bluuebunny/crossref_metadata_2025 huggingface dataset:
Preseason performance on cervical, vestibular and divided attention measures in youth ice hockey players
Authors: Schneider Kathryn J , Palacios-Derflingher Luz , Codd Chevonne , Shi Qian , Meeuwisse Willem H , Emery Carolyn A
Published: November 2017

Objective

To determine preseason values on cervical, vestibular and divided attention measures in youth ice hockey players aged 10-14 years

Design

Cross-Sectional study

Setting

Sport Injury Prevention Research Centre, Alberta, Canada

Participants

Youth Ice Hockey players (n=934, age 10-14 years).

Outcome measures

Numeric pain rating scores for neck pain, headache, dizziness; Cervical flexor endurance test (CFE), cervical flexion rotation test (CFRT), cervical spine strength, head perturbation test, functional gait assessment (FGA), walking while talking test (WWTT), head thrust test and dynamic visual acuity (DVA).

Main results

Symptoms of neck pain, headaches and dizziness were reported by 17%, 18% and 10% of participants respectively. The median time of CFE was 27.0 seconds (IQR: 19.9, 40.7). CFRT was positive in 52 (6.2%) participants. Median anterolateral cervical spine strength was 8.0 lbs (IQR: 6.1, 10.3) right and 7.8 lbs (IQR: 6.0, 10.1) left. 13% of participants were unable to maintain a stationary head position when an external force was applied. 48% of participants performed less than perfect on the FGA. Time to complete a complex task while walking increased 40 foot walking time by a median of 6.4 seconds (IQR: 4.0, 10.3). Head thrust test was positive in 33 (3.7%) participants. Clinical DVA score was a median of 0.2 logMar (IQR: 0.1, 0.3).

Conclusions

Symptoms are common at baseline and outcomes on many commonly used clinical tests may be different for healthy 10-14 year olds compared to the adult literature. These findings form an important reference point for the interpretation of post-injury testing.

Competing interests

None.
The feasibility of romberg quotient in assessment of balance after sport concussion
Authors: Vartiainen Matti , Holm Anu , Koskinen Sanna , Hokkanen Laura
Published: November 2017

Objective

To evaluate the feasibility of a computerised balance test and a calculated Romberg Quotient in acute recognition of concussion

Design

Prospective pilot study.

Setting

Finnish national ice hockey league.

Participants

Four teams participated in the study (n=113, male). Nine athletes who sustained a head/neck-related injury and control group of seven non-concussed volunteer players were followed.

Study procedure

All participants underwent the baseline assessment before season. The study period was one hockey season 2009- 2010. All game related concussions during this time were recorded. Post-concussion assessment was administered within 36 hours after injury.

Outcome measures

Balance was measured using a portable computerised platform. Romberg test stances were used on hard surface and soft foam. The participants stood still for 30 seconds with a closed stance. A relative balance change, Romberg Quotient (RQ), was assessed by calculating the ratio between eyes open, and eyes closed parameters. RQ was computed for sway length, area and velocity in each condition

Main results

Concussed and control group did not differ in balance measures at baseline. At post-injury, soft foam measures showed a difference between groups in sway length (U=5.0, p=0.005) and velocity (U=5.0, p=0.005). Among the concussed, RQ mean in sway velocity was 2.02 (1.7–2.3, 95% confidence limits) at baseline and 2.14 (1.9–2.4) post-injury

Conclusions

Alternating between different visual and/or somatosensory conditions in balance testing brings out the effect of concussions. RQ is easy to calculate regardless of the measurement systems or scales and can be used as valid tool in sport concussion measurement

Competing interests

None.
The sport concussion baseline assessment: an investigation of sex and sport differences
Authors: Resch Jacob E , Walton Samuel , Freeman Jason , Broshek Donna
Published: November 2017

Objective

To assess for sex and sport baseline differences for the Immediate Postconcussion and Cognitive Test (ImPACT) and Sensory Organisation Test (SOT) in collegiate athletes.

Design

Cross-sectional.

Setting

Research laboratory.

