Journal articles on the topic 'History of concussion'
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Collins, Michael W., Mark R. Lovell, Grant L. Iverson, Robert C. Cantu, Joseph C. Maroon, and Melvin Field. "Cumulative Effects of Concussion in High School Athletes." Neurosurgery 51, no. 5 (November 1, 2002): 1175–81. http://dx.doi.org/10.1097/00006123-200211000-00011.
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Abstract OBJECTIVE A common assumption in sports medicine is that a history of concussion is predictive of a lower threshold for, as well as a worse outcome after, subsequent concussive injury. The current study was conducted to investigate the relationship between concussion history in high school athletes and the on-field presentation of symptoms after subsequent concussion. METHODS One hundred seventy-three athletes who experienced sports-related concussion composed the initial study group. Binary groups were subsequently created on the basis of concussion history. Sixty athletes with no concussion history were compared with 28 athletes with a history of three or more concussions. The groups were compared in terms of the on-field presentation of symptoms after an in-study concussion. Dependent variables included the postinjury presence of loss of consciousness, anterograde amnesia, retrograde amnesia, and confusion. RESULTS Athletes with three or more prior concussions were more likely to experience on-field positive loss of consciousness (χ2 = 8.0, P = 0.005), anterograde amnesia (χ2 = 5.5, P = 0.019), and confusion (χ2 = 5.1, P = 0.024) after a subsequent cerebral concussion. An odds ratio revealed that athletes with a history of three concussions were 9.3 times more likely than athletes with no history of concussion to demonstrate three to four abnormal on-field markers of concussion severity. CONCLUSION This study is the first to suggest a cumulative effect of concussion in high school athletes. A more severe on-field presentation of concussion markers is evidenced in high school athletes with a pronounced history of concussion. This study's findings highlight the need for more long-term outcome studies in high school athletes who sustain sports-related concussions.
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Cover, Rebecca, Trevor Roiger, and Mary Beth Zwart. "The Lived Experiences of Retired Collegiate Athletes With a History of 1 or More Concussions." Journal of Athletic Training 53, no. 7 (July 1, 2018): 646–56. http://dx.doi.org/10.4085/1062-6050-338-17.
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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.Design: Qualitative study.Setting: Telephone interviews.Patients or Other Participants: Former National Collegiate Athletic Association Division I athletes (n = 14) with a history of 1 or more concussions and retired from 1 to 5 years.Data Collection and Analysis: Fourteen semistructured telephone interviews (8 men and 6 women) were audiotaped. Interviews were transcribed and inductively analyzed by 3 athletic trainers with 34 combined years of professional experience. Themes were negotiated through consensual review. Participant checks were completed to ensure trustworthiness of the findings.Results: Participants sustained their first concussion during adolescence and often experienced difficulties transitioning back into the postconcussion academic environment. Judgments of injury severity were clearly evident in participants' knowledge and perceptions of concussions. Participants experienced an array of emotional, physical, cognitive, and social challenges during the immediate postconcussion period but did not feel their concussion history decreased their current quality of life.Conclusions: Adolescent exposure to concussions is of concern due to the risk imposed on the developing brain and the potential for adverse outcomes later in life. Although a graduated return to play is heavily emphasized in concussion management, researchers need to investigate barriers inhibiting the implementation of return-to-learn protocols. Concussion education should aim to modify indifferent attitudes toward concussive injuries. Additionally, investigators should continue to assess how a history of concussion affects quality of life in recently retired collegiate athletes.
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Post, Andrew, T. Blaine Hoshizaki, Michael D. Gilchrist, David Koncan, Lauren Dawson, Wesley Chen, Andrée-Anne Ledoux, Roger Zemek, and _. _. "A comparison in a youth population between those with and without a history of concussion using biomechanical reconstruction." Journal of Neurosurgery: Pediatrics 19, no. 4 (April 2017): 502–10. http://dx.doi.org/10.3171/2016.10.peds16449.
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OBJECTIVE Concussion is a common topic of research as a result of the short- and long-term effects it can have on the affected individual. Of particular interest is whether previous concussions can lead to a biomechanical susceptibility, or vulnerability, to incurring further head injuries, particularly for youth populations. The purpose of this research was to compare the impact biomechanics of a concussive event in terms of acceleration and brain strains of 2 groups of youths: those who had incurred a previous concussion and those who had not. It was hypothesized that the youths with a history of concussion would have lower-magnitude biomechanical impact measures than those who had never suffered a previous concussion. METHODS Youths who had suffered a concussion were recruited from emergency departments across Canada. This pool of patients was then separated into 2 categories based on their history of concussion: those who had incurred 1 or more previous concussions, and those who had never suffered a concussion. The impact event that resulted in the brain injury was reconstructed biomechanically using computational, physical, and finite element modeling techniques. The output of the events was measured in biomechanical parameters such as energy, force, acceleration, and brain tissue strain to determine if those patients who had a previous concussion sustained a brain injury at lower magnitudes than those who had no previously reported concussion. RESULTS The results demonstrated that there was no biomechanical variable that could distinguish between the concussion groups with a history of concussion versus no history of concussion. CONCLUSIONS The results suggest that there is no measureable biomechanical vulnerability to head impact related to a history of concussions in this youth population. This may be a reflection of the long time between the previous concussion and the one reconstructed in the laboratory, where such a long period has been associated with recovery from injury.
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Hunzinger, Katie, Katelyn Costantini, Kelsey Bryk, Thomas Buckley, and C. Buz Swanik. "Preliminary Concussion and Lower Extremity Injury Risk Among R.O.T.C. Cadets." Neurology 93, no. 14 Supplement 1 (September 30, 2019): S4.1—S4. http://dx.doi.org/10.1212/01.wnl.0000580860.46940.2f.
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ObjectiveTo examine the association between concussions and lower extremity musculoskeletal injury (LE-MSI) rates in Reserve Officer Training Corps (ROTC) cadets.BackgroundConcussions have been associated with an increased risk for LE-MSI among high school, collegiate, and professional athletes as well as U.S. Army Soldiers. However, there is a paucity evidence on this relationship among U.S. Army ROTC cadets, future U.S. Army Officers, and a group similar to student-athletes in regards to physical activity levels.Design/MethodsA modified reliable injury questionnaire (ICC = 0.92) was used to identify the total number of reported concussions, intentionally unreported concussions, and potentially unrecognized concussions (e.g., memory loss not diagnosed as a concussion) as well as LE-MSI (e.g., muscle strains, ACL rupture) a cadet had suffered. A chi-square analysis was performed to identify the association between concussion and LE-MSI and any concussive injury and LE-MSI.Results47 cadets (19.9 ± 1.3 years) were recruited from one Army ROTC program. There was not a significant association between reported concussions and LE-MSI (Χ(1) = 3.122, p = 0.077). There was not a significant association between any concussive injury (reported, unreported, or potentially unrecognized) and LE-MSI (Χ(1) = 3.590, p = 0.058). The reported concussion history was 38.3% (18/47), any concussive history was 46.8% (22/47), and 68.1% (32/47) reported history of LE-MSI.ConclusionsPreliminary results showed that there was no statistically significant association between concussion and LE-MSI among ROTC cadets at this university. Future research is warranted on a larger cohort of cadets to determine if this relationship exists since cadets will soon commission, potentially risking injury while serving on active duty, causing limited duty days, reduced Department of Defense readiness, and increased healthcare costs. Cadets showed a high incidence of concussion and LE-MSK injury, and future research should target reducing these injuries among ROTC cadets prior to commissioning.
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Kay, Melissa C., Johna K. Register-Mihalik, Cassie B. Ford, Richelle M. Williams, and Tamara C. Valovich McLeod. "Parents’ and Child’s Concussion History as Predictors of Parental Attitudes and Knowledge of Concussion Recognition and Response." Orthopaedic Journal of Sports Medicine 5, no. 12 (December 1, 2017): 232596711774237. http://dx.doi.org/10.1177/2325967117742370.
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Background: Parents’ knowledge of and attitudes toward concussions are often vital factors that affect care for injured adolescent athletes. It is important to understand the role that parents’ personal experiences with concussions play with regard to current concussion knowledge and attitudes so that clinicians may tailor their educational approaches. Purpose/Hypothesis: The purpose of this study was to determine an association between parents’ personal experiences and their child’s experiences with concussions as well as parental concussion knowledge and attitudes. We hypothesized that parents who have personally experienced symptoms or have a child who has experienced symptoms would have better knowledge and more favorable attitudes toward concussions. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Parents of youth sport athletes (N = 234 [82 male, 144 female, 8 unreported]; mean age, 44.0 ± 6.3 years) completed a prevalidated survey for concussion knowledge (maximum score possible, 29) and attitudes (maximum score possible, 49). Higher scores indicated better knowledge and more favorable attitudes toward concussive injuries. Parents reported the frequency of concussion diagnoses and/or experiences of concussion-related symptoms and whether their child had suffered a diagnosed concussion or experienced concussion symptoms (yes/no). Spearman rank correlation and multivariable regression were used to examine the association between experience of symptom clusters (self or child) and concussion knowledge and attitudes. Results: Knowledge was moderate (mean, 23.3 ± 2.5 of 29), while attitudes prioritized disclosure (mean, 46.3 ± 3.7 of 49). Parents’ experience of the sleep-arousal symptom cluster was positively associated with concussion attitudes ( r = 0.22, P = .002; β = –3.301, P = .011). Parents with children who experienced sleep-arousal and vestibular-somatic symptom clusters were weakly associated with parental concussion knowledge (sleep-arousal: r = 0.15, P = .041; vestibular-somatic: r = 0.17, P = .020; β = 0.540, P = .012). Conclusion: Our findings suggest that parents’ personal experiences with concussion-related symptoms have little effect on parental knowledge and attitudes as a whole. However, clinicians should consider particular symptom clusters that may provide insight into targets for future concussion education. According to these findings, parents of youth sport participants would benefit from increased concussion education focusing on the types of symptoms as well as the consequences of suffering a concussion.
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Sandino, Adriana, Jordan Milano, Breton M. Asken, Russell M. Bauer, and Jessica Bove. "A-185 Influence of Improved Lifetime TBI History Ascertainment on Clinical Outcomes." Archives of Clinical Neuropsychology 37, no. 6 (August 17, 2022): 1340. http://dx.doi.org/10.1093/arclin/acac060.185.
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Abstract Objective: History of TBI/concussion earlier in life may have implications for long-term health. It is important to understand factors that influence retrospective reports of TBI/concussion history in the clinic. We examined whether providing a formal TBI/concussion definition affected self-reported TBI/concussion history and evaluated association of TBI/concussion history with current mood symptoms. Methods: Participants were 12 individuals (5 M, 7 F, average age = 40.4) seen in an interdisciplinary TBI/concussion clinic. Non-parametric Mann-Whitney-Wilcoxon tests compared the total number of reported TBI/concussions before and after providing patients a formalized definition for TBI/concussion in the overall sample and then separately for males and females. A secondary analysis used Pearson’s correlation to examine the relationship between total number of TBI/concussions and self-reported anxiety using Generalized Anxiety Disorder (GAD-7) total score. Results: Participants reported an average of 3.1 more concussions after being informed of the definition of a TBI/concussion. This result was primarily seen in men, who reported 5.8 more TBI/concussions (women = 0.5 more TBI/concussions) after the definition was provided (W = 1.5, p = 0.05). Further, there was a positive, strong correlation between total number of reported lifetime concussions post TBI/concussion definition and anxiety severity (r = 0.67, p = 0.05). Conclusions: Providing a definition of TBI/concussion increases reports of lifetime concussion, primarily in males. Higher trait anxiety may also be associated with self-reported concussion history. Larger sample sizes are needed to better understand factors that drive retrospective injury reports in those who seek concussion care.
