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Concussion management

Jérôme Gauvin-Lepage, Debbie Friedman, Lisa Grilli, Maria Sufrategui, Carol De Matteo, Grant L Iverson, Isabelle Gagnon
OBJECTIVE: (1) To determine the impact of providing participants aged 8 to 17 years who are slow to recover after a concussion with a well-developed active rehabilitation intervention (ARI), compared with receiving standard care alone, on postconcussion symptoms (PCS) at 2 and 6 weeks after the initiation of ARI; and (2) to investigate functional recovery 6 weeks after initiation of ARI. DESIGN: A multicenter prospective quasi-experimental control group design. SETTING: Tertiary care pediatric trauma center and community health care providers...
August 8, 2018: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
Trevor Roiger, Rebecca Cover, Mary Beth Zwart
CONTEXT:   Concussions remain misunderstood, underreported, and undiagnosed. Although most concussion symptoms resolve within 2 weeks, some patients experience persistent symptoms that adversely affect physical, emotional, social, or cognitive functioning or a combination of these. Minimal evidence delineating the effect of concussions on recently retired collegiate athletes currently exists. OBJECTIVE:   To examine the lived experiences of retired collegiate athletes with a history of 1 or more concussions to discern individual concussion histories, knowledge and perceptions of concussions, and postconcussion quality of life...
August 10, 2018: Journal of Athletic Training
John G Baker, John J Leddy, Andrea L Hinds, Jennifer Shucard, Tania Sharma, Sergio Hernandez, Joel Durinka, Robert Zivadinov, Barry S Willer
OBJECTIVE: To test the hypothesis that mild cognitive impairment (MCI) rates are higher among retired professional contact sport athletes than in noncontact athlete controls and compare history of contact sports with other MCI risk factors. SETTING: University Concussion Management Clinic. PARTICIPANTS: Twenty-one retired National Football League and National Hockey League players and 21 aged-matched noncontact athlete controls. DESIGNS: Case-control...
August 3, 2018: Journal of Head Trauma Rehabilitation
Barry S Willer, Michael Tiso, Mohammad N Haider, Andrea L Hinds, John G Baker, Jeffery C Miecznikowski, John J Leddy
OBJECTIVE: To compare retired professional contact sport athletes with age-matched noncontact sport athletes on measures of executive function and mental health. SETTING: The University Concussion Management Clinic. PARTICIPANTS: Twenty-one retired National Football League (NFL) and National Hockey League (NHL) players (mean age 56 years) and 21 age-matched noncontact sport athlete controls. DESIGNS: Case control. MAIN MEASURE: The self- and informant-reported Behavior Rating Inventory of Executive Function-Adult form (BRIEF-A); Wisconsin Card Sorting Test; Delis-Kaplan Executive Function System; Trail Making Part A and B; Wechsler Adult Intelligence Scale; Neuropsychological Assessment Battery; List Learning; Controlled Oral Word Association Test; Beck Depression Inventory; Beck Anxiety Inventory; and Personality Inventory of the DSM-5...
August 3, 2018: Journal of Head Trauma Rehabilitation
Barry Willer, Robert Zivadinov, Mohammad N Haider, Jeffrey C Miecznikowski, John J Leddy
OBJECTIVE: To provide an overview of 3 studies of the same population of retired professional contact sport athletes compared with age-matched noncontact sport athlete controls on cognition, executive function, behavior, and advanced brain imaging. SETTING: University Concussion Management Clinic. PARTICIPANTS: Twenty-two retired professional hockey and football athletes (average age 56 years) and 21 age-matched noncontact sport athlete controls...
August 3, 2018: Journal of Head Trauma Rehabilitation
M Byrd, C E Dixon, B Lucke-Wold
Concussion in athletes can contribute to early neuropsychological changes that may be indicative of future neurodegenerative disease. One of the hallmark findings of chronic traumatic encephalopathy is anxiety and impulsive behavior that often develops early in the course of the disease. The behavioral dysfunction can be grouped into a broader category referred to as cognitive disruption. The current gold standard for diagnosing chronic neurodegeneration is post-mortem evaluation of tauopathy to identify neurofibrillary tau tangles in neurons...
May 2018: Journal of Neurology and Psychology
Ann Mansur, Tyler M Hauer, Mohammed Wasif Hussain, Mohammed K Alatwi, Apameh Tarazi, Mozhgan Khodadadi, Charles H Tator
Liquid crystal display (LCD) screens refresh at a rate of 60 times per second, which can be perceived by concussed individuals who have photosensitivity, leading to computer intolerance. A non-LCD computer screen that refreshes at a much lower rate could relieve this photosensitivity and computer screen intolerance in patients with post-concussion syndrome (PCS). Twenty-nine patients with PCS, computer intolerance, and photosensitivity performed a reading task for a maximum of 30 min, with an LCD computer or a non-LCD device, and were given a comprehension test after completion of the reading task...