Participants

Participants consisted of 315 male (n=189) and female (n=126) division I collegiate athletes with an average of 19.5 + 1.34 and 19.3 + 1.31 years, respectively.

Intervention

Participants completed ImPACT and the SOT baseline assessments as part of their university concussion management protocol.

Outcome measures

Analyses of variance were used to assess for sex and sport differences for ImPACT’s Visual and Verbal Memory, Visual Motor Speed, and Reaction Time and the SOT’s composite scores. Post-hoc analyses were performed with Tukey’s test. All analyses were performed with α=.05.

Main results

In terms of sex, females scored significantly higher than males on ImPACT’s Verbal Memory (F (1,314)=4.85, p=0.03) and Visual Motor Speed (F (1,314)=4.51, p=0.03) composite scores. Within male sports, a significant difference was observed for the SOT composite score (F (6,181)=3.22, p=0.01). Within female sports, a significant difference was observed between sports for ImPACT’s Reaction Time composite score (F (6,125)=4.16, p=0.01).

Conclusions

Overall, sex as well as sport differences were observed for baseline ImPACT and SOT performance for one or more composite scores. Our results support the use of baseline assessments to account for performance differences between sex and sport.

Competing interests

None.
The value of computerised neurocognitive testing at medical clearance to return to play following a sport-related concussion in youth ice hockey players
Authors: Black Amanda M , Brooks Brian L , McLeod Regan S , Palacios-Derflingher Luz , Schneider Kathryn J , Blake Tracy A , Taylor Kirsten A , Meeuwisse Willem H , Emery Carolyn A
Published: November 2017

Objective

To determine the value of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) tool in measuring neurocognitive recovery following concussion.

Design

Nested case-control.

Setting

Sport Medicine Centre, Alberta, Canada.

Participants

Ice hockey players (n=96; 88.5% male, 11-17 years old) following concussion who completed ImPACT at baseline and medical clearance to return to play (RTP) were compared to controls (n=31) matched for age, sex, and testing time interval.

Assessment of risk factors

Players who sustained a concussion were referred to a study physician for assessment and RTP clearance based on clinical assessment and SCAT2/3. Physicians were blinded to ImPACT scores.

Outcome measures

ImPACT composite scores were measured (i.?e., verbal memory, visual memory, reaction time, visual motor) at each time interval [i.e., baseline and RTP (cases)/second measurement (controls)]. Between-interval ImPACT reliable change scores (80%CI) were compared.

Main results

At RTP (Median days since injury: 22, range: 2–84), 43/96 (44.8%) concussed players and 11/31 (35.5%) controls had ≥1 composite scores reliably worse than at baseline. Conditional logistic regression analysis (n=31 matched pairs) did not demonstrate a difference in the odds of having ≥1 reliably worse composite score between concussed and controls [OR=2.00 (95% CI: 0.5–8.0)] or ≥1 reliably better composite score [OR=1.2 (95% CI: 0.37–3.93)].

Conclusions

The utility of baseline ImPACT scores in medical decisions to RTP may be limited by the reliability of composite scores in youth populations. Caution is warranted when interpreting ImPACT scores post-concussion on an individual level using baseline performance. Future research including multivariable analyses is warranted in a larger sample.

Competing interests

Brian Brooks is a co-author of a paediatric memory test for which he receives royalties. No financial interests in ImPACT are declared.

None for all other authors.
A review of misnomers and misconceptions in concussion biomechanics
Authors: Patton Declan A , McIntosh Andrew S , Kleiven Svein
Published: November 2017

Objective

To identify potentially-misleading terms and concepts in concussion biomechanics.

Design

Literature review.

Setting

N/A.

Participants

N/A.

Intervention

N/A.

Outcome measures

Media articles and scientific literature describing potentially-misleading terms and concepts in concussion biomechanics.

