bluuebunny/crossref_metadata_2025 huggingface dataset:
The (non)referentiality of the word raha ‘money’ in Finnish conversation
Authors: Laury Ritva
Published: July 2024

This chapter concerns the use of the word raha ‘money’ in Finnish everyday conversation.
The main findings are that raha is most often used non-referentially in singular form in predications where
only the category of money is at issue. When the word is used to create referential mentions of some specific money with
continuity of identity, a plural form is used. The study shows that the singular-plural distinction is a manipulable resource
exploited by participants in conversation for interactional purposes to create stance and to accomplish actions.
Young children’s experience of referentiality and nonreferentiality in dialogue
Authors: Le Mené Marine , Salazar Orvig Anne , da Silva-Genest Christine , Marcos Haydée
Published: July 2024

This chapter focuses on young children’s experience of referential and nonreferential uses of noun phrases
(NPs) in everyday dialogues. Our study of a corpus of interactions between adults and children aged 1;10 to 2;6 showed that
the indeterminacy and instability that might characterise children’s uses can also be found in adults’ discourse. Not only are
(non)referential values co-constructed, but children are also not exposed to clear-cut contrasts between the uses or values of
NPs. On the contrary, both in the adults’ discourse and in the way adults react to children’s utterances, they seem to
experience the fact that noun phrases potentially present various facets, which can be successively or simultaneously
activated in dialogue.
(Non)referentiality of silent reference in Japanese conversation
Authors: Matsumoto Yoshiko
Published: July 2024

Japanese speakers carry out successful conversations in which arguments and adjuncts of predicates are not
expressed. I call such unmentioned members of an event or state that can be inferred
INFERABLES
.
Inferables present a range of interpretations from specific to more general and indeterminate. This chapter explores
principled explanations for this phenomenon in Japanese, which allows a variety of disparate interpretations. The discussions
find that frame semantics, a semantic theory that provides an envisionment of a described event with the attendant roles, can
offer an explanation. Hearers and speakers
TRUST
each other that some plausible entities
(inferables) instantiate the unmentioned elements. When clarification is needed, they seek to
ENSURE

the construal by providing more explicit descriptions
The indeterminacy and fluidity of reference in everyday conversation
Authors: Ono Tsuyoshi , Thompson Sandra A.
Published: July 2024

We focus on (a) the indeterminacy of reference, i.e., noun phrases which are described as having a ‘given’,
‘old’ or ‘definite’ referent, where that referent is unspecified; (b) the ways in which speakers shift reference between
categorial and specific designations. The data reveal that talk displaying indeterminate and shifting reference is
consistently accepted without being challenged. These facts show that reference can only be understood by considering how
speakers refer locally, in the unfolding of social action, and that referential common ground is generally established despite
the referential indeterminacy and fluidity. We thus promote the view that reference is a deeply social phenomenon, an emergent
set of practices that is used and negotiated by people in real time.
Manipulating referentiality and creating phaticness
Authors: Suzuki Ryoko
Published: July 2024

The focus of this study is the creation of novel ad hoc expressions from the perspective of referentiality.
Through the close analysis of three cases from video-recorded conversations in Japanese, we find that speakers create novel
NPs by manipulating referentiality and embodiment, and achieve social bonding by humorously and intensely repeating those
expressions. Even an onomatopoeic adverbial can be turned into a novel ad hoc NP. After creating and reinforcing those novel
NPs with exaggerated delivery, speakers drop the exaggerated delivery, pronouncing the novel NPs as if they are regular
NPs.
An interactional approach to generic second person expressions in Mandarin conversation
Authors: Tao Hongyin
Published: July 2024

This chapter tackles the hitherto under-explored question of when and why conversationalists deploy second
person generic expressions that feature a general and vague referential scope. I show that the conversational contexts in
which they appear are usually characterized most prominently by their relatively complex and/or controversial subject matters,
participants’ incongruent stances, and/or opposing positions to be contested. These contexts and their associated
interactional demands are argued to give rise to the patterning of clustering (multiplicity of instances in adjacent units),
limited generality (as good-enough-yet-not-too-broad general statements), and primary (or attempted primary) speakership. In
general, second person generic statements can be seen as a special and powerful rhetorical device designed for marked
interactional occasions.
The McCusker Subjective Cognitive Impairment Inventory (McSCI): a novel measure of perceived cognitive decline
Authors: Sohrabi Hamid R , Gavett Brandon E , Weinborn Michael , Speelman Craig P , Bucks Romola S , Martins Ralph N
Published: July 2024

Background

Subjective cognitive decline (SCD), i.e. self/other-reported concerns on one’s cognitive functioning without objective evidence of significant decline, is an indicator of dementia risk. There is little consensus on reliability and validity of the available SCD measures. Therefore, introducing a novel and psychometrically sound measure of SCD is timely.

Objective

The psychometric properties of a new SCD measure, the McCusker Subjective Cognitive Impairment Inventory–Self-Report (McSCI-S), are reported.

Methods

Through review of previously published measures as well as our clinical and research data on people with SCD, we developed a 46-item self-report questionnaire to assess concerns on six cognitive domains, namely, memory, language, orientation, attention and concentration, visuoconstruction abilities and executive function. The McSCI-S was examined in a cohort of 526 participants using factor analysis, item response theory analysis and receiver operating characteristic (ROC) curve.