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Cantarero, Gabriela, Jake Choynowski, Maria St. Pierre, Manuel Anaya, Matthew Statton, William Stokes, Vincent Capaldi, Vikram Chib, and Pablo Celnik. "Repeated Concussions Impair Behavioral and Neurophysiological Changes in the Motor Learning System." Neurorehabilitation and Neural Repair 34, no. 9 (July 29, 2020): 804–13. http://dx.doi.org/10.1177/1545968320943578.
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Background. Concussions affect nearly 3 million people a year and are the leading cause of traumatic brain injury–related emergency department visits among youth. Evidence shows neuromotor regions are sensitive to concussive events and that motor symptoms may be the earliest clinical manifestations of neurodegenerative traumatic brain injuries. However, little is known about the effects repeated concussions play on motor learning. Namely, how does concussion acuity (time since injury) affect different behavioral and neurophysiological components of motor learning? Methods. Using a 3-pronged approach, we assessed (1) behavioral measures of motor learning, (2) neurophysiological measures underlying retention of motor learning known as occlusion, and (3) quantitative survey data capturing affective symptoms of each participant. Collegiate student athletes were stratified across 3 groups depending on their concussion history: (1) NonCon, no history of concussion; (2) Chronic, chronic-state of concussion (>1 year postinjury), or (3) Acute, acute state of concussion (<2 weeks postinjury). Results. We found that athletes in both the acute and chronic state of injury following a concussion had impaired retention and aberrant occlusion in motor skill learning as compared with athletes with no history of concussion. Moreover, higher numbers of previous concussions (regardless of the time since injury) correlated with more severe behavioral and neurophysiological motor impairments by specifically hindering neurophysiological mechanisms of learning to affect behavior. Conclusions. These results indicate the presence of motor learning impairment that is evident within 2 weeks postinjury. Our findings have significant implications for the prognosis of concussion and emphasize the need for prevention, but can also direct more relevant rehabilitation treatment targets.
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Tran, Vi, Spencer Walser, Jeff Wayland, Adam Elwood, and Jose H. Posas. "Catching the snitch or the consequences? Profiling incidence of concussions in Quidditch players." Neurology 91, no. 23 Supplement 1 (December 4, 2018): S24.3—S25. http://dx.doi.org/10.1212/01.wnl.0000550653.12040.a6.
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BackgroundConcussions are caused by a blow to or a violent shaking of the head or body. With increasing popularity of novel sports, such as Quidditch inspired by the Harry Potter series, it is suspected that players are commonly misdiagnosed or not seeking treatment after suffering a concussion. Here, we look at the incidence of concussion in Quidditch players.Materials/methodsAfter obtaining IRB approval we conducted an anonymous cross-sectional survey amongst players in the Major League Quidditch for the 2017 season. The survey included questions corresponding to demographics, previous medical history specific to concussions, migraines, co-morbidities, and suspected concussions whilst engaging in Quidditch.ResultsFour hundred sixty-four players were contacted via email with 34% response rate. Of 34%, 96.2% previously engaged in sports either high school or collegiate level. Twenty-six percent of males and 29% of females reported having previously medically diagnosed concussions outside of Quidditch. Fifteen percent reported never hitting their head during a Quidditch match while 19% indicated more than 10 total head injuries. Twenty-five percent of players reported a medically confirmed concussion during play, with 20% indicating a suspected concussion without medical evaluation. Thirty-four percent reported a history of depression or anxiety with 21 players reporting a history of migraines. Those with confirmed head injuries or suspected concussion, 39% indicated that they sought medical treatment while 24% responded that they did not.ConclusionMajority of Quidditch players reported having suffered a concussion prior to playing while half reported suffering a confirmed or suspected concussion during a game. Players were divided on seeking treatment. It is well documented that history of migraines or other comorbidities combined with multiple concussions leads to longer recovery times as well as higher rates of post-concussive syndrome. With the growing rate of traumatic brain injuries, it is imperative that players are diagnosed and treated to prevent future consequences.
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Covassin, Tracey, David Stearne, and Robert Elbin. "Concussion History and Postconcussion Neurocognitive Performance and Symptoms in Collegiate Athletes." Journal of Athletic Training 43, no. 2 (March 1, 2008): 119–24. http://dx.doi.org/10.4085/1062-6050-43.2.119.
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Abstract Context: Athletes are at an inherent risk for sustaining concussions. Research examining the long-term consequences of sport-related concussion has been inconsistent in demonstrating lingering neurocognitive decrements that may be associated with a previous history of concussion. Objective: To determine the relationship between concussion history and postconcussion neurocognitive performance and symptoms in collegiate athletes. Design: Repeated-measures design. Setting: Multi-center analysis of collegiate athletes. Patients or Other Participants: Fifty-seven concussed collegiate athletes (36 without concussion history, 21 with a history of 2 or more concussions). Intervention(s): All subjects were administered an Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test battery, which measures verbal memory, visual memory, reaction time, and visual processing speed and 22 concussion symptoms. Main Outcome Measure(s): Subjects who sustained a concussion were administered 2 follow-up tests at days 1 and 5 postinjury. Independent variables were history of concussion (no history of concussion, 2 or more concussions) and time (baseline, day 1 postconcussion, or day 5 postconcussion). Results: A within-subjects effect (time) on ImPACT performance (P < .001), a between-subjects multivariate effect of group (P < .001), and a group-by-time interaction (P = .034) were noted. Athletes with a concussion history performed significantly worse on verbal memory (P = .01) and reaction time (P = .023) at day 5 postconcussion compared with athletes who did not report a previous concussion. No significant group differences were seen at day 5 postinjury on visual memory (P = .167), processing speed (P = .179), or total concussion symptoms (P = .87). Conclusions: Concussed collegiate athletes with a history of 2 or more concussions took longer to recover verbal memory and reaction time than athletes without a history of concussion.
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Chen, Jian, Bruce Oddson, and Heather C. Gilbert. "Differential Effect of Recurrent Concussions on Symptom Clusters in Sport Concussion Assessment Tool." Journal of Sport Rehabilitation 28, no. 7 (September 1, 2019): 735–39. http://dx.doi.org/10.1123/jsr.2018-0166.
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Context: Symptom checklist in Sport Concussion Assessment Tool has been widely used in preseason assessment and in concussion diagnosis, but the impact of prior concussions on the graded symptoms after a new concussion has not been evaluated. Objective: This study was undertaken to examine reported symptoms associated with recurrent concussions using data of a comprehensive survey among athletes. Design: Retrospective survey and cross-sectional study. Setting: College athletes. Participants: Student athletes who sustained one or more concussions. Main Outcome Measures: Concussion history and graded symptoms of the most recent concussion at time of the survey were surveyed. The impact of prior concussions was examined over symptoms and aggregated symptoms. Results: Multiple concussions were associated with greater reporting of individual symptoms related to emotion and physical symptoms of sensitivity to light and noise: more emotional (z = 2.3, P = .02); sadness (z = 2.4, P = .02); nervousness (z = 2.4, P = .02); irritability (z = 3.6, P = .01); sensitivity to light (z = 2.6, P = .01); and sensitivity to noise (z = 2.4, P = .04). The composite scores of emotional symptom and sensitivity symptom clusters were significantly higher: t = 2.68 (P < .01) and t = 3.35 (P < .01), respectively. Conclusions: The significant rises in emotional and sensitivity symptoms may be an important additive effect of concussive injury. Closer attention should be given to these symptom clusters when evaluating concussion injury and recovery.
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Taylor, Kathryn M., Marianthi-Anna Kioumourtzoglou, Jim Clover, Brent A. Coull, Jack T. Dennerlein, David C. Bellinger, and Marc G. Weisskopf. "Concussion History and Cognitive Function in a Large Cohort of Adolescent Athletes." American Journal of Sports Medicine 46, no. 13 (September 19, 2018): 3262–70. http://dx.doi.org/10.1177/0363546518798801.
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Background: The incidence of reported concussions in the adolescent population is increasing, yet research on the effects of concussions in this population is minimal and inconclusive. Purpose: To assess the association between concussion and performance on a cognitive test battery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Using multivariate models, the authors assessed the association between concussion and performance on a cognitive test battery among 5616 high school and junior high school athletes. The researchers utilized a global cognitive score and scores for 5 domains: verbal memory, visual memory, visual motor, reaction time, and impulse control. Each cognitive score was converted to a z score with the mean and SD of the nonconcussed population. Results from each model were then interpreted as change in the standardized unit score. In the models, concussion was evaluated as ever having a concussion, number of concussions, time since last concussion, and age at first concussion. Results: Ever having a concussion was associated with a mean decrease of 0.11 standardized units (95% CI, −0.20 to −0.01) on the global cognitive score and lower scores in all cognitive domains. Each additional concussion was associated with lower scores on global cognitive function (effect estimate, −0.06; 95% CI, −0.11 to −0.02), verbal memory, visual memory, and impulse control. Concussion in early childhood was associated with lower global cognition (effect estimate, −0.05; 95% CI, −0.08 to −0.01), visual memory, and motor visual scores as compared with concussions in later childhood. The associations between time since last concussion and cognitive test scores were nonlinear, and on all tests, lower scores were observed even ≥1 year after the concussion. Conclusion: On the basis of objective performance metrics for cognitive function, concussions had a more persistent effect on cognitive function than previously thought. The age at which an individual has his or her first concussion may be an important factor in determining long-lasting cognitive effects.
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D’Silva, Linda J., Catherine F. Siengsukon, and Hannes Devos. "Gaze stability in young adults with previous concussion history." Journal of Vestibular Research 30, no. 4 (October 17, 2020): 259–66. http://dx.doi.org/10.3233/ves-200706.
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BACKGROUND: Disruption of visual-vestibular interaction after concussion can cause gaze instability with head movements. The long-term impact of concussion on gaze stability is unknown. OBJECTIVE: This cross-sectional comparative pilot study examined gaze stability in the chronic stage after concussion (greater than one year). A secondary objective was to examine the relationship between gaze stability and sleep. METHODS: Outcome measures included: 1. Gaze stability in logMAR (mean loss of dynamic visual acuity (DVA) in the yaw and pitch planes); 2. Pittsburgh Sleep Quality Index (PSQI); 3. Epworth Sleepiness Scale (ESS). Post-Concussion Symptom Scale (PCSS), time since injury, and number of concussions were collected for the people with concussion. RESULTS: The study sample included thirty-four adults (mean age 23.35±1.3 years). Seventeen had a history of 1–9 concussions, with a mean duration of 4.4±1.9 years since last concussion; and 17 were age and sex-matched controls. Mean pitch plane DVA loss was greater in the concussion group compared to the control group (p = 0.04). Participants with previous concussion had lower sleep quality based on the PSQI (p = 0.01) and increased daytime sleepiness based on the ESS (p = 0.01) compared to healthy controls. Mean DVA loss in the pitch plane was significantly correlated with the PSQI (r = 0.43, p = 0.01) and the ESS (r = 0.41, p = 0.02). CONCLUSION: Significant differences in dynamic visual acuity may be found in young adults long after a concussion, compared with those who have no concussion history. Furthermore, loss of dynamic visual acuity was associated with poorer sleep quality and higher daytime sleepiness.
