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Concussion return to play

Svetlana A Dambinova, Joseph C Maroon, Alicia M Sufrinko, John David Mullins, Eugenia V Alexandrova, Alexander A Potapov
Concussion is a complex, heterogeneous process affecting the brain. Accurate assessment and diagnosis and appropriate management of concussion are essential to ensure that athletes do not prematurely return to play or others to work or active military duty, risking re-injury. To date, clinical diagnosis relies primarily on evaluating subjects for functional impairment using instruments that include neurocognitive testing, subjective symptom report, and neurobehavioral assessments, such as balance and vestibular-ocular reflex testing...
2016: Frontiers in Neurology
Alan J Pearce, Janet A Young, Lucy Parrington, Nicole Aimers
The objective of this study was to explore beliefs and attitudes of students studying exercise science in Australia towards sports concussion. A secondary objective explored differences between gender and previous experience of concussion. A total of 312 participants (m = 217; f = 95) responded to a series of statements ranging across a number of areas including personal attitudes and beliefs towards concussion: if they would risk playing with a concussion; their views on elite/professional athletes who continue to play after a concussion; and attitudes towards rehabilitation...
October 18, 2016: Journal of Sports Sciences
Lauren V Fortington, Dara M Twomey, Caroline F Finch
BACKGROUND: Head injuries, particularly concussion, are a major cause of concern in many sports, particularly the football codes, driving a need to better understand injury mechanisms and potential methods of prevention. The aim of this study was to describe the mechanisms and follow up care of concussion injuries sustained in adult male community Australian football to identify target areas for prevention and management. METHODS: Secondary analysis of injury data collected in a cluster randomised controlled trial in community Australian football across two states of Australia in 2007 and 2008...
December 2015: Injury Epidemiology
A J Gardner, R M N Kohler, C R Levi, G L Iverson
A new concussion interchange rule (CIR) was introduced in 2014 for the National Rugby League and National Youth Competition (NYC). The CIR allows a player suspected of having sustained a concussion to be removed from play and assessed without an interchange being tallied against the player's team. Participants included all NYC players who used the CIR during the 2014 season. 2 raters completed video analysis of 131 (of a total of 156 reported) uses of the CIR, describing injury characteristics, situational factors, and concussion signs...
October 13, 2016: International Journal of Sports Medicine
Sarah Stone, Bobby Lee, J Craig Garrison, Damond Blueitt, Kalyssa Creed
BACKGROUND: Recently, female sports participation has increased, and there is a tendency for women to experience more symptoms and variable presentation after sport-related concussion (SRC). The purpose of this study was to determine whether sex differences exist in time to begin a return-to-play (RTP) progression after an initial SRC. HYPOTHESIS: After initial SRC, female athletes (11-20 years old) would take longer to begin an RTP progression compared with age-matched male athletes...
October 3, 2016: Sports Health
Harold M Olson, Michael J Tunning, Ronnie J Boesch
OBJECTIVE: The purpose of this study is to describe the chiropractic management of a student athlete with postconcussion syndrome. CLINICAL FEATURES: A 14-year-old male hockey player presented to a chiropractic clinic with postconcussion symptoms 13 days after his initial injury. He experienced an occipital headache with a pain rating of 8/10, upset stomach, blurry vision, nausea, dizziness, balance problems, a "foggy feeling," difficulty with concentration, difficulty with memory, fatigue, confusion, drowsiness, and irritability...
September 2016: Journal of Chiropractic Medicine
Dean Cordingley, Richard Girardin, Karen Reimer, Lesley Ritchie, Jeff Leiter, Kelly Russell, Michael J Ellis
OBJECTIVE The objectives of this study were 2-fold: 1) to evaluate the safety, tolerability, and clinical use of graded aerobic treadmill testing in pediatric patients with sports-related concussion (SRC), and 2) to evaluate the clinical outcomes of treatment with a submaximal aerobic exercise program in patients with physiological post-concussion disorder (PCD). METHODS The authors conducted a retrospective chart review of pediatric patients (age < 20 years) with SRC who were referred to a multidisciplinary pediatric concussion program and underwent graded aerobic treadmill testing between October 9, 2014, and February 11, 2016...
