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Concussion management

Johna K Register-Mihalik, Kenneth L Cameron, Melissa C Kay, Zachary Y Kerr, Karen Y Peck, Megan N Houston, Laura A Linnan, Heidi Hennink-Kaminski, Paula Gildner, Steven J Svoboda, Stephen W Marshall
OBJECTIVES: Non-disclosure of concussion complicates concussion management, but almost nothing is known about non-disclosure in military settings. This study describes concussion disclosure-related knowledge, attitudes, perceived social norms, perceived control, and intention. Additionally, the study identifies determinants of high intention to disclose concussion symptoms. DESIGN: Cross sectional survey. METHODS: First-year service academy cadets completed a cross-sectional survey to assess perceptions of concussion disclosure...
November 14, 2018: Journal of Science and Medicine in Sport
Pamela M Dunlap, Anne Mucha, Dana Smithnosky, Susan L Whitney, Joseph M Furman, Michael W Collins, Anthony P Kontos, Patrick J Sparto
BACKGROUND: Concussion can cause vestibular dysfunction and oculomotor abnormalities which can lead to dizziness and protracted recovery time. There are few clinically useful, functional measures of the vestibulo-ocular reflex (VOR) post-concussion. PURPOSE: The purpose of this study was to examine the gaze stabilization test (GST) in those referred for vestibular physical therapy following concussion, to determine the association between GST and other measures of recovery following concussion, and to examine the effect of demographic variables on GST performance...
November 29, 2018: Journal of the American Academy of Audiology
Christopher Abeare, Isabelle Messa, Cameron Whitfield, Brandon Zuccato, Joseph Casey, Nicholas Rykulski, Laszlo Erdodi
OBJECTIVE: To assess the prevalence of invalid performance on baseline neurocognitive testing using embedded measures within computerized tests and individually administered neuropsychological measures, and to examine the influence of incentive status and performance validity on neuropsychological test scores. SETTING: Sport-related concussion management program at a regionally accredited university. PARTICIPANTS: A total of 83 collegiate football athletes completing their preseason baseline assessment within the University's concussion management program and a control group of 140 nonathlete students...
November 28, 2018: Journal of Head Trauma Rehabilitation
Ciaran Cosgrave, Colm Fuller, Andy Franklyn-Miller, Eanna Falvey, Cliff Beirne, John Ryan, Paul McCrory
Introduction: Sports-related concussion (SRC) can be challenging to diagnose, assess and manage. Much of the SRC research is conducted on adults. The assessment of SRC should aim to identify deficits using a detailed multimodal assessment; however, most studies investigating the effects of SRC use diagnostic tools in isolation. It is likely that a combination of diagnostic tests will improve diagnostic accuracy. In this study, we aim to investigate how concussion affects adolescent rugby players and how a variety of diagnostic tools interact with each other as participants recover from their injury...
2018: BMJ Open Sport & Exercise Medicine
Daniel B Charek, Michael Collins, Anthony Kontos
Concussion is a major public health concern, with an estimated 1.6-3.8 million sport-related concussions occurring annually in the United States. Although the majority of injured athletes recover within 7-21 days, 20-30% of athletes experience protracted recovery spanning more than a month, suggesting as many as 320,000-760,000 athletes may experience prolonged symptoms. This highlights the need for efficacious clinical interventions to facilitate recovery. While concussion was historically conceptualized as a homogeneous injury, a more nuanced understanding has recently emerged and led to a refined approach of categorizing concussions into clinical trajectories or symptom profiles...
2018: Handbook of Clinical Neurology
David W Wright, Jeffrey J Bazarian
The concussion evaluation commonly takes place in the emergency department (ED), but most clinicians have not received formal training in concussion diagnosis and management. Proper diagnosis and management of concussion in the ED diminish postconcussion complications and improve the likelihood of successful concussion recovery. The ED assessment begins with early recognition of the signs and symptoms of concussion, a directed history, appropriate documentation, and identification of conditions ("red flags") that need immediate intervention such as traumatic intracranial hemorrhage, followed by a systematic assessment for risk factors that can predict prolonged recovery, and a concussion-focused physical exam...