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Barnes, Brett C., Leslie Cooper, Donald T. Kirkendall, T. Paul McDermott, Barry D. Jordan, and William E. Garrett. "Concussion History in Elite Male and Female Soccer Players." American Journal of Sports Medicine 26, no. 3 (May 1998): 433–38. http://dx.doi.org/10.1177/03635465980260031601.
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A unique feature of soccer is the purposeful use of the head for controlling, passing, and shooting a soccer ball. Some concern has been expressed in the literature on the cumulative effects of heading on soccer players. Certain neurophysiologic and neuropsychologic changes have been reported in current or retired players, with heading being blamed. A major factor that could influence some of the findings is a player's history of concussive episodes, which are known to influence brain function. These episodes can occur during aspects of the game other than heading. We interviewed all male and female soccer players (N 137, average age 20.5 years) who competed at the U.S. Olympic Sports Festival in 1993. The mechanisms of injuries, frequency, and sequelae were determined. There were 74 concussions in 39 male players (grade I 50) and 28 concussions in 23 female players (grade I 19). For the men, 48 of the 74 episodes were from collisions with another player. For the women, 20 of 28 were from such collisions. Headaches, being “dazed,” and dizziness were the most common symptoms reported. Based on concussion history, the odds are 50% that a man, and 22% that a woman, will sustain a concussion within a 10-year period. The data indicate that concussions from player-to-player contact are a frequent hazard in soccer. Head injuries incurred this way may be more of an influence for published findings of physiologic and psychologic deficiencies than routine heading of the soccer ball.
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Fasoranti, Zarek, Alexander Enrique, Katie Hunzinger, Kelsey Bryk, Thomas Kaminski, and Thomas A. Buckley. "Concussion History Does Not Adversely Affect Trail Making Test Performance." Neurology 95, no. 20 Supplement 1 (November 16, 2020): S12.2—S12. http://dx.doi.org/10.1212/01.wnl.0000719984.77986.de.
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ObjectiveTo determine the effect of concussion history on the electronic version of the Trail Making Test (TMT) A and TMT-B performance.BackgroundThe effects of concussion history on cognitive performance when the individual is still young has received limited attention. There are inconsistent results in prior studies using computerized neurocognitive tests however the TMT assesses divergent neurologic systems including working memory, horizontal and vertical saccades, attention, cognitive processing, and executive function. While the TMT has routinely identified deficits acutely post-concussion, the long-term effect of prior concussions has not been established.Design/MethodsThis study utilized a cross-sectional design of 50 current intercollegiate division I athletes (56% female, age: 19.8 ± 1.3 y.o.). Participants completed a reliable concussion history questionnaire as well as the TMT-A and TMT-B on an iPad at baseline. The independent variable was concussion history and the dependent variables were total time on TMT-A and TMT-B which were compared by independent samples t-tests or Mann-Whitney U test.ResultsOf the 50 student athletes 26 (52%) reported at least one previously diagnosed concussion. There was no significant difference between groups for the TMT-A (No prior concussion: 22.9 + 6.1 sec and Concussion history: 19.7 + 4.1, U = 227.0, p = 0.10) or TMT-B (No prior concussion: 42.1 + 13.2 sec and concussion history: 38.1 + 11.3, t = 1.17, p = 0.25).ConclusionsThe results of this study suggest that while still in college, a history of one or more prior concussions, did not adversely affect neurocognitive performance on either the TMT-A or B test. As concussion history is sometimes associated with later life neurocognitive performance, future studies should assess TMT-A and B across the lifespan.
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van Donkelaar, Paul, Jill Dierijck, Alexander Wright, and Jonathan Smirl. "A History of Concussion Does Not Lead to an Increase in Ocular Near Point of Convergence." International Journal of Sports Medicine 39, no. 09 (June 21, 2018): 682–87. http://dx.doi.org/10.1055/s-0044-101454.
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AbstractOcular near point of convergence (NPC) has been shown to be sensitive to the effects of concussion and subconcussive impacts. To determine if NPC is also sensitive to a previous history of concussion, male contact-sport athletes either with (n=26) or without (n=16) a history of at least one previous concussion had their NPC assessed. The results showed that participants with a history of concussion displayed NPC values (9.4±1.6 cm) indistinguishable from those with no history of concussion (8.4±2.1 cm, t-test, p=0.09). This was the case regardless of whether 1, 2, or 3 or more concussions had occurred and despite the fact participants with concussion (mean time since last concussion: 1136 days) suffered from an increased number and severity of symptoms as assessed with the SCAT 3 (3.6±2.2 vs. 2.13±1.89 symptoms, 6.1±4.1 vs. 3.19±2.99 severity, t-test, p<0.05). Taken together, these results imply that NPC may not be a suitable tool to assess the potential long-term effects of one or more concussions over a longer time frame. Future research using larger sample sizes is warranted to evaluate the potential dose-response relationship between number of prior concussions and NPC.
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Hicks, Steven D., Robert P. Olympia, Cayce Onks, Raymond Y. Kim, Kevin J. Zhen, Gregory Fedorchak, Samantha DeVita, et al. "Saliva microRNA Biomarkers of Cumulative Concussion." International Journal of Molecular Sciences 21, no. 20 (October 20, 2020): 7758. http://dx.doi.org/10.3390/ijms21207758.
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Recurrent concussions increase risk for persistent post-concussion symptoms, and may lead to chronic neurocognitive deficits. Little is known about the molecular pathways that contribute to persistent concussion symptoms. We hypothesized that salivary measurement of microribonucleic acids (miRNAs), a class of epitranscriptional molecules implicated in concussion pathophysiology, would provide insights about the molecular cascade resulting from recurrent concussions. This hypothesis was tested in a case-control study involving 13 former professional football athletes with a history of recurrent concussion, and 18 age/sex-matched peers. Molecules of interest were further validated in a cross-sectional study of 310 younger individuals with a history of no concussion (n = 230), a single concussion (n = 56), or recurrent concussions (n = 24). There was no difference in neurocognitive performance between the former professional athletes and their peers, or among younger individuals with varying concussion exposures. However, younger individuals without prior concussion outperformed peers with prior concussion on three balance assessments. Twenty salivary miRNAs differed (adj. p < 0.05) between former professional athletes and their peers. Two of these (miR-28-3p and miR-339-3p) demonstrated relationships (p < 0.05) with the number of prior concussions reported by younger individuals. miR-28-3p and miR-339-5p may play a role in the pathophysiologic mechanism involved in cumulative concussion effects.
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Gaudet, Charles E., Grant L. Iverson, Ross Zafonte, Paul Berkner, and Nathan E. Cook. "A-187 Prior Concussion History and Recovery Time Following Sport-Related Concussion in High School Athletes." Archives of Clinical Neuropsychology 37, no. 6 (August 17, 2022): 1342. http://dx.doi.org/10.1093/arclin/acac060.187.
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Abstract Objective: To examine whether adolescents with prior concussions take longer to return to school and/or sports following a subsequent sport-related concussion. Method: Injury surveillance data for 780 adolescents (M age=16.3, SD=1.3 years) were analyzed. Adolescents were divided into three groups: (a) no prior concussion history (69%; n=538), (b) history of one prior concussion (19.2%; n=150), and (c) history of two or more prior concussions (11.8%; n=92). We analyzed between-group differences in time to return to school and sports. Results: Groups did not differ in time to return to school (K-W: χ2(2)=0.95, p=.62; Log Rank: χ2 (2)=2.83, p=.24) or sports (K-W: χ2(2)=2.19, p=0.33; Log Rank: χ2 (2)=3.95, p=.14). However, a greater proportion of student athletes with two or more prior concussions had not returned to their sport at 28 days postinjury compared to those with no prior concussions (23.5% vs. 12.7%; OR=2.10, 95% CI 1.18-3.73). Of note, the two or more prior concussion group contained a higher proportion of adolescents with potential pre-injury risk factors for complicated recovery, namely, depression and migraines. Conclusions: Prior concussion history was not associated with longer time to return to school nor return to sport when examined as a continuous variable. However, at 28 days postinjury, a greater proportion of athletes with two or more prior concussions remained out of sports compared to those with no prior concussions.
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Wallace, Jessica, Tracey Covassin, Sally Nogle, Daniel Gould, and Jeffrey Kovan. "Knowledge of Concussion and Reporting Behaviors in High School Athletes With or Without Access to an Athletic Trainer." Journal of Athletic Training 52, no. 3 (March 1, 2017): 228–35. http://dx.doi.org/10.4085/1062-6050-52.1.07.
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Context: Increased sport participation and sport-related concussion incidence has led to an emphasis on having an appropriate medical professional available to high school athletes. The medical professional best suited to provide medical care to high school athletes is a certified athletic trainer (AT). Access to an AT may influence the reporting of sport-related concussion in the high school athletic population; however, little is known about how the presence of an AT affects concussion knowledge, prevention, and recognition. Objective: To evaluate knowledge of concussion and reporting behaviors in high school athletes who did or did not have access to an AT. Design: Cross-sectional study. Setting: Survey. Patients or Other Participants: A total of 438 athletes with access to an AT and 277 without access to an AT. Intervention(s): A validated knowledge-of-concussion survey consisting of 83 items addressing concussion history, concussion knowledge, scenario questions, signs and symptoms of a concussion, and reasons why an athlete would not report a concussion. The independent variable was access to an AT. Main Outcome Measure(s): We examined the proportion of athletes who correctly identified knowledge of concussion, signs and symptoms of concussion, and reasons why high school student-athletes would not disclose a potential concussive injury by access to an AT. Frequency statistics, χ2 tests, independent t tests, and linear regression were conducted to analyze the data. Results: The underreporting of concussion among high school athletes was 55%. Athletes with access to an AT had more knowledge of concussion than did athletes without such access (P ≤ .001). Chi-square tests did not demonstrate a significant relationship between AT access and a higher percentage reporting concussions. Conclusions: High school athletes with access to an AT had more concussion knowledge, but they did not report suspected concussions to an authority figure more frequently than athletes without access to an AT.
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Iverson, G. L., P. M. Kelshaw, N. E. Cook, and S. V. Caswell. "Middle School Children with Attention-Deficit/Hyperactivity Disorder Have a Greater Concussion History." Archives of Clinical Neuropsychology 34, no. 5 (July 2019): 748. http://dx.doi.org/10.1093/arclin/acz026.18.
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Abstract Purpose Examine lifetime history of concussions in middle school student athletes who have attention-deficit/hyperactivity disorder (ADHD). Methods A sample of 1,037 students from nine middle schools in Virginia, USA (ages 11 to 14, M=12.6, SD=0.93; 45.8% girls) underwent baseline/pre-season assessments during the 2017-2018 academic year and self-reported their health history, including whether or not they had been diagnosed with ADHD and their concussion history. Athletes were divided into two groups, those with ADHD (n=71; 6.8%) and control subjects (n=966). Chi-Square tests were conducted to compare the number of prior concussions in students with and without ADHD. Results In the total sample, boys were more likely to report a prior history of concussion than girls [χ2(1) =10.81, p=.001; OR=1.92; 95% CI=1.30-2.85]. The frequency of prior concussion in children with ADHD (23.9%) was twice the frequency of prior concussion among children without ADHD (11.4%) [χ2(1)=9.70, p=.002; OR=2.45; 95% CI=1.37-4.38]. Approximately one in four boys with ADHD (24.5%) and one in five girls with ADHD (22.2%) reported having sustained one or more prior concussions. Conclusion ADHD is associated with a greater prevalence of prior concussion in middle school children. Further research is needed to understand the risk of sustaining concussion for young athletes with ADHD, as well as short- and long-term outcomes of concussion among young athletes with ADHD.