September 13, 2016: Journal of Neurosurgery. Pediatrics
Michael J Ellis, John Leddy, Barry Willer
Historically, patients with sports-related concussion (SRC) have been managed in a uniform fashion consisting mostly of prescribed physical and cognitive rest with the expectation that all symptoms will spontaneously resolve with time. Although this approach will result in successful return to school and sports activities in the majority of athletes, an important proportion will develop persistent concussion symptoms characteristic of post-concussion syndrome (PCS). Recent advances in exercise science, neuroimaging, and clinical research suggest that the clinical manifestations of PCS are mediated by unique pathophysiological processes that can be identified by features of the clinical history and physical examination as well as the use of graded aerobic treadmill testing...
2016: Frontiers in Neurology
Michael G Hutchison, Lynda Mainwaring, Arrani Senthinathan, Nathan Churchill, Scott Thomas, Doug Richards
BACKGROUND: Sport-related concussions are associated with a range of physical, cognitive, and behavioral disturbances that are highly variable across individuals. Much remains unknown about the effects of sport concussion, and changes in markers of psychological and physiological stress over the recovery timeline. OBJECTIVE: To examine psychological (mood, stress, sleep quality, and symptoms) and physiological (heart rate variability and salivary cortisol) measures in concussed athletes over clinical recovery milestones...
September 6, 2016: Journal of Head Trauma Rehabilitation
Colin W Fuller, Gordon W Fuller, Simon P T Kemp, Martin Raftery
OBJECTIVE: To evaluate World Rugby's concussion management process during Rugby World Cup (RWC) 2015. DESIGN: A prospective, whole population study. POPULATION: 639 international rugby players representing 20 countries. METHOD: The concussion management process consisted of 3 time-based, multifaceted stages: an initial on-pitch and/or pitch-side assessment of the injury, a follow-up assessment within 3 hours and an assessment at 36-48 hours...
September 1, 2016: British Journal of Sports Medicine
Peter C Fino, Maury A Nussbaum, Per Gunnar Brolinson
Two experiments compared multiple methods of estimating postural stability entropy to address: 1) if postural complexity differences exist between concussed and healthy athletes immediately following return-to-play; 2) which methods best detect such differences; and 3) what is an appropriate interpretation of such differences. First, center of pressure (COP) data were collected from six concussed athletes over the six weeks immediately following their concussion and from 24 healthy athletes. Second, 25 healthy non-athletes performed four quiet standing tasks: normal, co-contracting their lower extremity muscles, performing a cognitive arithmetic task, and voluntarily manipulating their sway...
August 26, 2016: Gait & Posture
Daniel C Herman, Debi Jones, Ashley Harrison, Michael Moser, Susan Tillman, Kevin Farmer, Anthony Pass, James R Clugston, Jorge Hernandez, Terese L Chmielewski
BACKGROUND: Laboratory-based studies on neuromuscular control after concussion and epidemiological studies suggest that concussion may increase the risk of subsequent musculoskeletal injury. OBJECTIVE: The purpose of this study was to determine if athletes have an increased risk of lower extremity musculoskeletal injury after return to play from a concussion. METHODS: Injury data were collected from 2006 to 2013 for men's football and for women's basketball, soccer and lacrosse at a National Collegiate Athletic Association Division I university...
August 20, 2016: Sports Medicine
Anne W Hunt, Luciano De Feo, Jennifer Macintyre, Dayna Greenspoon, Talia Dick, Katherine Mah, Melissa Paniccia, Christine Provvidenza, Nick Reed
BACKGROUND: Concussion is a considerable public health problem in youth. However, identifying, understanding and implementing best evidence informed recovery guidelines may be challenging for families given the vast amount of information available in the public domains (e.g. Internet). The objective of this study was to develop, implement and evaluate the feasibility of an evidence-informed self-management education program for concussion recovery in youth. METHODS: Synthesis of best evidence, principles of knowledge translation and exchange, and expert opinion were integrated within a self-management program framework to develop a comprehensive curriculum...
2016: BMC Health Services Research
Richelle Mychasiuk, Harleen Hehar, Irene Ma, Sydney Candy, Michael J Esser
Despite the most common form of brain injury, there has been little progress in the prognosis and treatment of concussion/mild traumatic brain injury (mTBI). Current 'return-to-play' guidelines are conservative, deterring the initiation of physical and social activity until patients are asymptomatic; but the effects of post-injury exercise have not been adequately investigated. Therefore, this study examined the effects of voluntary exercise on concussion recovery. Using a translational rodent model of concussion, we examined the influence of exercise on injury-associated behaviours that comprise post-concussive syndrome (PCS) and gene expression changes (bdnf, dnmt1, Igf-1, pgc1-a, Tert) in prefrontal cortex and hippocampus...