2018: Handbook of Clinical Neurology
Christopher Giza, Tiffany Greco, Mayumi Lynn Prins
The majority of the 3.8 million estimated annual traumatic brain injuries (TBI) in the United States are mild TBIs, or concussions, and they occur primarily in adolescents and young adults. A concussion is a brain injury associated with rapid brain movement and characteristic clinical symptoms, with no associated objective biomarkers or overt pathologic brain changes, thereby making it difficult to diagnose by neuroimaging or other objective diagnostic tests. Most concussion symptoms are transient and resolve within 1-2 weeks...
2018: Handbook of Clinical Neurology
Breton M Asken, Dallas C Hack, Michael A McCrea
The study of contact and collision sport athletes at risk for concussion began approximately three decades ago. Since then, sport-related concussion (SRC) research across several medical specialties has helped to develop consensus guidelines for clinical management through interdisciplinary efforts. The modern landscape of SRC research includes large-scale investigations to define the natural history of concussion and identify factors that should guide prevention, diagnosis, and treatment specific to the individual patient...
2018: Handbook of Clinical Neurology
John T Parsons, Christine Baugh
Beginning in 2009 with the passage of the Zackery Lystedt law in the state of Washington, all 50 states have passed concussion laws that implement a mandatory framework of care for high school and youth athletes. The structure of these laws generally shares the three primary components of the Lystedt law: (1) preseason concussion education; (2) mandatory removal from play with suspected concussion; and (3) clearance from a healthcare professional prior to return to play. These same three policy components are also found at the collegiate and professional levels of sport, either through established policy or labor contracts...
2018: Handbook of Clinical Neurology
Eric S Sussman, Arjun V Pendharkar, Allen L Ho, Jamshid Ghajar
Traumatic brain injury (TBI) is a major cause of morbidity and mortality throughout the world. Mild TBI, which is typically defined by Glasgow Coma Scale score ≥13, accounts for the vast majority of all TBIs, particularly in the setting of sports-related injuries. The terms concussion and TBI are often used interchangeably, both in the medical literature and in clinical care of this patient population. However, the lack of clearly defined definitions of these terms often leads to confusion, and this confusion may lead to delayed diagnosis and inconsistent management of affected patients...
2018: Handbook of Clinical Neurology
Steven P Broglio
Returning a concussed athlete to practice and competition is an ever-evolving concept that has received considerable scientific and public attention during the past 20 years. Whereas there is now more international consensus regarding return to play, the decision to do so is clinically based with scant objective measures to guide decision making. To encapsulate the return-to-play process, this chapter will give a historic overview of the graded progression process, outline how rest can be both beneficial and detrimental in recovery, and how exercise is emerging as a management tool...
2018: Handbook of Clinical Neurology
Ruben J Echemendia, Gerard A Gioia
Sport-related concussions are complex injuries of the brain. Since concussions can only be diagnosed clinically and manifest in different ways among athletes, diagnosis and management often require a multidisciplinary team approach. Sports neuropsychologists contribute to the team through their ability to assess cognitive, behavioral, and social-emotional domains that may or may not be a direct effect of the injury. This chapter describes the new field of sports neuropsychology and articulates how neuropsychologists can contribute to assessment and management...
2018: Handbook of Clinical Neurology
Brigid Dwyer, Douglas I Katz
Postconcussion syndrome (PCS) is a heterogeneous condition comprised of a set of signs and symptoms in somatic, cognitive, and emotional domains. PCS is a controversial concept because of differing consensus criteria, variability in presentation, and lack of specificity to concussion. Whereas symptoms of concussion resolve in most individuals over days to weeks, a minority of individuals experience symptoms persisting months to years. The clinical consequences of concussion may be best conceptualized as two multidimensional disorders: (1) a constellation of acute symptoms termed early-phase posttraumatic disorder (commonly headache, dizziness, imbalance, fatigue, sleep disruption, impaired cognition, photo- and phonophobia); and (2) late-phase posttraumatic disorder, consisting of somatic, emotional, and cognitive symptoms...