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Lynall, Robert C., Brian Pietrosimone, Zachary Y. Kerr, Timothy C. Mauntel, Jason P. Mihalik, and Kevin M. Guskiewicz. "Osteoarthritis Prevalence in Retired National Football League Players With a History of Concussion and Lower Extremity Injury." Journal of Athletic Training 52, no. 6 (June 1, 2017): 518–25. http://dx.doi.org/10.4085/1062-6050-52.2.03.
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Context: Dynamic balance deficits have been described postconcussion, even after athletes return to play. Lower extremity (LE) musculoskeletal injury rates increase for up to 1 year after concussion, but the long-term musculoskeletal implications of concussion are unclear. Objective: To (1) examine the association of concussion and LE injury histories with osteoarthritis (OA) prevalence in retired National Football League players and (2) examine the association of concussion and LE injury histories with OA prevalence in those ≤55 years of age. Design: Case-control study. Setting: Survey. Patients or Other Participants: We administered the Health Survey of Retired National Football League Players, which collects information about demographics, OA, LE injury, and concussion history. Main Outcome Measure(s): Twelve discrete categories were created based on concussion and LE injury history, ranging from 0 concussions and 0 LE injuries (referent group) to 3+ concussions and 2+ LE injuries. Binomial regression analysis modeled lifetime OA prevalence. Covariates were body mass index, age at the time of the survey, and total years playing professional football. Results: Complete data were available for 2696 participants. Lifetime OA prevalence was smallest in the referent group (21.1%) and largest in the 3+ concussion and 2+ LE group (50.6%; 2.5 times the referent; 95% confidence interval [CI] = 2.1, 3.1). Participants in all concussion groups (1, 2, 3+) who reported a history of 0 LE injuries had a greater OA prevalence than the referent group. When participants were stratified by age, the ≤55 years of age, 3+ concussions, and 2+ LE injuries group prevalence ratio (3.6; 95% CI = 2.7, 5.2) was larger than that of the >55 years of age, 3+ concussions, and 2+ LE injuries group (1.8; 95% CI = 1.3, 2.4) compared with the respective referent groups. Conclusions: Concussion with or without a history of LE injury may be an important moderator of OA. Future researchers should seek to better understand the mechanisms that influence the association among concussion, LE injury, and OA.
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Monaco, Matthew R., Britton W. Brewer, Judy L. Van Raalte, and Christine N. May. "How Many Concussions Would It Take for Athletes to Choose to Discontinue Participation in Their Primary Sport?" International Journal of Environmental Research and Public Health 18, no. 4 (February 8, 2021): 1582. http://dx.doi.org/10.3390/ijerph18041582.
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The process by which athletes decide to continue or discontinue sport participation after concussion has not been explicated. Intercollegiate and club sport athletes (N = 394) completed an online survey that included assessments of demographic factors, the total number of concussions (and anterior cruciate ligament (ACL) tears) that would prompt sport retirement, concussion history, and athletic identity. On average, participants reported that they would retire from their primary sport after sustaining 3 to 4 concussions (and approximately 2 ACL tears). The total number of concussions reported was negatively correlated with the number of additional concussions it would take to precipitate sport retirement. Athletic identity was positively associated with the number of concussions that participants with a history of one or more concussions reported would prompt them to retire from their primary sport. The results provide information of potential utility to professionals implementing concussion education programs and working with athletes at risk of experiencing concussion.
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Register-Mihalik, Johna K., Melissa C. Kay, Zachary Y. Kerr, Karen Y. Peck, Megan N. Houston, Paula Gildner, Steven J. Svoboda, Stephen W. Marshall, and Kenneth L. Cameron. "Influence of Concussion Education Exposure on Concussion-Related Educational Targets and Self-Reported Concussion Disclosure among First-Year Service Academy Cadets." Military Medicine 185, no. 3-4 (December 2, 2019): e403-e409. http://dx.doi.org/10.1093/milmed/usz414.
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Abstract Introduction Concussion disclosure is often essential for military personnel to receive appropriate care following concussive injury. Concussion-related education and training may play a role in improving disclosure and recognition among peers, allowing for more timely concussion identification and treatment. The objectives of this study were to: (1) describe concussion education exposure among first-year service academy cadets and (2) examine the association between exposure to concussion education sources (multiple vs. only one) and concussion-related knowledge, attitudes, perceived social norms, intention to disclose symptoms, and disclosure behaviors. Materials and Methods First-year service academy cadets completed a cross-sectional survey to assess perceptions of concussion disclosure during preseason concussion baseline testing sessions. Associations between key cadet characteristics and exposure to multiple concussion education sources were examined using odds ratios and 95% confidence intervals. Linear regression was used to model the continuous measures of concussion-related knowledge, attitudes, and perceived social norms. Log-binomial regression was used to model the categorical outcomes of high perceived control over concussion disclosure (higher vs. lower), intention to disclose (higher vs. lower), and disclosure of all possible concussive events at the time of injury (yes vs. no). The primary predictor for all models was exposure to multiple sources of concussion education (video, coach, medical professional, or other) vs. exposure to only one educational source. All models were adjusted for gender, high school contact sport participation, and previous concussion history. Results Of the 972 first-year cadets (85% response; age = 18.4 ± 0.9 years; 21.7% female, 29.0% NCAA student-athlete), 695 (71.5%) reported receiving some type of previous concussion education and 229 (23.6%) reported a previous concussion history (206/229 reported the actual number they experienced). Of those reporting previous concussion-related education (n = 695), 542 (78.0%) watched a video, 514 (74.0%) talked with a coach about concussion, 433 (62.3%) talked with a medical professional, and 61 (8.8%) reported other sources of education ranging from anatomy teachers to brochures. Overall, 527 (75.8%) reported receiving more than one source of concussion education. Having played a contact sport in high school and having a history of concussion were associated with having multiple concussion education exposures. Being female was associated with lower odds of multiple exposures. Exposure to multiple sources of concussion education was not associated with knowledge, attitudes, perceived norms, or higher intention to disclose concussion symptoms. However, among those with a concussion history, exposure to multiple sources of concussion education was associated with a nearly 40% higher prevalence of disclosing all concussions at the time of injury compared to only one source of educational exposure (67.1% vs. 48.3%; prevalence ratio = 1.4; 95% confidence interval: 0.9, 2.1). Thus, although multiple sources of education may not influence intermediate variables of knowledge, attitudes, perceived norms and intentions, exposure to multiple sources of concussion education may influence actual decision-making around concussion disclosure among first-year service academy cadets. Conclusion These data suggest disparities in concussion education exposure that can be addressed in first-year cadets. Additionally, findings support the importance and use of multiple sources of concussion education in improving cadet’s concussion-related decision-making.
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Cook, Nathan E., Charles E. Gaudet, Ryan Van Patten, Alicia Kissinger-Knox, and Grant L. Iverson. "A-180 Clinical Outcome Following Concussion Among Children and Adolescents with a History of Prior Concussion: A Systematic Review." Archives of Clinical Neuropsychology 37, no. 6 (August 17, 2022): 1336. http://dx.doi.org/10.1093/arclin/acac060.180.
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Abstract Purpose: This systematic review examined the association between prior concussion history and clinical outcomes following concussion among children and adolescents. Data Selection: This review was registered with PROSPERO database for systematic reviews (protocol ID: CRD42016041479 & CRD42019128300) and adhered to PRISMA guidelines. Three searches of nine online databases were conducted: (a) database inception to June of 2016; (b) January 1, 2016 to February 1, 2019; and (c) February 1, 2019 to May 15, 2021. We screened 5,118 abstracts and 51 studies were reviewed. We utilized a likelihood heuristic to assess evidence for an association between concussion history and clinical outcomes. Risk of bias was assessed using the Newcastle-Ottawa scale and level of evidence was appraised using the Oxford Classification for Evidence-Based Medicine. Data Synthesis: Concussion recovery or outcome was reported for 26,643 youth. A median of 36% had a prior history of concussion. Across all studies and outcomes, the majority (k=37, 72.5%) did not find a statistically significant association between lifetime history of concussion and outcome from a subsequent concussion. Important methodological limitations in the literature were identified (e.g., many studies were underpowered and/or coded prior concussion history as a binary variable as opposed to the number of prior concussions). Conclusions: Available studies do not provide compelling evidence that children and adolescents with a history of concussions are at increased risk for worse clinical outcome following a subsequent concussion. Clinicians are cautioned against routinely treating children and adolescents with one or more prior injuries more conservatively. Doing so, in some cases, might be counterproductive.
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Stafford, Clara Alexandra, Bobby Stojanoski, Conor Wild, and Adrian Owen. "The association between a history of self-reported concussion and response inhibition: a population-based study." Neurology 93, no. 14 Supplement 1 (September 30, 2019): S2.3—S3. http://dx.doi.org/10.1212/01.wnl.0000580844.16446.88.
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ObjectiveWe investigated the long-term cognitive effects of concussion in almost 20,000 members of the general population, using tests that are known to be sensitive to small changes in performance.BackgroundConcussions are the most common type of mild traumatic brain injury, with clinical symptoms such as headaches, dizziness, and nausea, persisting for months post-injury. Despite a growing understanding of the severity and duration of these symptoms, very little is known about the long-term effects of concussion on higher level cognitive functioning and emotional lability.Design/MethodsWe asked 19,261 participants to complete a demographic questionnaire as well as the Cambridge Brain Sciences (CBS) cognitive battery. We divided our sample into two groups: those reporting at least one concussion in their lifetime (post-concussion) and those reporting no concussions in their lifetime (non-concussed). We compared the performance of the two groups on the 12 CBS tasks, as well as on four non-cognitive variables measuring levels of social contact, anxiety, depression, and concentration difficulties.ResultsWe found that post-concussion individuals performed significantly worse on a modified Stroop task that measures aspects of response inhibition, but were no worse on any other cognitive measure, including short-term memory, reasoning, and verbal abilities. Crucially, performance profiles of the post-concussion individuals indicated that they made more errors on trials that involved an incongruent colour/word pair. Beyond measures of cognition, we found that post-concussion participants also reported higher levels of anxiety, depression, and trouble concentrating when compared to the non-concussed group. The number of reported concussions also predicted task scores on this task only.ConclusionsOur results suggest that sustaining a concussion is not associated with long-term global effects on cognition. Those who report at least one concussion appear to have a modest, but statistically significant deficit of response inhibition. This impairment seems to be related to the number of concussions reported.
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Laliberté Durish, Christianne, Keith Owen Yeates, and Brian L. Brooks. "Psychological Resilience as a Predictor of Persistent Post-Concussive Symptoms in Children With Single and Multiple Concussion." Journal of the International Neuropsychological Society 24, no. 8 (September 2018): 759–68. http://dx.doi.org/10.1017/s1355617718000437.