October 2016: European Journal of Neuroscience
Mary R Newsome, Xiaoqi Li, Xiaodi Lin, Elisabeth A Wilde, Summer Ott, Brian Biekman, Jill V Hunter, Pramod K Dash, Brian A Taylor, Harvey S Levin
Recovery following sports-related concussion (SRC) is slower and often more complicated in young adolescent athletes than in collegiate players. Further, the clinical decision to return to play is currently based on symptoms and cognitive performance without direct knowledge of brain function. We tested the hypothesis that brain functional connectivity (FC) would be aberrant in recently concussed, asymptomatic athletes who had been cleared to return to play. A seed-based FC analysis measured the FC of the default mode network (DMN) (seeds = anterior cingulate cortex, posterior cingulate cortex (PCC), right lateral parietal cortex, and left lateral parietal cortex) 30 days after SRC in asymptomatic high school athletes cleared to return to play (n = 13) and was compared to the FC of high school athletes with orthopedic injury (OI) (n = 13)...
2016: Frontiers in Neurology
Kathryn J Schneider
Concussion is one of the most common injuries in sport and recreation today. Reports of concussion have increased in recent years, likely due to increased societal awareness and the risk of longer-term sequelae. Presently, treatment includes a period of prescribed rest in the acute period following injury, followed by a protocol of graded exertion. Despite an initial period of rest and attempts at a gradual return to play, up to 30% of individuals may have ongoing symptoms past the acute period. The goal of this viewpoint is to introduce the reader to the most common symptoms of concussion and the need for a new, more active paradigm during treatment...
August 2016: Journal of Orthopaedic and Sports Physical Therapy
Tad Seifert
With regard to persistent posttraumatic headache, there is legitimate concern that duration of symptoms may have an impact on the efficacy of future treatment attempts. Without neuropathologic confirmation, a clinical diagnosis of chronic traumatic encephalopathy cannot be made with a high degree of confidence. Sport-related headaches are challenging in a return-to-play context, because it is often unclear whether an athlete has an exacerbation of a primary headache disorder, has new-onset headache unrelated to trauma, or is in the recovery phase after concussion...
August 2016: Neurologic Clinics
Loren A McLendon, Stephen F Kralik, Patricia A Grayson, Meredith R Golomb
BACKGROUND: Second impact syndrome is a devastating injury that primarily affects athletic children and young adults. It occurs when a second concussion occurs before symptoms from the first concussion have resolved. Diffuse and often catastrophic cerebral edema results. Reports of second impact syndrome are few, and some argue that second impact syndrome is simply diffuse cerebral swelling unrelated to the first concussion. METHODS: Ovid and PubMed were searched from years 1946 to 2015 using the terms "second impact syndrome," "repeat concussion," and "catastrophic brain injury...
September 2016: Pediatric Neurology
Kirstin Weerdenburg, Suzan Schneeweiss, Ellen Koo, Kathy Boutis
OBJECTIVES: To determine the sensitivity of parental suspicion of concussion relative to paediatric emergency physicians in children who presented to an emergency department (ED) with a head injury. A secondary objective was to examine the variables associated with parental suspicion of concussion concordant with that of a physician. METHODS: Parents of children five to 18 years of age presenting to an urban paediatric ED with a nonstructural head injury completed a 24-item questionnaire...
April 2016: Paediatrics & Child Health
Arrani Senthinathan, Lynda M Mainwaring, Michael Hutchison
OBJECTIVE: To assess heart rate variability (HRV) in athletes with concussion across three phases of recovery. DESIGN: A prospective matched control group design included the collection of HRV and symptoms measured by the Rivermead Post-Concussion Questionnaire. These measures were taken at 3 phases of recovery [(1) symptomatic; (2). asymptomatic; and (3) one-week after return-to-play (RTP)]. The same protocol was completed by noninjured athletes. SETTING: Interuniversity sports teams at a single institution...
July 1, 2016: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
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