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Concussion clinic

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By David Rhine MD FRCPC. Emergency medicine. Special interest in concussion management.
Ferdinando Iellamo, Maurizio Volterrani, Alessia Di Gianfrancesco, Chiara Fossati, Maurizio Casasco
Exercise training is increasingly promoted for physical and mental health and represents a major factor in both primary and secondary prevention of cardiovascular (CV) diseases. The beneficial effects of exercise, in part, can be ascribed to adaptations of neural CV regulation through several mechanisms. In this article, we summarize how exercise training affects neural CV regulation and outline the plasticity of neural network in the continuum from cardiac patients to elite athletes.
December 2018: Current Sports Medicine Reports
Margot Putukian, Kaitlin Riegler, Stephanie Amalfe, Jared Bruce, Ruben Echemendia
OBJECTIVES: To evaluate the relationship between preinjury risk factors (RFs) and subsequent occurrence of concussion and examine whether preinjury RFs or postinjury assessments predict clinical recovery in collegiate athletes. METHODS: Risk factors (sex, sport, and self-report history of concussion, migraine, attention-deficit disorder, learning disability, depression, and anxiety) and Sport Concussion Assessment Tool (SCAT), depression/anxiety screenings, and neuropsychological testing were obtained before the season...
December 6, 2018: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
Omar Akhand, Laura J Balcer, Steven L Galetta
PURPOSE OF REVIEW: To review emerging vision-based assessments in the evaluation of concussion. RECENT FINDINGS: Involvement of the visual pathways is common following concussion, the mildest form of traumatic brain injury. The visual system contains widely distributed networks that are prone to neurophysiologic changes after a concussion, resulting in visual symptoms and ocular motor dysfunction. Vision-based testing is increasingly used to improve detection and assess head injury...
November 30, 2018: Current Opinion in Neurology
Christopher Mares, Jehane H Dagher, Mona Harissi-Dagher
The most common symptom of post-concussive syndrome (PCS) is post-traumatic headache (PTH) accompanied by photophobia. Post-traumatic headache is currently categorized as a secondary headache disorder with a clinical phenotype described by its main features and resembling one of the primary headache disorders: tension, migraine, migraine-like cluster. Although PTH is often treated with medication used for primary headache disorders, the underlying mechanism for PTH has yet to be elucidated. The goal of this narrative literature review is to determine the current level of knowledge of these PTHs and photophobia in mild traumatic brain injury (mTBI) in order to guide further research and attempt to discover the underlying mechanism to both symptoms...
December 4, 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
David R Howell, Julie C Wilson, Anna N Brilliant, Andrew J Gardner, Grant L Iverson, William P Meehan
OBJECTIVES: To prospectively evaluate single/dual-task timed-up-and-go (TUG) and tandem gait performance among children and adolescents with concussion and healthy controls. DESIGN: Repeated measures. METHODS: Participants with concussion (n=23; age=14.1±2.5years; 52% female) completed single/dual-task TUG, tandem gait, and symptom assessments 6.7±2.6 and 23.3±6.1days post injury. The control group (n=27; age=14.1±2.3years; 48% female) completed the same protocol initially and 10...
November 22, 2018: Journal of Science and Medicine in Sport
William Johnston, Martin O'Reilly, Ciara Duignan, Mairead Liston, Rod McLoughlin, Garrett F Coughlan, Brian Caulfield
BACKGROUND: Concussion is one of the most common sports-related injuries, with little understood about the modifiable and nonmodifiable risk factors. Researchers have yet to evaluate the association between modifiable sensorimotor function variables and concussive injury. PURPOSE: To investigate the association between dynamic balance performance, a discrete measure of sensorimotor function, and concussive injuries. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3...
December 3, 2018: American Journal of Sports Medicine
Gian-Gabriel Palaci Garcia, Mariel S Lavieri, Ruiwei Jiang, Thomas McAllister, Michael McCrea, Steven P Broglio
Kutcher and Giza suggested incorporating levels of certainty in concussion diagnosis decisions. These guidelines were based on clinical experience rather than objective data. Therefore, we combined data-driven optimization with predictive modeling to identify which athletes are Unlikely to have concussion and classify remaining athletes as Possible, Probable, or Definite concussion by diagnostic certainty. We developed and validated our framework using data from the Concussion Assessment, Research, and Education (CARE) Consortium...