Results

A unidimensional model provided acceptable fit (CFI = 0.94, TLI = 0.94, RMSEA [90% CI] = 0.052 [.049, 0.055], WRMR = 1.45). The McSCI-S internal consistency was excellent (.96). A cut-off score of ≥24 is proposed to identify participants with SCDs. Higher McSCI-S scores were associated with poorer general cognition, episodic verbal memory, executive function and greater memory complaints and depressive scores (P < .001), controlling for age, sex and education.

Conclusions

Excellent reliability and construct validity suggest the McSCI-S estimates SCDs with acceptable accuracy while capturing self-reported concerns for various cognitive domains. The psychometric analysis indicated that this measure can be used in cohort studies as well as on individual, clinical settings to assess SCDs.
A - 01 Differences in Recovery among Acutely Injured Pediatric Concussion Patients with and without Cervicogenic Symptoms
Authors: Mathew A S , Datoc A E , Hartland L C , Roberts K , Sexton J A , Abt J P
Published: July 2024

Purpose

While previous research has demonstrated that cervicogenic symptoms may affect initial symptom burden, mixed findings exist regarding its effects on recovery time. The purpose of this study was to compare acutely injured pediatric sports-related concussion (SRC) patients, with and without cervicogenic symptoms, in terms of symptom burden, vestibular ocular motor components, and recovery time.

Method

Data were gathered from patients aged 8–18 years, evaluated within seven days since injury, and with and without cervicogenic symptoms. Demographic data were examined based on age, gender, race, and ethnicity. The neck and suboccipital regions were assessed for range of motion, tenderness, and spasm. Overall VOMS change score was calculated using Elbin et al., 2022 criteria. Symptom burden was assessed using Post-Concussion Symptom Scale (PCSS) scores. Analysis of variance and regression analyses were conducted.

Results

Of the 2018 pediatric patients diagnosed with SRC, 552 had cervicogenic symptoms. Those with cervicogenic symptoms had significantly greater PCSS scores (MCervical = 35.50¬ ± 23.50, MNoCervical = 21.70¬ ± 20.80), overall VOMS change scores (MCervical = 17.90¬ ± 17.40, MNoCervical = 12.00¬ ± 15.30) and longer recovery time (MCervical = 22.90¬ ± 13.90, MNoCervical = 20.0¬ ± 14.60) compared to those without cervicogenic symptoms (p < 0.001). The model revealed a significant interaction effect between cervicogenic symptoms, VOMS, and PCSS (R2 = 0.128, F(3, 1898) = 93.49, p < 0.001).

Conclusions

Our results showed that pediatric patients with cervicogenic symptoms not only demonstrate greater concussion symptom burden as demonstrated by PCSS and VOMS, but also take longer to recover than those without cervicogenic concerns. The results underscore the need for early detection and treatment of cervicogenic issues alongside standard concussion management to expedite recovery.
A - 02 Time to Physical Therapy in Pediatric Concussion Patients Influences Recovery Outcomes
Authors: Mathew A S , Datoc A E , Choi D M , Tak C R , Abt J P
Published: July 2024

Purpose

Physical therapy (PT) is an effective treatment approach for sports-related concussion (SRC) for patients with high symptom reporting, cervicogenic dysfunction, or vestibular/oculomotor deficits. The purpose of this study was to compare clinical indicators of concussion patients referred to PT who had protracted recovery (PR) and normal recovery (NR).

Method

108 patients (28 NR, 80 PR) were evaluated at a pediatric specialty concussion clinic between April 2021 and December 2023. Patients were between 12–18 years, diagnosed with SRC, evaluated for concussion within one week of injury, referred to PT, completed more than one PT session, and received medical clearance at follow-up appointment. Patients were divided based on PR (>21 days) and NR (‚â§ 21 days) and compared via days since injury to PT, days from concussion evaluation to PT, and number of PT sessions.

Results

Compared to the NR group, the PR group had greater days since injury to PT (MdnPR = 12.00; MdnNR = 3.00; U = 322.00,p < 0.001), days from concussion evaluation to PT (MdnPR = 6.00; MdnNR = 0.50; U = 517.50, p < 0.001), and engaged in a higher number of PT sessions than the NR group (MdnPR = 4.00; MdnNR = 3.00; U = 787.50, p = 0.02). The PR group also had a greater number of recovery days from PT evaluation compared to the NR group (MdnPR = 27.00; MdnNR = 10.00; U = 108.00, p < 0.001).

Conclusions

Previous studies have also shown that time to concussion evaluation is an important prognostic indicator of recovery. Correspondingly, prompt referral to PT should be promoted by providers, athletic trainers, and parents for patients who require higher escalation of concussion care to improve recovery outcomes.
A - 03 Outcomes of Standardized Care on Recovery for Repeated Concussion
Authors: Choi D M , Mathew A S , Roberts J K , Abt J P
Published: July 2024

Purpose

Recovery outcomes from consecutive concussions require greater empirical support. The purpose of this study was to compare recovery outcomes of patients who sustained repeated sport-related concussions (SRC) and received care at the same specialty clinic.

Method

Data were extracted from 148 patients, aged 12–18, diagnosed and evaluated in a specialty clinic for two consecutive SRCs. Comparisons between initial visits for first and second concussions included demographics, medical history, assessment scores, days since injury (DSI), and injury recovery days using paired sample t-tests. A linear regression model was built with relevant variables (age, gender, comorbidities, DSI, VOMS, PCSS) to predict recovery days for first SRC. Another model was constructed with significant variables to predict recovery days for second SRC.

