple concussions.
Prevention education about concussions and the use of return-to-play guidelines are especially important for young athletes. Burkhart, S. Incidence of sports-related concussion among youth football players aged years. The Journal of Pediatrics, 3 , Incidence rates IRs and incidence density ratios IDRs of concussion were calculated for games and practices and for age groups.
A majority of concussions were the result of head-to-head 45 percent contact. The combined concussion IR for practices and games was 1. The concussion IR was 0. The IDR for concussions in games to practices was The IDR of concussions for youth aged years compared with youth aged years was 2. However, participation in games was associated with an increase in risk of concussion compared with practices, which was higher than rates previously reported for high school and collegiate athletes.
Younger players were slightly less likely to incur a concussion than were older players. Translational Stroke Research, 4 4 , The benefit to using neurocognitive testing when managing concussion will be documented in this review. In addition to providing critical objective information on the neurocognitive status of the concussed athlete, research data will be provided on the pre- and post-concussion neurocognitive profiles of concussed male and female athletes.
Specifically, an overview of research will be presented on the epidemiology of male and female concussion rates, as well as concussion outcomes including symptoms and cognitive function post-injury. Chronic traumatic encephalopathy. Current Sports Medicine Reports, 12 1 , CTE was first described by Martland in as a syndrome seen in boxers who had experienced significant head trauma from repeated blows. The classic symptoms of impaired cognition, mood, behavior, and motor skills also have been reported in professional football players, and in , the histo-pathological findings of CTE were first reported in a former National Football League NFL player.
The pathophysiology is still unknown but involves a history of repeated concussive and sub-concussive blows and then a lag period before CTE symptoms become evident. The involvement of excite-toxic amino acids and abnormal microglial activation remain speculative. Early identification and prevention of this disease by reducing repeated blows to the head has become a critical focus of current research.
The relationship of symptoms and neurocognitive performance to perceived recovery from sports-related concussion among adolescent athletes. A multiple regression for neurocognitive performance and symptoms revealed a significant model that accounted for 58 percent of the variance in perceptions of recovery.
Adolescent athletes base their perceptions primarily on somatic symptoms e. These data further support the need for valid and reliable measures for concussion management. Efficacy of amantadine treatment on symptoms and neurocognitive performance among adolescents following sports-related concussion. The Journal of Head Trauma Rehabilitation, 28 4 , Treatment group consisted of patients treated with mg of amantadine twice daily mg total per day following a period of rest.
Matched controls were evaluated and treated conservatively without medication at the same concussion program prior to the start of the current amantadine protocol. RESULTS: Results support significantly greater improvements from pre- to post-test in reported symptoms, verbal memory, and reaction time performance for the amantadine group than the matched controls.
There were no significant differences for visual memory or visual motor processing speed. Advances in neuropsychological assessment of sport-related concussion. British Journal of Sports Medicine, 47 5 , Several books were also reviewed. The articles were pared down for review if they specifically addressed the key areas noted above. Brief cognitive evaluation tools are not substitutes for formal neuropsychological assessment.
At present, there is insufficient evidence to recommend the widespread routine use of baseline neuropsychological testing. Although scant, research suggests that psychological factors may complicate and prolong recovery from concussion in some athletes. Age-appropriate symptom scales for children have been developed but research into age-appropriate tests of cognitive functions lags behind.
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Neuropsychologists are uniquely qualified to interpret neuropsychological tests and can play an important role within the context of a multifaceted-multimodal approach to manage sports-related concussions. Davenport, E. Annals of Biomedical Engineering, 41 12 , Traditionally, research on the biomechanics of football-related head impact has been focused at the collegiate level.
Less research has been performed at the high school level, despite the incidence of concussion among high school football players. The objective of this study is to twofold: to quantify the head impact exposure in high school football, and to develop a cumulative impact analysis method. Head impact exposure was measured by instrumenting the helmets of 40 high school football players with helmet mounted accelerometer arrays to measure linear and rotational acceleration. A total of 16, head impacts were collected over the course of the season.
Biomechanical data were analyzed by team and by player. The median impact for each player ranged from The 95th percentile impact for each player ranged from