August 15, 2018: Journal of Neurotrauma
April L McPherson, Takashi Nagai, Kate E Webster, Timothy E Hewett
BACKGROUND: Clinical management of sport-related concussion typically involves a symptom checklist, clinical examination of mental status, and neurocognitive testing. However, recent studies have identified unresolved, impaired sensorimotor function after athletes return to sport. A review and meta-analysis of all current literature regarding risk of subsequent musculoskeletal (MSK) injury after concussion has yet to be published in the medical literature. Purpose/Hypothesis: To determine the odds that athletes will sustain MSK injury after concussion...
August 3, 2018: American Journal of Sports Medicine
Cheryl K Zogg, R Sterling Haring, Likang Xu, Joseph K Canner, Taylor D Ottesen, Ali Salim, Adil H Haider, Eric B Schneider
BACKGROUND: While deaths, hospitalizations, and emergency department visits for head trauma are well understood, little is known about presentations in outpatient settings. Our objective was to examine the epidemiology and extent of healthcare-seeking adult (18-64y) head trauma patients presenting in outpatient settings compared to patients receiving non-hospitalized emergency department care. METHODS: We used 2004-2013 MarketScan Medicaid/commercial claims to identify head trauma patients managed in outpatient settings (primary care provider, urgent care) and the emergency department...
July 30, 2018: Epidemiology
Daniel M Costello, Andrew H Kaye, Terence J O'Brien, Sandy R Shultz
Sport-related concussion is a common form of mild traumatic brain injury that is now recognised as a serious health issue. Growing evidence suggests concussion may result in long-term and severe neurological disabilities. Recent research into the diagnosis and management of concussion may provide new approaches to concussion management that limit the potential long-term adverse effects of concussion. This paper summarises the problem of sport-related concussion and reviews key factors (sex, age, genetics) that may modify concussion outcomes...
July 25, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Elizabeth A Beverly, Todd R Fredricks, Andrew Leubitz, Benjamin R Oldach, Daniel Kana, Michael D Grant, Jonathon Whipps, Emily H Guseman
BACKGROUND: Despite the risks, concussion symptoms often go underreported by athletes, leading to delayed or forgone treatment and increased potential for concussion recurrence. One of the most serious long-term consequences of sports-related concussions is Chronic Traumatic Encephelopathy (CTE), a disorder associated with progressive neurological deterioration. The purpose of this study was to explore former collegiate athletes' understanding of concussions and motivations behind concussion non-disclosure in order to better assist family medicine providers in screening for and managing a history of concussions...
July 27, 2018: BMC Family Practice
Kelli B Gunter, Christopher J Shields, Summer D Ott, Rogelio A Coronado
Study Design Case report. Background Equestrian riding is a sport with a high risk of concussion. Currently, the literature guiding rehabilitation for concussions in equestrian athletes is limited, especially for directing return to sport. Case Description A 14-year-old female equestrian athlete presented to physical therapy following her third concussion in three years. Her primary complaints were headaches, dizziness, difficulty concentrating, light sensitivity, and neck pain. On examination, the patient demonstrated reproduction of symptoms during testing of vestibular-ocular reflex (VOR), showed a 3-line symptomatic loss on the Dynamic Visual Acuity Test (DVAT), and had impairments in the Joint Position Error (JPE) test (1/5 correct on the left; 4/5 correct on the right) and Balance Error Scoring System (BESS) (38/60 errors)...
July 27, 2018: Journal of Orthopaedic and Sports Physical Therapy
Arnold Huurnink, Duncan P Fransz, Vosse A de Boode, Idsart Kingma, Jaap H van Dieën
Huurnink, A, Fransz, DP, de Boode, VA, Kingma, I, and van Dieën, JH. Age-matched z-scores for longitudinal monitoring of center of pressure speed in single-leg stance performance in elite male youth soccer players. J Strength Cond Res XX(X): 000-000, 2018-Coordination of corrective motor actions is considered important for soccer performance and injury prevention. A single-leg stance (SLS) test assesses the integrity and proficiency of the sensorimotor control system, quantified by center of pressure averaged speed (COPspeed)...