Results

Individuals were evaluated within approximately one year from their first SRC (MAge = 14.61¬ ± 1.47) to their second (MAge = 15.44¬ ± 1.37, MeanDifference = 0.83, p < 0.001). There were no significant differences between other variables (p > 0.05). PCSS and overall VOMS change scores predicted recovery days for first SRC (R2 = 0.30, p < 0.001). However, the new model for second SRC accounted for much less of the variance in recovery days (R2 = 0.11).

Conclusions

Our results show patients do not experience a worse outcome from subsequent concussion (PCSS, VOMS, DSI, recovery days). However, clinical outcomes from patients’first SRC do not seem to implicate recovery outcomes for their second SRC. Despite controlling for commonly researched predictors of recovery, our findings highlight the heterogeneous nature of SRC for the same individual receiving standardized care. Additional research is needed to examine further intraindividual differences in those who sustain consecutive SRCs.
A - 04 The Impact of Season Progression on Concussion Recovery In all Star Cheerleaders
Authors: Boucher S J , Datoc A E , Mathew A S , Choi D M , Sisneros N , Jones C A , Ellis C , Abt J P , Burkhart S O
Published: July 2024

Purpose

Little has been done to investigate the impact of cheerleading season progression on recovery trajectories of sports-related concussions (SRC). The purpose of this study was to assess the impact of season progression on concussion recovery in All Star cheerleaders.

Method

Female All Star cheerleaders (n = 52) aged 8–18 (13.9.0¬ ± 2.5 years) were evaluated in a specialty concussion clinic for SRC during the 2020–2023 seasons. Cheerleaders were sorted into groups based on when their injury occurred (T1 = tryout/practice portion of season, T2 = beginning of competition season, T3 = end of season/coveted competitions). Mann–Whitney U Tests were used to evaluate differences between groups.

Results

Most All Star cheerleaders were evaluated for SRC during T2 (n = 32) compared to T1 (n = 12) and T3 (n = 8). Cheerleaders injured during T2 reported significantly lower PCSS scores (M = 21.0, IQR = 15.0–37.0) compared to T1 (M = 52.5, IQR = 27.5–60.8) and T3 (M = 46.9, IQR = 34.0–90.0), p = 0.01. There were no significant differences in days since injury (DSI; T1 M = 5.67, SD = 7.84; T2 M = 6.13, SD = 8.64; T3 M = 3.50, SD = 2.67) and evaluation of overall recovery time across groups (T1 M = 20.92, SD = 10.19; T2 M = 24.25, SD = 17.85; T3 M = 16.38, SD = 13.89; p > 0.05).

Conclusions

Overall, cheerleaders injured during the beginning of competition season had the lowest PCSS scores upon evaluation, which may be due to presenting to clinic further from their injury. Though not significant, All Star cheerleaders were evaluated sooner during the coveted competitions portion of the season. Despite the small sample size, the pattern of results suggests that greater incentive and pressure to participate in coveted competitions may lead to quicker recovery times.
A - 05 The Relationship between Child Opportunity and Self-Efficacy Following Pediatric Concussion
Authors: Johnson H M , Guerin J M , Gioia G A , Vaughan C G
Published: July 2024

Purpose

An individual’s confidence in their ability to facilitate their concussion recovery (i.e., self-efficacy [SE]) is important for outcomes. Self-efficacy may be influenced by early childhood experiences and access to environmental resources. This study explores the relationship between neighborhood opportunity and self-efficacy following pediatric concussion.

Method

Participants completed a 17-item self-efficacy measure (PACE-SE) during an initial clinic visit. The Child Opportunity Index (COI) was obtained based on each child’s home address. A stepwise linear regression was employed to examine the relationship between COI and PACE-SE accounting for symptom burden, days since injury, and sex.

Results

431 participants aged 13–18 (M = 15.1+/−1.6; 58% female) were seen within three months of concussion (M days since injury = 19.2+/−16.2) at a specialty clinic. The majority were injured playing sports (67%). Lower PACE-SE score was associated with female sex (r = 0.180; p < 0.001), higher symptom burden (r = −0.493, p < 0.001), and more days from injury (r = −0.132; p = 0.003). There was a small but significant relationship between COI and PACE-SE, after accounting for covariates (R2 = 0.008, p = 0.033). Stepwise regressions showed associations between COI and the PACE-SE subdomains Managing my Stress (MMS; R2 = 0.008, p = 0.031), Seeking Adult Assistance (SAA; R2 = 0.015, p = 0.008), and Maintaining a Positive Outlook (MPO; R2 = 0.009, p = 0.022), but not Managing my Activity (MMA). SAA and COI were significantly associated in males (p < 0.05), while MPO and COI were significant in females (p = 0.001, <0.05).

Conclusions

The results suggest that lower neighborhood opportunity is associated with lower overall self-efficacy in facilitating one’s recovery after concussion. Specific aspects of self-efficacy may be uniquely impacted, such as seeking adult assistance.
A - 06 Examining Consumer Feedback on the 2023 International Conference Consensus Statement on Concussion In Sport
Authors: Magill R , Vaughan C , Echemendia R , Kringler W , Bailey C
Published: July 2024

Purpose

The 6th International Conference on Concussion in Sport distilled its main outcomes and recommendations into a consensus statement, which will likely have significant influence on the evaluation and management of sport-concussion. This abstract examines opinions on the statement among healthcare providers, including those who contributed to the conference and those who did not.