2018: Handbook of Clinical Neurology
Thomas W McAllister, Rachel Wall
Changes in mood, emotions, and behavior are common components of the acute clinical picture of sport-related concussion (SRC). Common concussion symptom inventories such as the Sport Concussion Assessment Tool-5 (SCAT5) contain a large number of questions that assess these neuropsychiatric domains. In fact, of 22 items assessed by the SCAT5, arguably only five of the items do not overlap with symptoms assessed by standard measures of anxiety and depression, suggesting that concussion is best viewed as a neuropsychiatric syndrome...
2018: Handbook of Clinical Neurology
Anne Mucha, Sheri Fedor, Danielle DeMarco
The assessment and treatment of sport-related concussion (SRC) often requires a multifaceted approach. Vestibular dysfunction represents an important profile of symptoms and pathology following SRC, with high prevalence and association with prolonged recovery. Signs and symptoms of vestibular dysfunction may include dizziness, vertigo, disequilibrium, nausea, and visual impairment. Identifying the central and peripheral vestibular mechanisms responsible for pathology can aid in management of SRC. The most common vestibular disturbances after SRC include benign paroxysmal positional vertigo, vestibulo-ocular reflex impairment, visual motion sensitivity, and balance impairment...
2018: Handbook of Clinical Neurology
Anne Marie Morse, Sanjeev V Kothare
Sleep disorders are a common sequel of sports-related concussion. Sleep-wake dysfunction can vary among patients, independent of cause or severity of concussive injury. The pathogenesis of postconcussive sleep disorder is unclear, but may be related to impaired signaling in neurons involved in normal sleep-wake control and circadian rhythm maintenance. Standardized methods of assessment for sleep disorders following concussion are important for diagnosis and management. Appropriate management is key because sleep dysfunction can have deleterious effects on concussion recovery...
2018: Handbook of Clinical Neurology
Tad Seifert
Concussion and migraine share many similar pathophysiologic mechanisms, including cortical spreading depression and failure in brain ion homeostasis. Migraine may predispose to concussion, and migraine and posttraumatic headache are common following concussion. This overlap may interfere with proper diagnosis following sport injury, thereby delaying either appropriate treatment or return-to-play. Posttraumatic headache is the most common symptom following concussion, and although symptoms are indistinguishable from migraine, persistent posttraumatic headache may be a unique entity that is more refractory to traditional headache management...
2018: Handbook of Clinical Neurology
Erin L Stewart, Scott A Anderson, Vernon B Williams
A multidisciplinary approach within sports neurology fills a critical role in the management of athletes with neurologic injury. This model promotes streamlined access to sports medicine providers who can offer high-quality multispecialty care in a collaborative manner, to provide optimal outcomes for athletes. This chapter highlights the rise of the multidisciplinary care approach in nonathletic healthcare settings and introduces the concept of the interdisciplinary sports medicine care model. Next, we review the roles of medical providers who are integral in effective management of sport-related concussion, followed by a discussion of the athletic healthcare teams that treat other sport-related neurologic injuries and athletes with pre-existing neurologic conditions...
2018: Handbook of Clinical Neurology
Hugo Paquin, Alex Taylor, William P Meehan
More children and adolescents are participating in competitive sports than ever before, causing an overall increase in sport-related injuries. Concussion is a common injury in the pediatric population and its prevalence has increased with increased visibility and awareness. This chapter will discuss the clinical presentation, evaluation, and management of concussions sustained by pediatric athletes, while addressing the distinctive factors that pertain to this population. Management of concussion should be tailored to patients' symptoms and should focus on an early and gradual return to both cognitive and noncontact low-risk physical activity...
2018: Handbook of Clinical Neurology
Lauren L Bennett, Jalayne J Arias, Paul J Ford, Charles Bernick, Sarah J Banks
OBJECTIVE: For concussions to be effectively managed in sports, they need to be correctly identified and reported. The extent to which professional athletes correctly recognize concussions, and their willingness to report symptoms, is not yet well understood. Given the risk of head injuries leading to concussions across combat sports, insight into professional fighters' knowledge and reporting of concussive symptoms is essential to improve concussion management. METHOD: To investigate understanding and reporting patterns of concussions sustained while training or competing, 257 fighters completed a self-report questionnaire assessing self-perception of concussion knowledge, trust of ringside medical providers, and reported number of previous head injuries...
November 27, 2018: Physician and Sportsmedicine
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