Main results

Potentially-misleading terms and concepts in concussion biomechanics were identified in media articles, clinical textbooks and some scientific articles. One such misconception is that during a concussion the brain ‘sloshes’ and slams into the skull. The brain, which has very high water content, is nearly incompressible and is tethered to an almost rigid cranial cavity. Therefore, the brain resists separation from the skull during radial impacts; however, there is little resistance to shear during oblique impacts, which results in brain tissue deformations. Another potentially-misleading concept is that the mass of headgear increases the angular acceleration of the head during an impact. Such a concept is incorrect as the mass of the headgear increases the moment of inertia of the head and, therefore, decreases the tendency of the head to rotate. Lastly, the term ‘sub-concussion’ originally referred to animal model head impacts not resulting in loss-of-consciousness. However, ‘sub-concussion’ is currently used to refer to any head impact not resulting in concussion, e.g. head accelerations experienced by a soccer player when heading a ball. A biomechanical threshold for concussion has yet to be identified; therefore, careful use of the term ‘sub-concussion’ is suggested.

Conclusions

Potentially- misleading terms and concepts in concussion biomechanics have the potential to misinform and confound attempts to further the understanding of concussion.

Competing interests

None.
Costs and contexts: factors affecting self-report of concussion in a military academy
Authors: D’Lauro Christopher , Johnson Brian Rudolph , Foster Craig A , McGinty Gerald , Campbell Darren
Published: November 2017

Objective

To understand the factors affecting the decision to self-report a concussion – particularly among sub-groups like athletes and future pilots.

Design

Survey.

Setting

A United States military academy.

Participants

Voluntarily participatingcadets (n=2,503, 23.9%=female).

Assessment of risk factors

NCAA Division I athlete status, future pilot status, gender, school year were examined as factors affecting self-report.

Outcome measure

Anticipated Self-Report (ASR) of concussion on a scale from 1–9 (most to least likely to self-report). Cadets completed a 2-page survey matching ASR to demographic risk factors (above), and to self-report questions assessing Costs, Rewards, Attitude, Subjective Norms, Self-Efficacy, and Social Support.

Main results

Cadets demonstrated an overall willingness to self-report a concussion – indicated by a mean ASR score of 6.07 (95% CI=5.97–6.17, SD=2.47, median=7.00, n=2.332) above the scale midpoint. Costs (r=−0.61, p<0.001), Rewards (r=0.67, p<0.001) and Attitude (r=0.70, p<0.001) were highly, significantly predictive of ASR. Cadet sub-populations revealed the importance of specific costs. Aspiring pilots – concerned about concussions affecting their pilot qualification status –steadily decreased ASR by year, while non-pilot cadets retained consistent ASR, shown by Future Pilot x Class Year ANOVA (F(3,2196)=11.78, p<0.001). NCAA Athletes, conversely, showed no ASR differences from non-athletes, t(2251)=0.16, p=0.87, CI =±0.23.

Conclusions

Symptom self-report is a crucial factor in all stages of concussion care. Costs and rewards affecting self-report may have unique contexts that drive unexpected self-report patterns. Here, aspiring pilots showed lower self-report behaviour while athletes showed average self-report behaviour – based on perceived costs to career aspirations. These data will be used to design interventions to increase to concussion self-report.

Competing interests

All authors received funding from the National Collegiate Athletic Association and Department of Defense (NCAA Mind Matters Challenge).
Efficacy of a football rule to prevent concussion
Authors: Beaudouin Florian , Reinsberger Claus , Meyer Tim
Published: November 2017

Objective

Although the incidence of concussion per athlete exposure is relatively low in comparison to high risk sports, absolute numbers of concussions are considerable in football, because of its high popularity and high number of athletes. In 2006, the International Football Association Board (IFAB) employed a modification of football rules to protect the brain and reduce head injuries. Starting during the season 2006/2007, an attack towards the head (e.g. by elbow check) was punished more consequently and can even lead to an elimination from the game, if performed on purpose. The objective of our study is to examine, whether the rule change resulted in a lower incidence of concussion in professional German football.

Design

Based on data of a German football magazine (obtained by in depth coverage on each club of the German Bundesliga), a database of all head injuries in the German football Bundesliga between 2000/2001 and the current season was created. The incidence of concussion during six years before and six years after the initiation of the rule change was then calculated and compared. Furthermore, the number of missed days of practice and/or games and the mechanism of injury (based on player’s position and club) was analysed.