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AbstractObjectives:To evaluate the relationship of psychological resilience to persistent post-concussive symptoms (PCS) in children with a history of single or multiple concussions, as well as orthopedic injury (OI).Methods:Participants (N=75) were children, ages 8–18 years, who sustained a single concussion (n=24), multiple concussions (n=25), or an OI (n=26), recruited from a tertiary care children’s hospital. All participants sustained injuries at least 6 months before recruitment, with an average time since injury of 32.9 months. Self-reported psychological resilience was measured using the Connor-Davidson Resilience Scale, and both self- and parent-reported PCS were measured using the Post-Concussion Symptom Inventory. Hierarchical regression analyses examined psychological resilience as a predictor of PCS, both as a main effect and as a moderator of group differences.Results:Multiple concussions and low psychological resilience were both significant predictors of persistent PCS. Resilience was not a significant moderator of group differences in PCS.Conclusions:Sustaining multiple concussions may increase a child’s risk of persistent PCS; however, high psychological resilience may serve as a protective factor, regardless of the number or type of injuries sustained. These findings provide support for developing and testing interventions aimed at increasing psychological resilience as a potential means of improving outcomes for children suffering from persistent PCS after concussion. (JINS, 2018,24, 759–768)
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Stockbridge, Melissa D., and Rochelle Newman. "Enduring Cognitive and Linguistic Deficits in Individuals With a History of Concussion." American Journal of Speech-Language Pathology 28, no. 4 (November 19, 2019): 1554–70. http://dx.doi.org/10.1044/2019_ajslp-18-0196.
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Purpose The purpose of this research is to determine whether individuals with a history of concussion retain enduring differences in narrative writing tasks, which necessitate rapid and complex integration of both cognitive and linguistic faculties. Method Participants aged 12–40 years old, who did or did not have a remote history of concussion, were recruited to take an online survey that included writing both a familiar and a novel narrative. They also were asked to complete multiple tasks targeting word-level and domain general cognitive skills, so that their performance could be interpreted across these dimensions. Results Participants with a concussion history were largely similar to participants with no history of brain injury across tasks that targeted a single skill in isolation. However, participants with prior concussions demonstrated difficulty in providing both key content and details when presented with a novel video and asked to provide a summary of what they had just seen. Number of lifetime concussions predicted the inclusion of key content when summarizing the video. Thus, differences in cognitive and linguistic skills required for written narrative language may continue to be present far after concussion, despite average normative levels of performance on tasks targeting these skills in isolation. Conclusions These findings suggest that individuals with a concussion history, particularly a history of multiple concussions, may continue to experience difficulties for a long period after injury and are likely to benefit from more complex and ecologically valid assessment prior to discharge. Individuals with a concussion history who return to full participation in work, school, and recreational activities may continue to benefit from assistance when asked to rapidly acquire and distill novel information, as is often required in academic and professional environments.
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Weaver, Donald F. "Concussion, Cagney, Captains of the Clouds." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, no. 6 (November 2018): 682–85. http://dx.doi.org/10.1017/cjn.2018.332.
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AbstractThe case of James Cagney adds interesting details to the history of concussion. It is underappreciated that a movie-star of Cagney’s stature incurred multiple concussions over many years. Moreover, the fact that he sustained one of these concussions in Canada while filming Captains of the Clouds, a major Hollywood film, is essentially unknown, and was seldom discussed by Cagney despite his willingness to discuss his many other concussions. The scene showing this concussion was left in the final released version of the movie, making it one of the earliest filmed concussions and the first concussion ever filmed in Technicolor.
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Tierney, Gregory J., and Ciaran K. Simms. "Concussion in Rugby Union and the Role of Biomechanics." Res Medica 24, no. 1 (December 31, 2017): 87–95. http://dx.doi.org/10.2218/resmedica.v24i1.2507.
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Due to the physical and high-impact nature of rugby, head impacts can occur within the game which can result in concussion injuries as well as other moderate-to-severe head injuries 1. Concussion has been defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces”1 and was found to be one of the more common brain injuries throughout the world.2 This is particularly true in sport; it has been estimated that over half of all concussions are sports related.3 A systematic review of the incidence of concussion in contact sports found that rugby union has a higher incidence rate compared with other sports such as American football and soccer.4
Unlike other sports injuries, detecting a concussion is difficult as the neuropathological changes cannot be recognized on standard neuroimaging technology.5,6 \Therefore, if a player is suspected of having a concussion, they are removed from play for a Head Injury Assessment (HIA). The HIA is a standardized tool for the medical assessment of concussion injuries in rugby and aims to improve detection and patient education.7 The HIA assesses a range of degenerative concussive symptoms including memory, cognitive ability, balance and player discomfort. This concussion diagnosis protocol therefore relies heavily on side-line medical staff to identify if a player is exhibiting concussive symptoms. A major disadvantage to this is that concussion has a variable natural history, with transient, fluctuating, delayed and evolving signs or symptoms.8) This means that symptoms can take up to 48 hours to become apparent.8 It has therefore been acknowledged that the content of the HIA will be modified as the research around concussion diagnosis evolves.8
The reliance on side-line medical staff to accurately identify concussive symptoms means that there is a possibility a concussed player may remain on the field; this is one problem that biomechanical research into concussion is trying to overcome. This study will give an overview of concussion in rugby union with a focus on incidence, severity and protection strategies. It will discuss current biomechanical research and further biomechanical research required in the area of concussion injuries in rugby union.
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Karr, J. E., B. A. Maxwell, R. Zafonte, P. D. Berkner, and G. L. Iverson. "A Four-Factor Symptom Model for Student Athletes with and without Prior Concussions." Archives of Clinical Neuropsychology 34, no. 5 (July 2019): 750. http://dx.doi.org/10.1093/arclin/acz026.20.
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Abstract Purpose This study was designed to determine whether the factor structure of the Post-Concussion Symptom Scale (PCSS) is consistent (i.e., invariant) in subgroups of youth stratified by their history of prior concussions. A four-factor model of the PCSS has empirical support (i.e., cognitive-sensory, sleep-arousal, vestibular-somatic, and affective symptoms), and the current investigation examined (i) whether this model is invariant across athletes with 0, 1, or ≥2 prior concussions and (ii) group differences across symptom clusters. Methods Participants included a large sample of adolescent athletes (54.4% boys; 13–18 years-old, M=15.50±1.27 years) with 0 (n=32,668), 1 (n=4,110), or ≥2 prior concussions (n=1,681) administered the 22-item PCSS at pre-season baseline. Measurement invariance was tested (good fit=CFI≥0.95; significant change-in-fit=∆CFI≥0.01) and effect sizes for group differences in symptom clusters were calculated. Results The four-factor model showed configural (CFI=0.968) and weak invariance (∆CFI=0.006), but not strong invariance. Comparisons based on concussion history across symptom clusters indicated very small differences between athletes with 0 and 1 prior concussion(s) (d=0.05-0.15), slightly larger differences between athletes with 1 and ≥2 prior concussion(s) (d=0.12-0.24), and modestly larger differences between athletes with 0 and ≥2 prior concussion(s) (d=0.17-0.35). Conclusion These findings support partial invariance of the four-factor PCSS model across athletes with and without a history of concussion. The association with prior concussion was greatest for cognitive-sensory symptoms and smallest for vestibular symptoms. Future research should explore whether alternative factor models are invariant across athletes with different numbers of prior concussions.
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Harvey, Kayla P., Eric E. Hall, Kirtida Patel, Kenneth P. Barnes, and Caroline J. Ketcham. "Potential factors influencing recovery from concussion in collegiate student-athletes." Journal of Concussion 1 (January 2017): 205970021770708. http://dx.doi.org/10.1177/2059700217707084.
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Background Factors including sex, previous diagnosis of migraines, previous diagnosis of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder, and a history of concussion may influence the length of recovery from concussion in collegiate student-athletes. Purpose To better understand factors that may influence recovery from concussion in collegiate-student athletes. Methods A total of 91 student-athletes from a Division I NCAA University who sustained concussions from the fall of 2011 to the spring of 2015 were evaluated. They were considered recovered from their concussion when neurocognitive and symptom scores returned to baseline and they were cleared by their physician. Analyses of variance were conducted to determine if potential factors influenced concussion recovery ( p < .0125). Results No significant differences were found for sex (males = 7.4 ± 5.9; females = 8.3 ± 4.8 days; p = 0.417), previous diagnosis of migraines (diagnosis = 8.0 ± 5.7; no diagnosis = 7.8 ± 5.4 days; p = 0.926), or history of concussion (history = 8.3 ± 5.7; no history = 5.6 ± 3.4 days; p = 0.088). However, a significant difference in the length of recovery was found between those with a previous diagnosis of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder and those without (diagnosis = 13.3 ± 7.3; no diagnosis = 7.3 ± 4.9 days; p = 0.002). Conclusion Student-athletes with Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder show significantly longer recovery from concussions than those without. Further investigation of this and other factors that influence recovery from concussion may help in concussion recovery and return-to-play guidelines that improve student-athlete well-being.
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Moore, Robert D., Steven P. Broglio, and Charles H. Hillman. "Sport-Related Concussion and Sensory Function in Young Adults." Journal of Athletic Training 49, no. 1 (January 1, 2014): 36–41. http://dx.doi.org/10.4085/1062-6050-49.1.02.
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Context: The long-term implications of concussive injuries for brain and cognitive health represent a growing concern in the public consciousness. As such, identifying measures sensitive to the subtle yet persistent effects of concussive injuries is warranted. Objective: To investigate how concussion sustained early in life influences visual processing in young adults. We predicted that young adults with a history of concussion would show decreased sensory processing, as noted by a reduction in P1 event-related potential component amplitude. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Thirty-six adults (18 with a history of concussion, 18 controls) between the ages of 20 and 28 years completed a pattern-reversal visual evoked potential task while event-related potentials were recorded. Main Outcome Measure(s): The groups did not differ in any demographic variables (all P values > .05), yet those with a concussive history exhibited reduced P1 amplitude compared with the control participants (P = .05). Conclusions: These results suggest that concussion history has a negative effect on visual processing in young adults. Further, upper-level neurocognitive deficits associated with concussion may, in part, result from less efficient downstream sensory capture.
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Brooks, Brian L., Noah Silverberg, Bruce Maxwell, Rebekah Mannix, Ross Zafonte, Paul D. Berkner, and Grant L. Iverson. "Investigating Effects of Sex Differences and Prior Concussions on Symptom Reporting and Cognition Among Adolescent Soccer Players." American Journal of Sports Medicine 46, no. 4 (January 11, 2018): 961–68. http://dx.doi.org/10.1177/0363546517749588.
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Background: There has been increasing concern regarding the possible effect of multiple concussions on the developing brain, especially for adolescent females. Hypothesis/Purpose: The objectives were to determine if there are differences in cognitive functioning, symptom reporting, and/or sex effects from prior concussions. In a very large sample of youth soccer players, it was hypothesized that (1) there would be no differences in cognitive test performance between those with and without prior concussions, (2) baseline preseason symptoms would be better predicted by noninjury factors than concussion history, and (3) males and females with prior concussions would not have differences in cognition or symptoms. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants included 9314 youth soccer players (mean = 14.8 years, SD = 1.2) who completed preseason baseline cognitive testing, symptom reporting, and a health/injury history questionnaire from the ImPACT battery (Immediate Post-concussion Assessment and Cognitive Testing). On the basis of injury history, athletes were grouped by number of prior concussions: 0 (boys, n = 4012; girls, n = 3963), 1 (boys, n = 527; girls, n = 457), 2 (boys, n = 130; girls, n = 97), or ≥3 (boys, n = 73; girls, n = 55). The primary measures were the 4 primary cognitive scores and the total symptom ratings from ImPACT. Primary outcomes were assessed across injury groups, controlling for age, sex, learning disability, attention-deficit/hyperactivity disorder (ADHD), treatment for headaches/migraines, substance abuse, and mental health problems. Results: Cognitive test performance was not associated with concussion history but was associated with sex, age, learning disability, ADHD, and prior mental health problems. Greater symptom reporting was more strongly associated with psychiatric problems, older age, learning disability, substance abuse, headaches, being female, and ADHD than with a history of multiple concussions. Boys and girls did not differ on cognitive scores or symptom reporting based on a history of concussion. Conclusion: In this very large sample of youth soccer players with prior concussion, there was no evidence of negative effects on cognition, very weak evidence of negative effects on symptom reporting, and no evidence of sex × concussion differences in cognition or symptom reporting.