July 26, 2018: Journal of Strength and Conditioning Research
Sean P Patrick, Lindsay A Gaudet, Lynette D Krebs, Thane Chambers, Brian H Rowe
Objectives: Mild traumatic brain injury (mTBI) is the most common emergency department (ED) brain injury presentation worldwide. Despite its frequency, practice variation and care gaps exist among emergency physicians (EPs) in diagnosing and appropriately managing mTBI in the ED. The objective of this review was to identify mTBI-specific training undertaken to improve the detection and management of mTBIs by EPs and its impact on practice. Methods: A comprehensive search strategy utilized four bibliographic databases, the gray literature and the keywords concussion, mild traumatic brain injury, medical education, and continuing medical education (CME)...
October 2017: AEM education and training
John Neidecker, Nitin K Sethi, Randolph Taylor, Raymond Monsell, Don Muzzi, Bruce Spizler, Larry Lovelace, Edmund Ayoub, Rick Weinstein, Joseph Estwanik, Patricio Reyes, Robert C Cantu, Barry Jordan, Margaret Goodman, John W Stiller, Jonathan Gelber, Robert Boltuch, Domenic Coletta, Angela Gagliardi, Stephen Gelfman, Patrick Golden, Nicholas Rizzo, Paul Wallace, Allan Fields, Calvin Inalsingh
Various organisations and experts have published numerous statements and recommendations regarding different aspects of sports-related concussion including definition, presentation, treatment, management and return to play guidelines.1-7 To date, there have been no written consensus statements specific for combat sports regarding management of combatants who have suffered a concussion or for return to competition after a concussion. In combat sports, head contact is an objective of the sport itself. Accordingly, management and treatment of concussion in combat sports should, and must, be more stringent than for non-combat sports counterparts...
July 26, 2018: British Journal of Sports Medicine
Anne W Hunt, Dylan Laupacis, Emily Kawaguchi, Dayna Greenspoon, Nick Reed
OBJECTIVE: To identify key ingredients in a six-week active rehabilitation intervention from the perspectives of youth recovering from concussion and their parents. METHODS: Surveys with open- and closed-ended questions were administered to youth (N = 38) ages 10-18 years (average = 14.5 years) and their parents (n = 36) immediately post intervention. Descriptive statistics and thematic analysis were used to analyse data. RESULTS: One hundred percent (N = 38) of youth and 100% (N = 36) of parents reported that the active rehabilitation intervention was helpful...
July 26, 2018: Brain Injury: [BI]
Peter C Fino, Jennifer Wilhelm, Lucy Parrington, Samuel Stuart, James C Chesnutt, Laurie A King
OBJECTIVE: To examine whether horizontal head turns while seated or while walking, when instrumented with inertial sensors, were sensitive to the acute effects of concussion and whether horizontal head turns had utility for concussion management. SETTING: Applied field setting, athletic training room. PARTICIPANTS: Twenty-four collegiate athletes with sports-related concussion and 25 healthy control athletes. DESIGN: Case-control; longitudinal...
July 24, 2018: Journal of Head Trauma Rehabilitation
Jennifer Kosoy, Ronald Feinstein
Learning about concussion diagnosis and management is important for all individuals who will be taking care of young athletes. There are about 1.7million reported concussions per year, and, of these, about 20% are sports related. There are risks in all sports, but the highest rates of concussions are from football, rugby, and hockey, with soccer being the highest cause for girls. An on-field assessment includes evaluating airway, breathing, and circulation, followed by cervical spine assessment. Then, concussion evaluation tools can be used to aid in making the diagnosis...
July 14, 2018: Current Problems in Pediatric and Adolescent Health Care
Alissa Wicklund, Shayla D Foster, Ashley A Roy
CONTEXT:   Despite a high incidence of injury in their sport, rodeo athletes have been underrepresented in the concussion literature. No standard postconcussion protocols are available across rodeo organizations for evaluating fitness to return to competition. OBJECTIVE:   To review the literature on concussion in rodeo, examine published guidelines, and offer an active return-to-play (RTP) protocol specific to rodeo athletes. BACKGROUND:   Unique barriers complicate the management and treatment of rodeo athletes with concussion, such as the solo nature of the sport, lack of consistent access to health care professionals, and athletic conditioning that often occurs outside of a traditional gym-based exercise regimen...
July 11, 2018: Journal of Athletic Training
Zachary Y Kerr, Johna K Register-Mihalik, Juliet Haarbauer-Krupa, Emily Kroshus, Vivian Go, Paula Gildner, K Hunter Byrd, Stephen W Marshall
Behavioral interventions to increase disclosure and proper management of concussion in youth sports have unrealized potential when it comes to preventing concussion. Interventions have focused on changing individual athlete behavior and have fallen short of the potential for sustained systemic behavioral change. One potentially critical reason for this shortfall is that other key determinants of risk behaviors at all levels of the socio-ecological model (e.g. interpersonal, community, policy) are not addressed in extant programming...
July 9, 2018: Injury Epidemiology
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