Method

A survey was designed with minor concussion-specific modifications using the Appraisal of Guidelines Research and Evaluation 2nd edition (AGREE II) framework. This framework features 6 domains evaluated on a 7-point Likert scale - Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability, and Editorial Independence. 72 participants completed the survey, including neuropsychologists (29.2%), physicians (31.9%), and athletic trainers (31.9%). The majority were not involved in the statement (71.8%).

Results

The Scope and Purpose domain was most favorably endorsed (80.3%), followed by Rigour of Development (76%), Clarity of Presentation (74%), Editorial Independence (72.1%) and Stakeholder Involvement (70.7%). The Applicability domain was least favorably endorsed (69.5%). The majority of domain ratings did not differ significantly among healthcare providers, except for the Stakeholder Involvement and Applicability domains were rated higher by athletic trainers than physicians (p = 0.011, p = 0.007, respectively). No differences in opinions across the six domains were found between those who did and did not contribute to the statement.

Conclusions

Overall, the consensus statement was rated favorably by survey participants. Lower ratings in the Applicability domain suggest an area for improvement when developing future consensus statements.
A - 07 Three Brief, Public-Domain Performance-Validity Measures for Concussion Baseline Testing: Normative Performance and Sub-Optimal Cut Scores
Authors: Bankston A , Malkin R , LoGalbo A , Webbe F
Published: July 2024

Purpose

Purpose: We report normative data with non-athlete college students for three brief, public-domain performance validity tests (PVT) representing auditory-verbal memory (Rey Word Recognition Test; RWRT), auditory vigilance; (A-Test), and visual attention (Rey Dot Counting Test; DCT). Cut scores for suboptimal performance (SOP) were determined, and the importance of using multiple PVTs was established.

Method

Method: 150 non-athlete college students (45% female; representing four college year levels) were recruited via the college’s research participation application and assigned randomly to honest-effort, fake-bad, or instructed fake-bad groups. 50 student-athletes were selected randomly to compare athlete performance with non-athletes. Group differences for PVT measures, and receiver operating curve (ROC) cut scores for suboptimal performance are reported.

Results

Results: Only the RWRT measures met normality and homogeneity of variance assumptions. MANOVA with post-hoc Tukey tests showed no differences between groups for RWRT. For DCT and A-Test, non-parametric Kruskal-Wallis comparisons were conducted, each resulting in significant differences (all p < 0.001) between honest-effort and SOP groups. No differences were found between the two SOP groups, nor athlete baseline vs honest effort groups, but athletes differed significantly from both SOP groups. ROC cut scores that suggested suboptimal effort were DCT combination score ≥ 15; RWRT combination score ≤ 12; and A-Test omission errors ≥1. Four participants from the honest-effort group and 49 from the fake-bad groups fell below criteria for two tests.

Conclusions

Conclusion: The DCT combination and A-Test omission scores were valid indicators of suboptimal performance. Combining multiple PVT “failures”maximized identification of suspect performers and minimized inclusion of honest-effort participants.
A - 08 Mental Health and Identity in Digital vs. Physical Sports (Individual vs. Team Dynamics)
Authors: Clise E , Logalbo A
Published: July 2024

Purpose

To investigate how digital (e-sports) vs traditional (physical) sports affect athletes’mental health outcomes and identity perceptions.

Method

39 e-sports athletes (37 male, 2 female, aged 17–23) and 188 physical athletes (94 male, 94 female, aged 17–23) were administered the Athletic Identity Measurement Scale-Plus (AIMS-Plus), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7th Edition (GAD-7) questionnaire during baseline concussion testing. The AIMS-Plus questionnaire contains a Role Identity Rating, where athletes rate the importance of family, friendships, athletics, academics, religion, and romance in their lives (0–100).

Results

No significant differences in PHQ-9 and GAD-7 totals were observed between e-sports and physical athletes [p > 0.05]. E-sports athletes rated athletic and family identity lower than physical sports athletes (p = 0.015). Among physical sports athletes, higher athletic and family identity ratings were associated with lower PHQ-9 scores (p = 0.015), contrasting with nonsignificant findings in e-sports athletes. Among physical sports athletes, those participating in individual sports endorsed more symptoms on both GAD-7 and PHQ-9 than team sports athletes (p = 0.009; p = 0.045). Furthermore, individual sports athletes also rated family and athletic identity lower than team sports athletes (p < 0.001; p = 0.041).

Conclusions

Sport modality (digital or physical) does not affect mental health scores, suggesting that other factors influence student-athlete emotional functioning. Stronger athletic and family-role identity may serve as protective factors against depression for physical athletes. Although e-sports athletes rated athletic and family-roles lower, they did not appear to be more likely to experience emotional distress. Findings have implications for tailoring treatment to different types of athletes.
A - 09 An Examination of Pre-Existing Individual Characteristics and Concussion Presentations among Collegiate Athletes
Authors: Collyer A , Murray K , Miller K , Capriglione A , D‚ÄôArgenzio N , Baath S , LoGalbo A
Published: July 2024

Purpose

To examine the relationship between pre-existing individual characteristics and concussion outcomes among collegiate athletes.

Method

Archival data were analyzed from 142 collegiate athletes, ages 17–24 (M = 19.84, SD = 1.50), diagnosed with concussion based on cognitive impairment and symptom endorsement (CS; n = 88) or symptom endorsement alone (S; n = 54).