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Cookinham, Brittani, and Chad Swank. "Concussion history and career status influence sports concussion assessment tool (SCAT-3) performance in elite football players." Neurology 91, no. 23 Supplement 1 (December 4, 2018): S5.3—S6. http://dx.doi.org/10.1212/01.wnl.0000550631.88276.6a.
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ObjectiveTo determine if concussion history and career status influences baseline Sports Concussion Assessment Tool (SCAT-3) performance in elite football players.Design/methodsFifty-seven elite football players (age 29.39 ± 7.49 years) categorized by career status (draft prospects, active professional players and retired professional players) underwent SCAT-3 assessments. The SCAT-3 was administered in accordance to published recommendations.14 To examine our primary purpose, participants were placed into either a low concussion history (0–1 concussions) or multiple concussion history (2 + concussions) group. A Mann-Whitney U test was used to examine the differences of concussion history on SCAT-3 total symptoms, total symptom severity, SAC total scores, and m-BESS balance scores. To examine our secondary purpose, a Kruskal-Wallis test and a post-hoc analysis was used to analyze differences between career status categories.ResultsAt baseline, common baseline symptoms were: fatigue (45.6%), trouble falling asleep (35.1%), difficulty remembering (33.3%) and irritability (22.8%); 36.8% reported no symptoms. The low concussion (0–1) group reported fewer symptoms (U = 608.50, p = 0.001), less symptom severity (U = 598.00, p = 0.001), and produced greater scores on the Standardized Assessment of Concussion (SAC) total scores compared to the multiple concussion (2+) group (U = 253.00, p = 0.024), but no differences were observed on modified Balance Error Scoring System (m-BESS) scores (U = 501.50, p = 0.066) on the Mann-Whitney U test. The Kruskal-Wallis Test and post-hoc analysis indicated retired players were significantly different from draft prospects and current professional players for total symptom scores (p < 0.001), total symptom severity (p < 0.001), SAC total scores (p = 0.030), and m-BESS (p < 0.001).ConclusionsConcussion history and career status appear to influence performance on the SCAT-3 in elite football players. With this in mind, future research is recommended to determine normative scores on the SCAT-3 for elite football players.
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Ha, Margaret L., Tricia M. Kasamatsu, Tamara C. Valovich McLeod, Johna K. Register-Mihalik, and Cailee E. Welch Bacon. "Teachers’ Perceived Knowledge and Confidence Regarding Adolescent Concussion Management." Journal of Education and Learning 9, no. 5 (August 17, 2020): 27. http://dx.doi.org/10.5539/jel.v9n5p27.
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Teachers play an important role in facilitating a student’s return to school after a concussion. Currently, there is limited evidence on teachers’ experiences and their role in managing concussions in the classroom. This study investigated teachers’ perceived knowledge and confidence regarding concussion recognition and management. A cross-sectional design was used for this online survey of secondary school teachers in the United States. Practicing teachers self-reported being moderately knowledgeable and confident in their knowledge of concussion signs and symptoms. Whereas teachers were moderately knowledgeable and confident in their knowledge of academic support strategies after a student’s concussion, teachers were minimally knowledgeable and confident in their knowledge of the criteria for the student’s return to school and activity. Personal history of concussion and participation in formal concussion education were associated with increases in teachers’ perceived knowledge and confidence regarding concussion and its management process. Overall, teachers believed it was important to learn about concussions to support a student’s return to school. Therefore, integration of concussion education into preservice teacher education programs and in-service trainings is recommended. Providing teachers with practical resources on academic adjustments can enhance the support provided to symptomatic students, reduce misconceptions about concussion, and facilitate dialogue among stakeholders involved in the management of concussions.
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Wennberg, Richard, Carmen Hiploylee, Peter Tai, and Charles H. Tator. "Is Concussion a Risk Factor for Epilepsy?" Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, no. 3 (March 20, 2018): 275–82. http://dx.doi.org/10.1017/cjn.2017.300.
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AbstractBackground: Epidemiologic studies have suggested that concussion, or mild traumatic brain injury (mTBI), is associated with a twofold or greater increase in relative risk for the development of post-traumatic epilepsy. To assess the clinical validity of these findings, we analyzed the incidence of epilepsy in a large cohort of post-concussion patients in whom concussion was strictly defined according to international guidelines. Methods: A retrospective cohort study of 330 consecutive post-concussion patients followed by a single concussion specialist. Exclusion criteria: abnormal brain CT/MRI, Glasgow Coma Scale<13 more than 1-hour post-injury, hospitalization >48 hours. Independent variable: concussion. Outcome measure: epilepsy incidence (dependent variable). Results: The mean number of concussions/patient was 3.3 (±2.5), mean age at first clinic visit 28 years (±14.7), and mean follow-up after first concussion 7.6 years (±10.8). Eight patients were identified whose medical records included mention of seizures or convulsions or epilepsy. Upon review by an epileptologist none met criteria for a definite diagnosis of epilepsy: four had episodic symptoms incompatible with epileptic seizures (e.g., multifocal paraesthesiae, multimodality hallucinations, classic migraine) and normal EEG/MRI investigations; four had syncopal (n=2) or concussive (n=2) convulsions. Compared with annual incidence (0.5/1000 individuals) in the general population, there was no difference in this post-concussion cohort (p=0.49). Conclusion: In this large cohort of post-concussion patients we found no increased incidence of epilepsy. For at least the first 5-10 years post-injury, concussion/mTBI should not be considered a significant risk factor for epilepsy. In patients with epilepsy and a past history of concussion, the epilepsy should not be presumed to be post-traumatic.
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Ellis, Michael, Cameron Krisko, Erin Selci, and Kelly Russell. "Effect of concussion history on symptom burden and recovery following pediatric sports-related concussion." Journal of Neurosurgery: Pediatrics 21, no. 4 (April 2018): 401–8. http://dx.doi.org/10.3171/2017.9.peds17392.
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OBJECTIVEThe aim of this study was to examine differences in symptom burden and duration until physician-documented clinical recovery among pediatric patients with sports-related concussion (SRC) with and without a history of concussion.METHODSA retrospective chart review was performed for all pediatric patients (7–19 years old) referred to the Pan Am Concussion Program in Winnipeg, Canada, with an SRC and evaluated < 30 days postinjury between September 1, 2013, and August 1, 2015.RESULTSA total of 322 patients with SRC (64.91% male, mean age 13.96 years) who were evaluated a median of 7 days (interquartile range [IQR] 5–11 days) postinjury were included. Patients without a history of concussion endorsed significantly fewer concussion symptoms at initial assessment (median 5.5 symptoms, IQR 1–10 symptoms) than those with a previous concussion (median 7 symptoms, IQR 2–13.25 symptoms; p = 0.036). The median Post-Concussion Symptom Scale scores were 9 (IQR 1–23) for patients with no concussion history and 13 (IQR 3–33) for those with a history of concussion (p = 0.032). For patients with no previous concussion, the median number of days until physician-documented clinical recovery was 23 (IQR 15–44 days) compared with 25 days (IQR 18–43 days) for those with a history of concussion (p = 0.281). There was no significant difference in the proportion of patients who experienced delayed time until physician-documented clinical recovery (> 1 month postinjury) between the groups (p = 0.584).CONCLUSIONSAlthough a history of concussion may be associated with increased symptom burden following pediatric SRC, there was no difference in the time until physician-documented clinical recovery. Pediatric patients with SRC who have a history of concussion should be managed on an individualized basis. Future work is needed to examine the short- and long-term effects of multiple concussions in children and adolescents.
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Terry, D., B. Maxwell, R. Zafonte, P. Berkner, and G. Iverson. "B-64 Symptom Reporting and Cognitive Functioning in Middle School Athletes with Past Concussions." Archives of Clinical Neuropsychology 34, no. 6 (July 25, 2019): 1011–12. http://dx.doi.org/10.1093/arclin/acz034.147.
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Abstract Objective We examined the association between past concussions and current preseason symptom reporting and cognitive performance in boys participating in school sports. Method A sample of 2,582 boys ages 11-13 completed neurocognitive testing prior to participating in a school sport, using ImPACT®, between 2009-2015. A minority reported prior concussions: 0 (n = 2,244, 86.9%), 1 (n = 261, 10.1%), and ≥2 (n = 77, 3.0%). Results There was a significant difference in total symptom scores across groups (Kruskall-Wallis = 10.75, p = .005). Those with ≥2 prior concussions reported more symptoms than those with 0 concussions (p = .004, Cohen’s d = 0.41). A multivariate regression examining the contribution of concussion history and developmental/health history to symptom reporting was significant [F(7, 2,267) = 16.80, p < .001]. The following were independent predictors of symptoms scores (in descending order of strength): treatment for a psychiatric condition, treatment for headaches, history of learning disability, age, and history of ADHD. Prior concussion history was not a significant independent predictor in this multivariate model. There was a very small omnibus difference in visual motor speed (ANOVA, F = 4.10, p = .02); athletes with 1 prior concussion performed worse than those with no prior concussions (Tukey p = .01; d = 0.19). There were no significant differences on the other cognitive variables. Conclusions Boys with two or more prior concussions reported more symptoms than those with no prior concussions, but performed similarly on cognitive testing. The strongest predictors of current symptom reporting were a prior history of treatment for mental health problems or headaches, and a personal history of learning disability.
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Brown, Jessica, and Kelly Knollman-Porter. "Continuum of Care Following Sports-Related Concussion." American Journal of Speech-Language Pathology 29, no. 3 (August 4, 2020): 1389–403. http://dx.doi.org/10.1044/2020_ajslp-19-00131.
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Purpose Although guidelines have changed regarding federally mandated concussion practices since their inception, little is known regarding the implementation of such guidelines and the resultant continuum of care for youth athletes participating in recreational or organized sports who incur concussions. Furthermore, data regarding the role of speech-language pathologists in the historic postconcussion care are lacking. Therefore, the purpose of this retrospective study was to investigate the experiences of young adults with history of sports-related concussion as it related to injury reporting and received follow-up care. Method Participants included 13 young adults with history of at least one sports-related concussion across their life span. We implemented a mixed-methods design to collect both quantitative and qualitative information through structured interviews. Participants reported experiencing 42 concussions across the life span—26 subsequent to sports injuries. Results Twenty-three concussions were reported to a parent or medical professional, 14 resulted in a formal diagnosis, and participants received initial medical care for only 10 of the incidents and treatment or services on only two occasions. Participants reported concussions to an athletic trainer least frequently and to parents most frequently. Participants commented that previous experience with concussion reduced the need for seeking treatment or that they were unaware treatments or supports existed postconcussion. Only one concussion incident resulted in the care from a speech-language pathologist. Conclusion The results of the study reported herein shed light on the fidelity of sports-related concussion care management across time. Subsequently, we suggest guidelines related to continuum of care from injury to individualized therapy.