Main results

The incidence of concussion during the seasons 2006/07 – 2012/13 is lower than the incidence during 2000/01 – 2005/06.

Conclusions

A rule change with the intention to punish attacks to the head more consequently to protect the brain might be an effective means to prevent concussion in football.

Competing interests

This work was funded by a grant of the Federal Institute of Sports Science (Federal Ministry of the Interior).
Higher risk-taking behavioursbehaviors and sensation seeking needs in collegiate student-athletes with a history of multiple sport-related concussions
Authors: Beidler Erica , Covassin Tracey , Donnellan MB , Nogle Sally , Pontifex Matthew B , Kontos Anthony P
Published: November 2017

Objective

To investigate differences in risk-taking behaviours and sensation seeking needs between collegiate student-athletes with and without a history of sport-related concussion (SRC).

Design

Cross-sectional quantitative study.

Setting

Four National Collegiate Athletic Association (NCAA) universities.

Participants

A total of 1,398 (68%) of 2,055 collegiate student-athletes completed the survey. There were 146 participants excluded due to: age<18, current SRC/acute musculoskeletal injury, SRC within 3-months, non-NCAA, non-SRC, and incomplete survey. Therefore, 1,252 subjects from 18 sports were included.

Assessment of risk factors

A10-minute survey was administered that included demographic information, SRC history, Barratt Impulsiveness Scale (BIS) for risk-taking, and Brief Sensation Seeking Scale (BSSS). The independent variable was SRC history: 0(n=938), 1(n=205), 2+(n=109).

Outcome measures

The dependent variables were BIS total risk-taking impulsivity and BSSS total sensation seeking scores.

Main results

Significant differences were found between SRC groups for the totalrisk-taking impulsivity [F(1,227)=7.15,p=0.00] and sensation seeking [F(1,214)=4.53,p=0.01] variables. Total risk-taking impulsivity was significantly higher for the 2+ SRC group compared to the 0 SRC group (MD±95%CI=0.18 ± 0.11,p=0.00) and the 1 SRC group (MD±95%CI=0.15 ± 0.12,p=0.02). Total sensation seeking scores were significantly higher for the 2+ SRC group compared to the 0 SRC group (MD±95%CI=0.19 ± 0.17, p=0.03).

Conclusions

Total risk-taking and sensation seeking scores were higher for collegiate student-athletes with a history of multiple SRC. This finding could be useful when implementing behaviour modifications for safer play. Future longitudinal research should adopt a pre-/post-test design to determine if increased risk-taking and sensation seeking are SRC risk-factors or if multiple SRCs cause an increase in psychological variables.

Competing interests

None.
Q. why doesn’t headgear prevent concussion? a. no one bothered to ask
Authors: McIntosh Andrew S , Patton Declan A
Published: November 2017

Objective

The study identifies barriers to the supply of helmets/headgear/headguards (headgear) that are likely to be effective in preventing concussion.

Design

Literature review and biomechanical testing.

Setting

All sports.

Outcome measures

Sport federation rules on headgear and headgear impact performance with regards to concussion.

Main results

A review of laws and regulations showed that many sports have not developed relevant performance based technical specifications for headgear. World Rugby performance requirements comprise a drop height of 300 mm and pass level of greater than 200 g in impact energy attenuation tests. Testing of current World Rugby approved headgear showed peak linear headform accelerations (PLA) in the range 400 to 600 g in 200 mm and 300 mm drop tests. The performance of the exemplar models is arguably worse than in similar models tested circa 2000 and exceed informative concussion injury criteria, e.g. PLA<75 g. Combat sports generally do not mandate performance requirements. Similarly, there is a range of performance from good to poor in laboratory-tested combat sport headgear with respect to concussion prevention; e.g. for headgear tested at a 500 mm drop height, PLA ranged from 50 g to 466 g. PLA results were reflected in angular head acceleration performance in impact tests. Other sports will be considered, e.g. ice hockey and American football, where performance standards are mandated.

Conclusions

The availability of headgear designed to prevent concussion is limited because relevant performance requirements are absent and/or aligned with other head injury prevention goals, e.g. preventing severe head injury.