Results

Statistical analyses revealed no significant group differences for nearly all pre-existing individual characteristics analyzed, including sex, depressive symptoms, history of ADHD, baseline ImPACT performance, and balance. However, among baseline SCAT-5 symptom clusters, a chi-squared test of independence revealed a statistically significant association between group and endorsement of one or more symptoms of the cognitive fatigue cluster, χ2(2) = 5.82, p = 0.016, Cramer’s V = 0.20. Specifically, CS athletes were more likely to endorse cognitive fatigue than S athletes. No group differences were observed among other baseline SCAT-5 symptom clusters. Meanwhile, a Mann–Whitney U test indicated that post-concussive PHQ-9 scores were significantly higher for CS athletes (Mdn = 3.50) than S athletes (Mdn = 2.00), U = 1727.50, z = −2.59, p = 0.010. Moreover, CS athletes were more likely to endorse more post-trauma symptomatology than S athletes, in addition to demonstrating cognitive impairments.

Conclusions

Compared to pre-existing individual characteristics, the severity of post-concussive symptoms appears to be a better indicator of concussion outcome in terms of whether athletes present with symptoms only versus symptoms and cognitive impairment. This suggests that these differences in outcome may be better explained by injury-related factors (e.g., severity of injury or impact).
A - 10 Post-Concussive Changes in Functional Status and Associations between Concussion Symptoms and Domain-Specific Impairment
Authors: Clise E , Nelson F , Poskus J , LoGalbo A
Published: July 2024

Purpose

To investigate post-concussive changes in functional status and the relationships between concussion symptoms and domain-specific impairment.

Method

25 collegiate athletes (11 males, 14 females, ages 17–23) were administered the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7th Edition (GAD-7), Vertigo Symptom Scale-Short Form (VSS-SF), and Sport Concussion Assessment Tool-5th Edition (SCAT-5) at baseline and post-injury evaluations. Athletes were diagnosed with concussion at post-injury. WHODAS 2.0 dimension-level scores in “cognition”, “mobility”, “self-care”, “getting along with others”, “life activities”, and “participation in society”were calculated via the second-order model approach. Disparity scores (d-scores) were calculating by subtracting baseline scores from post-injury scores.

Results

Dimension-level paired t-tests revealed significant increases in WHODAS 2.0 “cognition”(baseline: M = 2.36, SD = 0.70; post-injury: M = 2.96, SD = 1.65) and “participation in society”(baseline: M = 2.16, SD = 0.47; post-injury: M = 2.72, SD = 1.28) scores from baseline to post-injury [t(24) = 1.84, p = 0.039; t(24) = 2.59, p = 0.008], but not for other functional domains. SCAT-5 Symptom Severity d-scores were positively correlated with “getting along”d-scores (r = 0.42, p = 0.037). VSS-SF d-scores were positively correlated with “cognition”and “mobility”d-scores (r = 0.45, p = 0.025; r = 0.51, p = 0.009). GAD-7 and PHQ-9 d-scores were not significantly correlated with any functional domain d-scores.

Conclusions

Results suggest that concussed athletes report greater declines in cognitive functioning and participation in society, as compared to other WHODAS 2.0 functional dimensions. Additionally, increased post-concussive symptom severity and vertigo/imbalance difficulties appear to be associated with increased disability in certain functional dimensions. Dimension-specific compensatory strategies may be beneficial in improving the functional status of concussed athletes with similar symptom profiles.
A - 11 Autonomic Anxiety vs Generalized Anxiety: Predictive Recovery Time in Sport-Related Concussions among Collegiate Athletes
Authors: Nelson F , Clise E , LoGalbo A
Published: July 2024

Purpose

This study represents the second phase in testing a self-report anxiety questionnaire and self-report vestibular symptom questionnaire, including its subscales, as potential competing predictive factors of protracted concussion recovery times among collegiate athletes.

Method

The Vertigo Symptom Scale-Short Form (VSS-SF) and Generalized Anxiety Disorder-7 (GAD-7) were administered to 31 collegiate athletes (18 females, 13 males, ages 18–23) at baseline and post-injury. Participant data was grouped by number of days until symptom resolution post-concussion (1–10 days [N = 18], 11+ days [N = 13]). VSS-SF, VSS-SF-Autonomic-Anxiety (VSS-SF-A), VSS-SF-Vestibular-Balance (VSS-SF-V), and GAD-7 scores were calculated via scoring guidelines.

Results

Results from an independent-samples t-test demonstrated that post-injury VSS-SF-A scores were significantly higher among athletes with 11+ recovery days (M = 3.08, SD = 3.71) compared to those with 1–10 recovery days (M = 1.06, SD = 2.65); t(29) = 1.78, p = 0.043, Cohen’s d = 0.65. Similar t-tests for post-injury VSS-SF-V (11+ [M = 5.23, SD = 6.41], 1–10 [M = 3.17, SD = 3.67]) and GAD-7 (11+ [M = 4.08, SD = 4.84], 1–10 [M = 2.50, SD = 2.23]) scores were not significant; t(29) = 1.14, p = 0.132, t(29) = 1.22, p = 0.116. A linear regression revealed that post-injury VSS-SF-A scores significantly predicted recovery time and explained 14.1% of the variance (b = 0.88, R2 = 0.14, p = 0.037). Post-injury VSS-SF-V and GAD-7 scores were not significant predictors.