November 28, 2018: Journal of Neurotrauma
Emily Kroshus, Sara P D Chrisman, Kimberly G Harmon, Stanley A Herring, Steven P Broglio, Christina L Master, Catherine A McGill, Margot Putukian, Johna K Register-Mihalik, Frederick P Rivara
OBJECTIVE: Many schools and sports leagues provide preseason concussion education to parents/guardians, and in some jurisdictions, it is required for interscholastic sports participation. However, directives about content are absent or vague. The purpose of this study was to obtain expert consensus about what parents/guardians need to know to about concussion. DESIGN: A modified Delphi process with nationally recognized expert panel members was used to obtain consensus about parent/guardian behaviors relevant to concussion prevention, identification, and management and knowledge domains relevant to performance of those behaviors...
November 20, 2018: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
Sandra M Fox, Paul Koons, Sally H Dang
Visual dysfunctions and symptoms are commonly experienced after even mild traumatic brain injury (TBI) despite excellent visual acuity. All individuals who have experienced a TBI/concussion should be screened for vision symptoms and visual dysfunction. A TBI-specific eye examination is necessary to identify the visual sequelae of TBI and address any vision/ocular issues that may be contributing to other post-TBI complaints. A vision rehabilitation plan that includes vision therapy can improve visual dysfunction secondary to TBI...
February 2019: Physical Medicine and Rehabilitation Clinics of North America
Michael D Cusimano, Stanley Zhang, Jane Topolovec-Vranic, Ashley Grosso, Rowan Jing, Gabriela Ilie
Objective: The goal of this research was to assess the effectiveness of available concussion educational resources in Canada, the means used to disseminate this knowledge and the impact of these educational resources on players' concussion prevention knowledge. Methods: We assessed concussion knowledge before and after exposure to one or more of 19 resources introduced through a national program aimed to increase awareness and knowledge of concussion. The effectiveness of the mode of delivery was measured by changes in concussion knowledge scores (CKS) between pre and pro scores...
2018: Frontiers in Neurology
Daniel M Cushman, Lauren Borowski, Colby Hansen, John Hendrick, Troy Bushman, Masaru Teramoto
OBJECTIVE: To examine the association of commonly prescribed post-concussive medications, namely gabapentin and tricyclic antidepressants (TCAs), with symptom reduction after concussion. BACKGROUND: Concussion is a common diagnosis in modern medicine. Many providers use medication to target the residual symptoms of a concussion, with little evidence supporting their efficacy. DESIGN: Retrospective study with longitudinal analysis using mixed-effects and piecewise regression analyses of 277 patients presenting to an academic sports medicine clinic, all of whom were clinically diagnosed with a concussion...
November 19, 2018: Headache
Melissa S Puffenbarger, Fahd A Ahmad, Michelle Argent, Hongjie Gu, Charles Samson, Kimberly S Quayle, Jacqueline M Saito
OBJECTIVE: The purpose of this study was to determine if implementation of a Pediatric Emergency Care Applied Research Network (PECARN)-based closed head injury assessment tool could safely decrease computed tomography (CT) use for pediatric head injury evaluation at a non-pediatric community emergency department (ED). METHODS: A quality improvement project was initiated at a non-pediatric community ED to implement an institution-specific, Pediatric Emergency Care Applied Research Network (PECARN)-based Pediatric Closed Head Injury Assessment Tool...
November 14, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Michael Fralick, Eric Sy, Adiba Hassan, Matthew J Burke, Elizabeth Mostofsky, Todd Karsies
Importance: Concussion is the most common form of traumatic brain injury (TBI). While most patients fully recover within 1 week of injury, a subset of patients might be at a higher risk of suicide. Objective: To assess the risk of suicide after concussion. Data Sources: We performed a systematic search of Medline (PubMed), Embase, PsycINFO, and Published International Literature on Traumatic Stress (PILOTS) from 1963 to May 1, 2017. We also searched Google Scholar and conference proceedings and contacted experts in the field to seek additional studies...