Competing interests

None.
The impact of mandatory helmet use on career length in the national hockey league (nhl)
Authors: Reinsberger Claus , Frick Bernd
Published: November 2017

Objective

In 1979, the National Hockey League (NHL) announced that helmets would become mandatory for incoming players. The objective of this study is to evaluate, whether the mandatory use of helmets has a positive impact on the career length in NHL players.

Design

A public database (www.hockeydb.com) was utilised to extract career lengths of NHL players before and after 1979. Since the rule allowed players who signed professional contracts prior to June 1, 1979 to continue not to wear a helmet, career lengths of all players entering the NHL via the draft in ten seasons before (1969–1978) and ten seasons after (1979–1988) the introduction of the helmet rule was compared.

Main results

In the 20 years analysed, 3952 players were selected by NHL teams of which 1818 eventually appeared in at least one match and were considered for further analysis. Controlling for draft round, draft number, individual players’ performance (games played per season, number of goals and assists per game, number of penalty minutes per game), year of entry and team picking the player, players during the era of mandatory helmet use had significantly longer careers (approximately 2.5 years, cox regression z=−0.768, p<0.01). Defenders and forwards benefit to the same extent from wearing a helmet.

Conclusions

The introduction of mandatory use of helmets in the NHL was associated with an increase in career length. Protection of head and brain together with associated conditions may be contributing to this observation.

Competing interests

None.
Ability of children aged 5-16 years to perform scat3 and child-scat3 testing in the emergency department
Authors: Babl Franz E , Dionisio Diana V , Davenport Lucy , Baylis Amy , Hearps Stephen , Bressan Silvia , Anderson Vicki , Oakley Ed , Davis Gavin A
Published: November 2017

Objective

To evaluate children’s ability to perform the child-SCAT3 and SCAT3 Sports Concussion Assessment Tool.

Design

Prospective observational study.

Setting

Tertiary children’s hospital emergency department.

Participants

264 children presenting to ED with concussion (CONC, n=90) and two control groups (i) upper limb injury (ULI, n=90) and (ii) well children (WELL, n=84) with equal sized subgroups in three age bands of 5–8, 9–12, and 13–16 years.

Assessment and outcome

Ability to complete SCAT subtests administered by trained research assistants, stratified by age band and participant group. Child-SCAT3 was used for 5–12 years, SCAT3 for 13–16 years.

Results

Inability to complete at least one sub-test of child-SCAT3 occurred in 29 (32.2%) of the 5-8 year age band and 5 (5.5%) in the 9–12 year age band. The 5 and 6 year olds had the lowest completion rates. In the 13–16 year age band 11 (13.3%) participants were unable to complete at least one sub-test of SCAT3.

The most frequent reasons for inability to complete any sub-test (n=116) were ‘did not understand’ (n=45), and ‘refusal to continue’ (n=26). Fewer were due to ‘feeling too unwell to continue’ (n=13).The subtests with the highest rates of inability to complete were child-SCAT3 and SCAT symptoms scale (n=17), BESS (n=9), coordination (n=9), digits backwards (n=8) and concentration (n=8).

Conclusions

Child-SCAT3 should be applied with caution in young children due to an inability to understand certain test items and may need to be modified. SCAT3 can be reliably applied in teenagers 13–16 years of age.

Competing interests

GAD is an honorary member of the Australian Football League Concussion Working Group, and has attended meetings organised by sporting organisations including the National Football League (USA), National Rugby League (Australia) and FIFA (Switzerland); however has not received any payment, research funding, or other monies from these groups other than for travel costs. GAD is a member of the International Concussion in Sport group that developed the SCAT3 and ChildSCAT3.
How to interpret post-concussion symptom severities of scat3 in professional ice hockey players
Authors: Hänninen Timo , Parkkari Jari , Tuominen Markku , Iverson Grant L , Vartiainen Matti , Öhman Juha , Luoto Teemu M
Published: November 2017

Objective

To characterise the baseline to post-concussion variation of each SCAT3 symptom.

Design

Prospective cohort.

Setting

Finnish professional ice hockey league.