Conclusions

Results suggest that post-injury VSS-SF-A scores can aid in identifying athletes that may be at risk for longer recovery times. Additionally, post-concussive autonomic anxiety appears to have a greater influence on athletes’recovery time, as compared to generalized anxiety symptoms. Interventions directed towards reducing and/or coping with autonomic anxiety symptoms may be particularly important for supporting post-concussive recovery.
A - 12 Pre-Morbid Migraine Impact on Concussion Recovery Time
Authors: Kantharaj Ramya , Ray Darryl , Asuncion Mia , Burkhart Dr Scott
Published: July 2024

Purpose

This observational study evaluated how premorbid migraines impact post-concussion recovery time.

Method

Our retrospective-cohort study analyzed data gathered from 2021 to 2022. Data reviewed patients diagnosed with concussions from sports and non-sports injuries at the Children’s Health Andrews Institute in Plano, Texas at the outpatient sports medicine clinic. 1303 participants completed four assessments for their pretreatment testing. Of the total participants, 91 indicated diagnosed pre-morbid migraines. Measures including the Vestibular Ocular Motor Screening test (VOMS), King-Devick Test, C3 Trails A, B, and AB, and Post Concussion Symptom Scale (PCSS) were analyzed using an independent samples T test. The results along with demographic information and recovery time were recorded on paper then transferred onto an excel sheet.

Results

There was a significant difference in PCSS scores at initial visit for patients with pre-morbid migraines compared to those without pre-morbid migraines, t(1303) = 4.235, p = <0.001. Levene’s test for equality of variances was violated for the following analysis and indicated no significance between premorbid migraines and those without pre-morbid in terms of recovery days, days since injury before seeking treatment, total visits, King Devick Test, Trails A/B/AB, or VOMS related headache scores.

Conclusions

The results of this study did not show any significance of premorbid migraines on concussion recovery time which contradicts prior findings. Individuals with premorbid migraines presented with higher PCSS symptoms during their initial clinical evaluation, but it did not impact recovery time. Future studies should evaluate how higher PCSS scores contribute to headache presentation during concussion recovery time.
A - 13 Social Determinants of Health and Health Equity in Return to Learn Following Sport-Related Concussion
Authors: Kissinger-Knox A , Stephenson K L , Santangelo J , Adubofour K , Iverson G L , Cook N E
Published: July 2024

Purpose

We conducted a narrative review and content analysis to (i) determine the extent to which research on return to learn (RTL) following sport-related concussion (SRC) has considered social determinants of health (SDoH) or health equity and (ii) provide recommendations to enhance the incorporation of SDoH and health equity into considerations of how best to support concussed students as they RTL following injury.

Data Selection

We coded 32 studies from a systematic review focused on clinical recovery following SRC, including RTL (Putukian et al., 2023). The review informed the latest Concussion in Sport Group consensus statement (Patricios et al., 2023). We examined studies to determine whether the SDoH domains and subcategories, derived from the US Department of Health and Human Services Healthy People 2020 and 2030 websites, were addressed. Pairs of raters coded articles independently and resolved disagreements through discussion.

Conclusions

SDoH remain largely unrepresented in studies on return to school following concussion. Future research is needed to better characterize how SDoH and health equity factors influence return to school following concussion to ensure that concussed and recovering students are supported.
A - 14 Examining Race-Associated Differences on Sway Medical System Balance and Cognitive Tests
Authors: Stephenson K , Maietta J E , Kissinger-Knox A M , Cook N E , Iverson G L
Published: July 2024

Purpose

To determine if there are race-associated differences in Sway Medical System balance and cognitive test scores among athletes undergoing baseline preseason testing.

Method

Athletes between 12 and 23 years old were administered the Sway Medical System balance and cognitive tests during pre-season baseline testing. Participants who did not report a past medical history of ADHD or concussion within the past 6 months were included (N = 32,918). Athletes who self-identified as “Black or African American”or “White”were compared on Balance, Reaction Time, Inspection Time, Impulse Control, and Memory module scores using Mann–Whitney U tests, and statistical tests were stratified by age and gender.

Results

The race-associated differences (effect sizes) between Black and White athletes ranged from extremely small (negligible) to small across all ages for both genders on Balance, Reaction Time, Inspection Time, and Impulse Control scores. For the Memory module, the effect sizes ranged from small to medium across all ages for both genders. White boys obtained higher Memory scores than Black boys (Hedge’s g = −0.18 to −0.43) and White men obtained higher Memory scores than Black men (g = −0.30 to −0.60). White girls obtained higher Memory scores than Black girls (g = −0.19 to −0.34).

Conclusions

The race-associated differences between Black and White student-athletes on Sway Medical System balance and cognitive test scores are generally negligible. The reasons for modest race-associated differences in Memory scores are unknown and future research to examine the potential role or influence of social risk factors and social psychological factors on test scores is recommended.
A - 15 Incorporating the Child Opportunity Index and Area Deprivation Index in Sport Concussion Research
Authors: Iverson G L , Santangelo J , Maietta J E , Cook N E
Published: July 2024

Purpose

Social determinants of health, including socioeconomic status (SES) and neighborhood characteristics, are underrepresented in concussion research. We examined two measures of neighborhood advantage and opportunity among patients accessing a multidisciplinary sports concussion clinic in Greater Boston.

Method

We collected the Child Opportunity Index (COI) and Area Deprivation Index (ADI) state decile scores and national percentile ranks for all new patients who presented to our clinic in 2023. The COI is an index of neighborhood conditions that may impact childhood development (e.g., education quality, SES, access to healthy food) with ratings from Very Low to Very High. The ADI characterizes an area’s socioeconomic conditions (e.g., income, housing quality, employment, education), with higher scores representing more disadvantage.