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Flood, S., H. Kuwabara, J. Hussey, B. Fraga, T. Kinsora, S. Ross, and D. Allen. "B-50 Frequency of Sports-Related Concussion in Athletes with Neurodevelopmental Conditions." Archives of Clinical Neuropsychology 34, no. 6 (July 25, 2019): 996. http://dx.doi.org/10.1093/arclin/acz034.133.
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Abstract Objective Research demonstrates that athletes with neurodevelopmental diagnoses may have a higher frequency of lifetime concussions (Iverson et al., 2016; Alosco, Fedor & Gunstad, 2014) possibly due to underlying attention, processing speed, or reaction time difficulties. The present study investigates concussion history and sports-related concussions between athletes with and without a history of neurodevelopmental disorders in a longitudinal, state-wide sample. Method Participants included 39,586 high school athletes (Mage = 15.18; 56.2% males) who were assessed pre and post-concussion with ImPACT between 2008 and 2016. There were 36,880 athletes (55.1% males) who did not report neurodevelopmental disorders and served as the control group and 2,706 athletes (71.4% males) in the clinical group who self-reported diagnosis of ADHD (55.6%), Learning Disability (LD;13.6%), Autism (3.2%), ADHD+LD (4.5%), and athletes in special education but no reported diagnosis (SpEd; 22%). Concussion frequency in each group was analyzed using chi-square analysis. Results Athletes were more likely to report prior concussions if they had a self-reported neurodevelopmental diagnosis (17%) compared to the control group (9%, χ2(1) = 112.11, p < .001). Odds ratios indicated that athletes with neurodevelopmental conditions were 1.43 times more likely to have a sports-related concussion. Conclusions Consistent with past research, results indicate that neurodevelopmental conditions are associated with greater lifetime risk of concussion, including sport-related concussions. Future studies may expand this research by examining underlaying causes of this increased risk in order to develop specific interventions to help reduce rates of concussion for this population.
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Miller, J. Chance, Kenneth Shubin Stein, Tyler J. Moon, David P. Trofa, Hamish Kerr, Thomas Bottiglieri, and C. S. Ahmad. "Concussion-Reporting Behavior in Rugby: A National Survey of Rugby Union Players in the United States." Orthopaedic Journal of Sports Medicine 9, no. 1 (January 1, 2021): 232596712097214. http://dx.doi.org/10.1177/2325967120972141.
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Background: Rugby is the fastest growing team sport in the United States for male and female athletes. It is a contact/collision sport with an injury risk profile that includes concussions. Purpose: To examine the prevalence of concussions in male and female rugby players in the United States and to characterize behaviors around reporting concussions that could be a target for prevention and treatment efforts. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An online survey distributed to active members on the USA Rugby membership list was used to examine self-reported concussions in male and female athletes. Concussion-reporting behaviors and return to play after a concussion were also explored. Statistical analysis was used to compare male with female athletes and report differences, with years of experience as a dependent variable. Results: The proportion of athletes with a history of at least 1 concussion was 61.9% in all respondents. Of those who reported a concussion, 50.8% reported the concussion during the game or practice in which it occurred, and 57.6% reported at least 1 concussion to a qualified medical provider. Overall, 27.7% of participants who reported ≥1 rugby-related concussion in our survey noted that at least 1 of these concussions was not formally reported. The most commonly cited reasons for not reporting a concussion included not thinking that it was a serious injury, not knowing that it was a concussion at the time, and not wanting to be pulled out of the game or practice. Additionally, 61.0% of athletes did not engage in recommended return-to-play protocols after their most recent rugby-related concussion. Conclusion: US rugby union athletes may not report concussions to medical personnel or follow return-to-play protocols guided by medical advice. This could result from a lack of education on concussion recognition and the risks associated with continued play after a concussion as well as limited access to health care. Further education efforts focusing on the identification of concussions, removal from play, and return-to-play protocols are necessary in the US rugby union population.
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Patel, Bhavik H., Kelechi R. Okoroha, Toufic R. Jildeh, Yining Lu, Alexander J. Idarraga, Benedict U. Nwachukwu, Sarek A. Shen, and Brian Forsythe. "Concussions in the National Basketball Association: Analysis of Incidence, Return to Play, and Performance From 1999 to 2018." Orthopaedic Journal of Sports Medicine 7, no. 6 (June 1, 2019): 232596711985419. http://dx.doi.org/10.1177/2325967119854199.
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Background: The effect of concussions on professional athletes has been investigated in many sports. However, few studies have evaluated concussions in National Basketball Association (NBA) players. Hypothesis: We hypothesized that concussion incidence has increased, yet the return-to-play (RTP) rate will remain high following the institution of the NBA concussion policy (NBACP). We also hypothesized that the incidence of repeat concussions will be similar to first occurrences and that player performance and game availability will not be significantly affected by sustaining a concussion. Study Design: Descriptive epidemiology study. Methods: Publicly available records were searched to identify all concussions from NBA seasons 1999-2000 to 2017-2018. Player demographics and information regarding career history were tabulated. Incidence of concussion and RTP timing were evaluated before and after institution of the NBACP (2011). Minutes per game and game score per minute were evaluated pre- versus postconcussion. Player availability and performance were also compared with an age-, body mass index–, position-, and experience-matched control group of players who did not sustain a concussion. Results: A total of 189 concussions were reported in the NBA from 1999 to 2018, with a mean ± SD incidence of 9.7 ± 7.3 concussions per season. Following implementation of the NBACP, incidence significantly increased from 5.7 ± 2.8 to 16.7 ± 7.5 concussions per season ( P = .007). All players returned to play following first-time concussion after missing 7.7 ± 8.6 days and 3.5 ± 4.1 games. RTP time was not significantly different after implementation of the NBACP (games missed, P = .24; days missed, P = .27), and there was no difference in concussion-free time interval ( P = .29). Game score per minute and minutes per game were not significantly affected by sustaining a concussion (both P > .05). Conclusion: Concussion incidence in NBA players is approximately 17 instances per season since the 2011 institution of a league-wide concussion policy. The number of reported concussions significantly increased following the policy, in line with trends seen in other professional sports leagues. Players have retained a high rate of RTP after 3 to 4 missed games. Player performance and availability are not affected by sustaining a concussion following successful RTP.
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Kerr, Zachary Y., Johna K. Register-Mihalik, Melissa C. Kay, J. D. DeFreese, Stephen W. Marshall, and Kevin M. Guskiewicz. "Concussion Nondisclosure During Professional Career Among a Cohort of Former National Football League Athletes." American Journal of Sports Medicine 46, no. 1 (September 25, 2017): 22–29. http://dx.doi.org/10.1177/0363546517728264.
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Background: Despite a focus on the incidence and effects of concussion, nondisclosure of sports-related concussions among retired players from the National Football League (NFL) has yet to be examined. Purpose: Examine the prevalence of and factors associated with nondisclosure of sports-related concussions in former NFL athletes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A sample of 829 former NFL players completed a general health survey. This historical cohort included players who had played before World War II to 2001. Respondents retrospectively recalled sports-related concussions that they sustained during their professional careers and whether at least one of these sports-related concussions was not reported to medical staff. We computed the prevalence of nondisclosure among those recalling sport-related concussions during their professional careers. Multivariable binomial regression estimated adjusted prevalence ratios (PR) with 95% confidence intervals (CIs) controlling for race/ethnicity, number of years played, primary position played, professional career concussion history, and playing era. Playing era was categorized by whether the majority of a player’s career was before or after a 1976 rule change to limit contact (“spearing”). Results: Overall, 417 (50.3%) respondents reported they had sustained a concussion and did not inform medical staff at least once during their professional playing career. Nonwhite respondents had a higher prevalence of nondisclosure than white/non-Hispanic respondents (adjusted PR = 1.19; 95% CI, 1.02-1.38). An interaction between professional career concussion history and playing era was also found ( P = .08). Compared with those in the pre–spearing rule change group with 1 or 2 concussions, all other groups had larger prevalences of nondisclosure (increases ranging from 41% to 153% in multivariable models). Across concussion strata, nondisclosure prevalence was generally higher in the post–spearing rule change group than the pre–spearing rule change group, with the largest differences found among those with 1 or 2 concussions or those with 3 or 4 concussions. Conclusion: A large proportion of former NFL players in this historical cohort reported at least one instance of not disclosing sports-related concussions to medical staff. Future research on concussion nondisclosure needs to identify mechanisms to improve football players’ intentions to disclose concussion-related symptoms to health care providers and to equip health care providers with more effective strategies for timely identification of concussion.
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J, Maietta, Hopkins N, Maietta L, Flood S, Johnson L, Kuwabara H, Kinsora T, Ross S, and Allen D. "A-110 Are Invalid Baselines More Frequent in those with Concussion History?" Archives of Clinical Neuropsychology 35, no. 6 (August 28, 2020): 903. http://dx.doi.org/10.1093/arclin/acaa068.110.
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Abstract Objective The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a commonly utilized measure for sports concussion. Across the literature we have reviewed there is an abundance of information that focuses on invalid baselines and the effects of concussions. Yet, no previous studies have investigated the effect of a history of concussion on frequency of invalid baselines. The current study examined these effects within high school athletes. Methods Participants included 47,874 high school athletes (mean age = 15.0, SD = 1.2; mean education = 9.0; SD = 1.5; 42.6% female). These athletes were selected from a larger database of athletes who completed baseline ImPACT testing from 2008–2016. Self-reported history of concussion (none vs. 1+) was obtained from the demographic section of the ImPACT. Invalid performance was based on standard ImPACT criteria (“Baseline++”). Results Chi-square tests of homogeneity were performed to assess differences in invalid baselines between those with and without a history of concussion. Results revealed significantly more invalid baselines for those with a history of concussion (p < .01). Conclusions Results indicate that high school athletes with a self-reported history of concussion may be more likely to have invalid baseline test performance. Based on these preliminary results, clinicians who are managing return-to-play decisions may want to take into account concussion history when interpreting baseline data. Future research should, of course, investigate whether this result is consistent in other samples and, if so, whether alternative validity criteria may be needed. Future investigations of athletes with confirmed clinical diagnosis of concussion is an important next step in investigating differences in rates of invalid baselines.
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Worrall, Hannah, Jane Chung, Munro Cullum, and Shane Miller. "Specialist Referral and Outcomes in Adolescent Athletes With Prior Concussion History." Neurology 98, no. 1 Supplement 1 (December 27, 2021): S19.2—S20. http://dx.doi.org/10.1212/01.wnl.0000801916.20997.22.