Participants

SCAT3 baseline testing has been mandatory in the Finnish hockey league since 2013. The league recommends day of injury testing for all players with suspected concussion. Of the reported day of injury SCAT3s, between seasons 2013–2016, a total of 29 concussions were confirmed by the teams’ medical staff.

Intervention

Outcome measures

The day of concussion symptom severities for each of the 22 symptoms were compared to (i) the league’s normative reference values [based on 2013–2014 preseason baselines (n=270)] and (ii) the baseline scores of the 29 concussed players. The change between day of concussion score and players’ individual baseline score was compared to: (i) the reference variation of the league’s two preseason baselines [2013–2014 and 2014–2015 (n=179)], and (ii) the variation between two preseason baselines of the concussed players.

Main results

The most prevalent post-concussion symptoms were: “Don’t feel right” (100%), headache (97%), and pressure in the head (90%). In addition, these symptoms were the most common to worsen on the day of concussion compared to players’ individual baseline. “Feeling like in a fog”, confusion, and dizziness were common on the day of injury (each reported by 72%) but rare on baselines (1–2%). Fatigue or low energy and neck pain were the most common and unstable baseline symptoms in the league.

Conclusions

Headache and “Don’t feel right” were the most useful symptoms on the SCAT3 in acute concussion recognition.

Competing interests

None.

Timo Hnninen, Jari Parkkari, Markku Tuominen, Matti Vartiainen, Juha hman, Teemu M. Luoto: None.

Grant L. Iverson has been reimbursed by the government, professional scientific bodies, and commercial organisations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including professional athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has not received research support from a test publishing company in the past 5 years.
A preliminary video review of in-game head injury incidents (hii) and use of the head injury assessment (hia) from the 2015 super rugby season
Authors: Kohler Ryan , Makdissi Michael , McDonald Warren , Partridge Bradley , Gardner Andrew J
Published: November 2017

Objective

To complete a video evaluation of the management of players suspected of sustaining concussion in professional Rugby Union during the 2015 season.

Design

Retrospective, observational study.

Setting

Super Rugby match play.

Participants

Players representing Australian Super Rugby franchises who were evaluated by their team doctor (TD) and an independent match day doctor (MDD) for concussion during the 2015 season.

Outcome measures

In-game ‘head injury incidents’ (HII) and use of the World Rugby (WR) Head Injury Assessment (HIA) process were recorded. TD and MDD had access to video during games which allowed review of HIIs as part of their decision making process. A retrospective review of the video of each incident by three experienced clinicians was conducted to assess the decision-making process (i.e., permanent removal, remain-in-play, or return-to-play).

Main results

There were 47 ‘head injury incidents’ (HII) evaluated by TD and MDD. Using WR HIA criteria, 18 incidents resulted in a player’s permanent removal, of which 16 were subsequently diagnosed with concussion. On retrospective video review, the in-game decision to permanently remove a player was agreed upon in 78% (14/18) of cases. Using WR HIA criteria, there were 28 decisions to temporarily remove a player and conduct a HIA. On retrospective review, the in-game decision to complete a HIA was agreed upon in 68% (19/28) of cases.

Conclusions

Reviewing match video footage can be a useful addition to the TDs’ and MDDs’ in-game clinical assessment of concussion. The clinical relevance of some brief signs on video review warrants further investigation.

Competing interests

Ryan Kohler, Bradley Partridge – None.

Michael Makdissi (see declaration form for full disclosures)

Warren McDonald is the Chief Medical Officer of the Australian Rugby Union (ARU). He also operates his own private sports and exercise medicine practice in Canberra, Australia.

Andrew Gardner has a clinical practice in neuropsychology involving individuals who have sustained sport-related concussion (including current and former athletes). He serves, in a voluntary capacity, as a member of the Australian Rugby Union (ARU) concussion advisory group. He has received travel funding from the Australian Football League (AFL) to present at the Concussion in Football Conference in 2013. Previous grant funding includes the NSW Sporting Injuries Committee, the Brain Foundation and the Hunter Medical Research Institute (HMRI), supported by Jennie Thomas. He is currently receiving research funding through the HMRI, supported by Anne Greaves.
Feasibility study of a simple reaction test for immediate sideline-analysis â€“ preliminary results$
Authors: Gnsslen Axel , Krutsch Werner
Published: November 2017

Objective

Reaction testing is an integral part of sideline testing in sport-related concussion. Present established tools include time-demanding computer-based tools and analysis of the clinical reaction time with a special apparatus. The present tool is a mobile phone program using a simple reaction time equivalent.