Results

There were 247 new patients who visited the clinic (Mage = 17.5, SDage = 5.2, 47.8% Girls/Women, 81.4% White, 4.0% Black, 6.5% Asian, 4.9% Hispanic). The majority lived in an area with a High or Very High state COI (74%) and High or Very High national COI (88%). The median ADI state decile was 2.00 (IQR = 1.00–4.00) and the median national percentile was 10.00 (IQR = 5.00–18.00) (representing the highest 10% of advantage). The state deciles for the two measures were correlated (Spearman rho = 0.64), but not redundant.

Conclusions

The COI and ADI are important, accessible measures of SES that can be included in future studies. Patients from low SES were greatly underrepresented in the clinic compared to the population of our metropolitan area. Patients were predominantly from higher SES, consistent with prior studies suggesting socioeconomic disparities accessing specialty concussion care.
A - 17 Pre-injury Predictors of Protracted Recovery from Pediatric Concussion: a Latent Class Analysis
Authors: June D , Iampietro M , Zelikovsky Z , Grady M , Master C
Published: July 2024

Purpose

This person-centered study examined pre-injury psychological and neurodevelopmental risk factors in youth experiencing persistent concussion symptoms (PCS). Latent class analysis (LCA) was used to empirically define groups of children and adolescents experiencing PCS, and compare their functional outcomes.

Method

126 pediatric patients (Mean age = 15.94 years; 65.1% female) experiencing PCS (Mean time since injury = 315 days) participated in a clinical neuropsychological consultation and evaluation within the Minds Matter Concussion Program at Children’s Hospital of Philadelphia. LCA models were run using pre-injury variables (mood and anxiety concerns, attention and learning challenges). Functional outcomes (neuropsychological performance, academic decline, symptom magnification) were then compared across the resulting classes.

Results

Statistical indicators [Akaike Information Criteria (804.59), adjusted Bayesian Information Criteria (801.01), Bootstrap Likelihood Ratio Test (p < 0.001)] indicated that a two-class model provided the best fit. Class 1 (n = 58) was predominately females (78.3%) with comorbid pre-injury developmental (46.6% learning challenges, 54.6% attention concerns) and psychological concerns (75.6% anxiety, 48.9% mood concerns). Class 2 (n = 68) was half females (49.8%) with fewer comorbid pre-injury developmental (14.6% learning challenges, 22.5% attention concerns) and psychological concerns (39.3% anxiety, 0% mood concerns). The two classes did not significantly differ on functional outcomes. Standardized testing scores were within the average range across the sample.

Conclusions

Pre-injury risk factors contribute to persistent symptom experience and functional complaints in the absence of objective cognitive impairment. Given the incidence across groups, these findings highlight the importance of understanding psychological and neurodevelopmental factors, as well as sex-based differences when directing referrals and treatment of PCS within a multidisciplinary program.
A - 19 Reliability of Mobile Ecologic Momentary Assessment Platform ReCoUPS to Monitor Concussion Symptoms and Psychological HRQoL
Authors: Tracey A J , Bretzin A C , Rettmann A , Wiebe D J , Covassin T
Published: July 2024

Purpose

The purpose of this study was to determine the psychometric properties of a concussion symptom checklist and psychological health-related quality of life (PHRQoL) inventories administered by novel, mobile ecological momentary assessment (EMA) platform, Recovering Concussion Update on Progression of Symptoms (ReCoUPS) in healthy individuals.

Method

We enrolled 53 healthy individuals (female = 34; Μ age = 20.79 years, SD = 2.68) into our test–retest reliability study using the ReCoUPS platform on participants’smartphones. Thirty survey questions from the Sport Concussion Assessment Tool6 (SCAT-6) and the PROMIS Emotional Distress Shorts Forms Anxiety and Depression (PROMISAnx and PROMISDepress), were administered at random times, daily, for 7 days via ReCoUPS text messages. Eight days after enrollment, participants completed recalled PHRQoL (rPHRQoL) inventories (i.e., “within the past 7 days”). Cronbach’s alpha (Α) determined the internal consistency of momentary PHRQoL (mPHRQoL). Intraclass correlation coefficients (ICC), 2-way mixed effects model (95% confidence intervals,[CI]) measured agreement between rHRQoL and mPHRQoL. Spearman’s rho (rs) correlation coefficients determined linear relationships between mPHRQoL and SCAT-6 symptom clusters.

Results

There was strong internal consistency among all mPHRQoL items (PROMISAnx Α = 0.83; PROMISDepress Α = 0.95). rPHRQoL demonstrated excellent agreement with mPHRQoL (PROMISAnx ICC = 0.92, 95% CI: 0.57–0.99; PROMISDepress ICC = 0.79, 95% CI: −0.09-0.99). mPROMISAnx was significantly correlated with all clusters (affective rs = 0.81, p < 0.001; cognitive-fatigue rs = 0.66, p < 0.001; migraine rs = 0.34; p < 0.001). mPROMISDepress was significantly correlated with affective (rs = 0.69, p < 0.001) and cognitive-fatigue (rs = 0.58, p < 0.001) clusters.