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ObjectiveTo examine specialist referral patterns and clinical outcomes in adolescents with differing levels of prior concussion history.BackgroundLimited evidence exists on healthcare utilization and outcomes in concussed adolescent athletes with and without a history of prior concussion.Design/MethodsData were prospectively collected from participants aged 12–18 diagnosed with a sport-related concussion and documented prior concussion history between August 2015-March 2020. Participants were separated into 3 groups: 0, 1, and 2 + prior concussions. Demographics, medical history, specialist referrals, and clinical outcome variables obtained at 3-months post-concussion were analyzed.ResultsOne thousand one hundred ninety-seven participants were included: 114 (10.4%) had 2+, 213 (19.4%) had 1, and 770 (70.2%) had 0 prior concussions. There was no difference in sex or time to presentation. A small difference was found across age (15.3 ± 1.6 vs 14.9 ± 1.6 vs 14.5 ± 1.6 years, p < 0.001). Significant differences were also observed between groups in self-reported history of psychological disorders (14.9 vs 15 vs 8.4%, p = 0.01) and headaches/migraines (25.4 vs 20.2 vs 15.5%, p = 0.02). Significant differences between the groups were found in specialist referrals, with more referrals made in the 2 + group to physical therapy (39.6 vs 28.2 vs 23.4%, p = 0.001), neuropsychology (17.1 vs 5.3 vs 7.5%, p = 0.001), and neurology (8.9 vs 2.9 vs 2.2%, p = 0.001). Fewer participants in the 2 + group recovered in = 30 days (53.6 vs 65.6 vs 68.5%, p = 0.04) and reported lower rates of return to activity at 3-months post-concussion (67.9 vs 85.9 vs 87.6%, p < 0.001). No differences were seen in symptom severity, PHQ-8, or GAD-7 scores. All reported as 2 + vs 1 vs 0.ConclusionsConcussed adolescent athletes with a history of 2 or more prior concussions had a higher rate of specialist referrals, were less likely to have returned to prior level of play/activity 3 months following injury, and were less likely to have resolution of symptoms in 30 days or less.
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Panayi, Monica, and Lei Guo. "Cognitive Impairment Among Collegiate African American Student-Athletes Who Have One Or More Concussions." International Journal for Innovation Education and Research 9, no. 8 (August 1, 2021): 433–45. http://dx.doi.org/10.31686/ijier.vol9.iss8.3313.
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The purpose of this research was to examine concussion induced cognitive impairment among collegiate athletes for a long term. This study attempted to determine if there was a significant decrease in cognitive function in student-athletes with a history of concussion after one year of concussion. Totally 46 student athletes who were qualified was included in this study. Of all the 46 student athletes, 14 are females, and 32 males from the following sports: Women’s Basketball (n=3), Men’s Basketball (n=2), Football (n=30), Softball (n=7), Women’s Tennis (n=2), and Women’s Volleyball (n=2) (Table 1). The age range was18-23 years old. Seven of them had two or more concussions Results of this study showed that while all the scores of the ImPACT test improved after one year of concussion for the student-athletes with one or more concussions, there was significant improvement only in the processing speed. For the student-athletes with two or more concussions, the processing speed score after one year of concussions was a little lower even than the score after initial concussion, but it is not statistically significant.
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Erlanger, David, Tanya Kaushik, Robert Cantu, Jeffrey T. Barth, Donna K. Broshek, Jason R. Freeman, and Frank M. Webbe. "Symptom-based assessment of the severity of a concussion." Journal of Neurosurgery 98, no. 3 (March 2003): 477–84. http://dx.doi.org/10.3171/jns.2003.98.3.0477.
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Object. Current grading systems of concussion and return-to-play guidelines have little empirical support. The authors therefore examined the relationships of the characteristics and symptoms of concussion and the history of concussion to three indicators of concussion severity—number of immediate symptoms, number of symptoms at the initial follow-up examination, and duration of symptoms—to establish an empirical basis for grading concussions. Methods. Forty-seven athletes who sustained concussions were administered alternate forms of an Internet-based neurocognitive test until their performances were within normal limits relative to baseline levels. Assessments of observer-reported and self-reported symptoms at the sideline of the playing field on the day of injury, and at follow-up examinations were also obtained as part of a comprehensive concussion management protocol. Although loss of consciousness (LOC) was a useful indicator of the initial severity of the injury, it did not correlate with other indices of concussion severity, including duration of symptoms. Athletes reporting memory problems at follow-up examinations had significantly more symptoms in general, longer durations of those symptoms, and significant decreases in scores on neurocognitive tests administered approximately 48 hours postinjury. This decline of scores on neurocognitive testing was significantly associated with an increased duration of symptoms. A history of concussion was unrelated to the number and duration of symptoms. Conclusions. This paper represents the first documentation of empirically derived indicators of the clinical course of postconcussion symptom resolution. Self-reported memory problems apparent 24 hours postconcussion were robust indicators of the severity of sports-related concussion and should be a primary consideration in determining an athlete's readiness to return to competition. A decline on neurocognitive testing was the only objective measure significantly related to the duration of symptoms. Neither a brief LOC nor a history of concussion was a useful predictor of the duration of postconcussion symptoms.
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Pagani, Linda S., Dave Ellemberg, and Robert Davis Moore. "Clinically Historical and Prospective Associations Between Learning Disorders and Concussion in Young Adult Athletes." American Journal of Lifestyle Medicine 14, no. 2 (September 14, 2018): 187–93. http://dx.doi.org/10.1177/1559827618793350.
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Background. Athletes with specific learning disorder (LD) tend to score lower on neuropsychological tests and are at increased risk of personal injury than their counterparts without such disorders. Using a retrospective historical and prospective design, we examined whether adult athletes with LD, the most prevalent of neurodevelopmental disorders, experience greater chances of past and future concussions than their counterparts without LD. We expected to find that young athletes with LD would show greater risk of past (historical) and future (prospective) cerebral concussions. Methods. Participants (95 men and 53 women aged 18 to 25 years) were recruited from university sports teams and followed during an entire season. Of these, 38 participants had a history of LD and 101 had a history of at least 1 concussion (72 males, 29 females) at the preseason baseline. One-third experienced a new concussion. Data analytic procedures include inferential cross-tabulations. Results. Athletes with LD were twice more likely to have a concussion history at baseline and to have a history of multiple concussions than athletes without LD; 95% CI = [0.86, 4.92] and [0.77, 3.40], respectively. Athletes with LD were twice more likely to incur a new concussion than those without LD; 95% CI = [0.86, 4.92]. Conclusions. Adult athletes with LD experience greater chances of previous and future concussions compared with counterparts without LD. Preventive practices regarding individuals with neurodevelopmental disorders may not only prevent the biopsychosocial consequences of brain trauma for the individual, but also represent a cost-effective public health measure.
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Gaudet, L. A., L. Eliyahu, J. Beach, M. Mrazik, G. Cummings, D. C. Voaklander, and B. H. Rowe. "Workers’ recovery from concussions presenting to the emergency department." Occupational Medicine 69, no. 6 (July 24, 2019): 419–27. http://dx.doi.org/10.1093/occmed/kqz089.
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AbstractBackgroundThe emergency department (ED) is the first point of care for many patients with concussion, and post-concussion syndrome can impact vocational outcomes like successful return to work. Evaluation of concussion in general adult populations is needed.AimsTo document the occurrence and outcomes of work-related concussion presenting to the ED for treatment.MethodsThis study enrolled adults presenting with concussion to three urban Canadian EDs. Baseline ED interviews, physician questionnaires and patient phone interviews at 30 and 90 days documented work-related events, ED management, discharge advice, patient adherence and symptom severity. Work-related injury and return to work were modelled using logistic or linear regression, as appropriate.ResultsOverall, 172 enrolled workers completed at least one follow-up. Work-related concussions were uncommon (n = 28). Most employees (80%) missed at least 1 day of work (median = 7; interquartile range: 3–14). Most (91%) employees returned to work within 90 days, while 41% reported persistent symptoms. Manual labour and self-reported history of attention deficit hyperactivity disorder were associated with work-related concussion, while days of missed work increased with marital status (divorced), history of sleep disorder and physician’s advice to avoid work.ConclusionWork-related concussions are infrequent; however, most workers who sustain a concussion will miss work, and many return while still experiencing symptoms. Work-related concussion and days of missed work are mainly affected by non-modifiable factors. Workers, employers and the workers’ compensation system should take necessary precautions to ensure that workers return to work safely and successfully following a concussion.
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Dobney, Danielle M., Scott G. Thomas, Tim Taha, and Michelle Keightley. "Physiological and Performance Measures for Baseline Concussion Assessment." Journal of Sport Rehabilitation 27, no. 4 (July 1, 2018): 312–18. http://dx.doi.org/10.1123/jsr.2017-0038.
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Context: Baseline testing is a common strategy for concussion assessment and management. Research continues to evaluate novel measures for potential to improve baseline testing methods. Objectives: The primary objective was to (1) determine the feasibility of including physiological, neuromuscular, and mood measures as part of baseline concussion testing protocol, (2) describe typical values in a varsity athlete sample, and (3) estimate the influence of concussion history on these baseline measures. Design: Prospective observational study. Setting: Ryerson University Athletic Therapy Clinic. Participants: One hundred varsity athletes. Main Outcome Measures: Frequency and domain measures of heart rate variability, blood pressure, grip strength, profile of mood states—short form, and the Sport Concussion Assessment Tool-2. Results: Physiological, neuromuscular performance, and mood measures were feasible at baseline. Participants with a history of 2 or more previous concussions displayed significantly higher diastolic blood pressure. Females reported higher total mood disturbance compared with males. Conclusions: Physiological and neuromuscular performance measures are safe and feasible as baseline concussion assessment outcomes. History of concussion may have an influence on diastolic blood pressure.
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Kerr, Zachary Y., Erin M. Snook, Robert C. Lynall, Thomas P. Dompier, Latrice Sales, John T. Parsons, and Brian Hainline. "Concussion-Related Protocols and Preparticipation Assessments Used for Incoming Student-Athletes in National Collegiate Athletic Association Member Institutions." Journal of Athletic Training 50, no. 11 (November 1, 2015): 1174–81. http://dx.doi.org/10.4085/1062-6050-50.11.11.
Full textAbstract:
Context National Collegiate Athletic Association (NCAA) legislation requires that member institutions have policies to guide the recognition and management of sport-related concussions. Identifying the nature of these policies and the mechanisms of their implementation can help identify areas of needed improvement. Objective To estimate the characteristics and prevalence of concussion-related protocols and preparticipation assessments used for incoming NCAA student-athletes. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants Head athletic trainers from all 1113 NCAA member institutions were contacted; 327 (29.4%) completed the survey. Intervention(s) Participants received an e-mail link to the Web-based survey. Weekly reminders were sent during the 4-week window. Main Outcome Measure(s) Respondents described concussion-related protocols and preparticipation assessments (eg, concussion history, neurocognitive testing, balance testing, symptom checklists). Descriptive statistics were compared by division and football program status. Results Most universities provided concussion education to student-athletes (95.4%), had return-to-play policies (96.6%), and obtained the number of previous concussions sustained by incoming student-athletes (97.9%). Fewer had return-to-learn policies (63.3%). Other concussion-history–related information (eg, symptoms, hospitalization) was more often collected by Division I universities. Common preparticipation neurocognitive and balance tests were the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; 77.1%) and Balance Error Scoring System (46.5%). In total, 43.7% complied with recommendations for preparticipation assessments that included concussion history, neurocognitive testing, balance testing, and symptom checklists. This was due to moderate use of balance testing (56.6%); larger proportions used concussion history (99.7%), neurocognitive testing (83.2%), and symptom checklists (91.7%). More Division I universities (55.2%) complied with baseline assessment recommendations than Division II (38.2%, χ2 = 5.49, P = .02) and Division III (36.1%, χ2 = 9.11, P = .002) universities. Conclusions National Collegiate Athletic Association member institutions implement numerous strategies to monitor student-athletes. Division II and III universities may need additional assistance to collect in-depth concussion histories and conduct balance testing. Universities should continue developing or adapting (or both) return-to-learn policies.