November 12, 2018: JAMA Neurology
Mohammad N Haider, John J Leddy, William Du, Alexander J Macfarlane, Kaitlin B Viera, Barry S Willer
This article presents a brief, focused physical examination [PE, the Buffalo Concussion Physical Examination (BCPE)] for sport-related concussion (SRC) to be considered for use in the outpatient setting by sports medicine physicians, pediatricians, and primary-care physicians. This companion paper describes how to perform the PE, which was derived in a separate study presented in this journal. It is envisioned for use at the initial and follow-up outpatient visits both for acute concussions and in patients with prolonged symptoms...
November 7, 2018: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
John Leddy, Kevin Lesh, Mohammad N Haider, Natalie Czuczman, John G Baker, Jeffrey Miecznikowski, Barry Willer
OBJECTIVE: To describe the derivation of a brief but pertinent physical examination (PE) for adolescents who have sustained sport-related concussion (SRC). DESIGN: Prospective cohort. SETTING: University concussion management clinic. PARTICIPANTS: Acutely concussed (AC, n = 52, 15.5 ± 1.4 years, 4.4 ± 2 days since injury, 26.2 ± 38 days to recovery, 71% males) and healthy control (HC) adolescents (n = 30, 15.8 ± 1...
October 29, 2018: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
Russell Lane, Paul Davies
AIM: To explore post traumatic headache characteristics and risk factors in compensation claimants by observational retrospective cohort analysis. CASE RESULTS: Medicolegal reports on 116 consecutive compensation claimants aged 41.9 ± 15.0 years were reviewed 21 ± 14 months after injury. Eighty eight had suffered head and neck injuries, 21 reported only neck injury and seven had "other injuries". Ninety four percent of the head injuries were "mild"...
November 8, 2018: Cephalalgia: An International Journal of Headache
Scott L Zuckerman, Benjamin L Brett, Aaron S Jeckell, Aaron M Yengo-Kahn, Gary S Solomon
PURPOSE OF REVIEW: Sport-related concussion (SRC) and mild traumatic brain injury (mTBI) have been thrust into the national spotlight, with youth athletes bearing the burden of this public health problem. The current review aims to provide a practical summary of pediatric SRC, including key terminology, return to play/school, and risk factors for post-concussion syndrome (PCS). RECENT FINDINGS: While the majority of youth athletes recover within 2 to 4 weeks, approximately 10% of athletes experience a protracted recovery with symptoms lasting months, impacting social, scholastic, and sporting activities...
November 5, 2018: Current Neurology and Neuroscience Reports
Andrée-Anne Ledoux, Ken Tang, Keith O Yeates, Martin V Pusic, Kathy Boutis, William R Craig, Jocelyn Gravel, Stephen B Freedman, Isabelle Gagnon, Gerard A Gioia, Martin H Osmond, Roger L Zemek
Importance: The natural progression of symptom change and recovery remains poorly defined in children after concussion. Objectives: To describe the natural progression of symptom change by age group (5-7, 8-12, and 13-18 years) and sex, as well as to develop centile curves to inform families about children after injury recovery. Design, Setting, and Participants: Planned secondary analysis of a prospective multicenter cohort study (Predicting Persistent Postconcussive Problems in Pediatrics)...
November 5, 2018: JAMA Pediatrics
Jessica Wallace, Tracey Covassin, Meghan Lafevor
Purpose: The purpose of this study was to determine whether practicing athletic trainers (ATs) were using the stepwise progression to make return-to-play (RTP) decisions after concussion and to determine what factors influenced their decision to use the stepwise progression. Methods: A total of 166 ATs (response rate = 16.6%) completed a 21-item questionnaire that evaluated participant demographics, methods of concussion management, and RTP decision-making using the stepwise progression...
April 2018: Journal of Sport and Health Science
Emily Kroshus, Christine M Baugh, William P Meehan, Kasisomayajula Viswanath
BACKGROUND: There is increasing focus on the number of concussions after which an athlete should discontinue participating in contact or collision sports. This is a clinically subjective and, in some cases, a preference-sensitive decision. PURPOSE: Our goal was to assess whether there is personal subjectivity in when athletic trainers (ATs) discuss the possibility of sport retirement post-concussion with athletes. METHODS: A national sample of ATs who provide clinical care to college athletes completed a questionnaire (n = 677, 34% response rate)...
July 31, 2018: Social Science & Medicine
2018-10-20 21:32:58
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