Conclusions

These findings ensure the robustness and generalizability of administering the SCAT-6 symptom checklist, PROMISAnx, and PROMISDepress via ReCoUPS for monitoring concussion symptoms and PHRQoL in healthy participants.
A - 20 Identifying Concussion in College-Aged Individuals Using a Multimodal Assessment of Vestibular and Oculomotor Function
Authors: Klein Lilian A , Zynda Aaron J , Loftin Megan C , Tracey Allie J , Pollard-McGrandy Alyssa M , Clark Haley , Davis E Reid , Covassin Tracey
Published: July 2024

Purpose

Vestibular and oculomotor assessments are fundamental tools to identify concussions. However, research is unclear on which vestibular and oculomotor assessment or combination of assessments best detect concussions. The purpose of this study was to assess the discriminant ability of the Vestibular/Ocular Motor Screening (VOMS), Balance Error Scoring System (BESS), modified BESS (mBESS), and High-Level Mobility Assessment Tool (HiMAT) to identify college-aged individuals with concussion from controls.

Method

A prospective study of college-aged individuals (18–30 years) diagnosed with concussion within 5 days of enrollment was conducted. Demographics, injury information, VOMS, BESS/mBESS, and HiMAT were completed at the initial visit. Logistic regressions (LR) and receiver operating characteristic (ROC) analyses of the area-under-the-curve (AUC) determined the ability of the VOMS, BESS/mBESS, and HiMAT to identify concussion from control. A total of 214 participants (mean age = 20.4¬ ± 2.5 years, 52.8% female) were enrolled, with 137 (64.0%) concussions and 77 (36.0%) controls.

Results

The VOMS total (AUC = 0.93, 95%CI = 0.90–0.97, p < 0.001) and HiMAT total (AUC = 0.79, 95%CI = 0.65–0.93, p < 0.001) significantly identified concussion from control, while the BESS (AUC = 0.58, 95%CI = 0.50–0.67, p = 0.05) and mBESS (AUC = 0.55, 95%CI = 0.47–0.64, p = 0.23) did not. A 2-factor model with combined VOMS and HiMAT totals did not improve identification (AUC = 0.92, 95%CI = 0.85–1.00, p < 0.001).

Conclusions

The VOMS total score demonstrated outstanding discriminant ability, HiMAT total score demonstrated adequate discriminant ability, and BESS/mBESS total errors demonstrated unacceptable discriminant ability in identifying concussions from controls. Our findings suggest that the VOMS remains a preferred vestibular and oculomotor functioning assessment for identifying concussion. Furthermore, incorporating objective assessments with the VOMS, such as HiMAT, does not improve diagnostic yield.
A - 21 Attention-Deficit Hyperactivity Disorder and Post-Concussion Performance on the ImPACT
Authors: Stafford C , Slicer K , Bennett R
Published: July 2024

Purpose

To investigate whether there are differences between individuals with and without a diagnosis of ADHD on cognitive measures and symptom reporting post-concussion.

Method

Participants were selected from an archival de-identified database. The sample consisted of 198 (47.7% male, 52.3% female) student-athletes with a mean age of 19.67 years. All student-athletes were administered the ImPACT post-concussion. The student athletes were further divided into two groups: having a prior diagnosis of ADHD (N = 66 Mage = 19.55, 54.5% males, 59.1% females) and not having a prior diagnosis of ADHD (N = 66 Mage = 19.79, 40.9% males, 45.5% females). Multiple independent samples t-tests were utilized to compare symptom report scores between the two groups.

Results

No significant differences were found between the groups on measures of verbal memory [t(130) = −1.032, p = 0.304], visual memory [t(130) = −0.541, p = 0.589], visual motor function [t(130) = −0.833, p = 0.406], reaction time [t(130) = 1.302, p = 0.194], and impulse control [t(130) = 1.305, p = 0.194]. There were no differences in symptoms reported with the exception of difficulty concentrating [t(130) = 2.169, p = 0.032].

Conclusions

There were no differences in cognitive performance and symptom reporting between student athletes with and without ADHD. This suggests that there may be little to no influence of ADHD on post-concussion performance. Further research should be conducted to examine the effect of ADHD for athletes following SRC.
A - 22 Baseline testing for athletes: where are we now and where are we going?
Authors: Slicer K , Stafford C , Bennett R
Published: July 2024

Purpose

The purpose of this pilot study is to find out the current state of baseline neurocognitive testing for athletes across multiple ages and organizations, by gathering information from professionals in the field.

Method

16 sports neuropsychologists completed a one-time anonymous online survey that contained questions regarding concussion baseline testing practices and opinions.

Results

15 sports neuropsychologists answered “yes”to conducting baseline testing, with one responding “no.”Of those, 10 reported working with professional athletes, 8 with college athletes, 8 with adolescents aged 13–17, and 5 with children aged 8–12. All 15 sports neuropsychologists reported using the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), in accordance with other measures such as the VOMS, sway, force platform, SCAT, and traditional paper and pencil measures, among other assessments. Baseline testing took place in the sports medicine clinic, at the sports facility, at the university, private office, or research lab. A majority of the sports neuropsychologists reported that testing was supervised by themselves, an athletic trainer, student trainee, and/or clinic staff. A portion (20%) of the sports neuropsychologists indicated they were not satisfied with their current method of baseline testing. One neuropsychologist reported that they currently conduct remote baseline testing and a minority of the respondents stated they would consider remote testing.

Conclusions

There was a consensus on the use of the ImPACT as the main baseline neurocognitive measure, among other assessments. This study should be expanded to include a larger sample size and variety of sports professionals to better understand the current state of sport concussion assessment.