Design

Case control study.

Setting

Professional German Hockey League Players and regional youth players.

Participants

20 professional ice-hockey players.

Interventions (or Assessment of risk factors)

Analysis of a simple dual task reaction time (sRT; one of two symbols) and a complex one of four symbol reaction time (cRT).

Outcome measures

Analysis of average baseline times, fastest and slowest 10% values, overall application time and comparison to 4 players sustaining concussions.

Main results

Mean sRT was 0,354s (95% confidence intervals (0,330;0,377) with fastest 10% 0,294s and slowest time 0,539s. The overall procedure needed 65,4s. Mean cRT was 0,43s (95% confidence intervals (0,423;0,437) with fastest 10% 0,34s and slowest time 0,592s. The overall procedure needed 117,364. The 4 patients with sustained concussion had immediately a sRT and a cRT of 0,518s and 0,677s, respectively. A value of 0,5s is probably an expected cut-off.

Conclusions

This simple web- and mobile-phone-based program allows safe analysis of prolonged reaction times in concussed athletes.

Competing interests

None.
Sport-related concussion physician’s chart review – 2011–2016
Authors: D Carson James , A Kraft Sari , Kuwahara Nariko , Cheung Lovisa , Mansoora Qurat-ul-Ain , Safwan Aliya , Jegatheesan Vijitha , Mubarik Mariam , Kirloss Mena , Chiu Julie , Moineddin Rahim , Fremont Pierre
Published: November 2017

Objective

To determine what proportion of patients experience an exacerbation of their symptoms as a result of premature return to play (RTP) and return to learn (RTL) following a sport-related concussion (SRC).

Design

Retrospective longitudinal chart review.

Setting

A sport medicine physician’s office in Ontario, Canada.

Participants

266 cases related to 251 students with an SRC.

Interventions

A review of 266 electronic medical records (charts) of patients seen for SRC over a five-year period (2011–2016). Two blinded authors independently reviewed each chart and SCAT2 or SCAT3/Child SCAT3 symptom self report form. In situations where there was discrepancy between the two reviewers’ results, a third author reviewed the charts.

Outcome measures

remature RTP and RTL were defined as chart records documenting the recurrence or worsening of symptoms that accompanied the patients’ RTP or RTL.

Main Results

403 cases were identified as concussion patients assessed. 266 were included as these cases were related to 251 students involved in a sport activity. Premature return to sport and to school were observed in 67 (25.19%) and 107 (40.23%) of the cases, respectively.

Conclusions

In our comparable study ending 5 years prior, premature return to sport and to school were observed in 43.5% and 44.7% of the cases, respectively. Despite changing our medical advice, based upon evolving expert recommendations on return to learn (RTL) after an SRC, premature RTL is still quite common. Efforts are needed to find the best method of implementing a coordinated plan for the post-concussion athlete who is returning to school.

Competing interests

None.
When is it time to start rehab? exploring the optimal timing to initiate active rehabilitation for concussion management in children and adolescents
Authors: Gagnon Isabelle , Dobney CAT (C) Danielle M. , MSc PT Lisa Grilli , Kocilowicz Helen , Beaulieu Christine , Straub Meghan , Friedman Debbie
Published: November 2017

Objective

Estimate the influence of time to initiation of active rehabilitation on post-concussion symptom (PCS) severity in youth who are slow to recover from concussion.

Design

Retrospective analysis of a prospective cohort

Setting

Concussion clinic of a tertiary care Paediatric Trauma Centre in Canada.

Participants

569 youth (14.3±2.3 years) with persistent PCS. Clinic patients’ information is entered prospectively in a clinical database and participants were selected for this study if they 1) participated in the active rehabilitation program, and 2) had available PCS assessments at the intake and follow-up visits.

Intervention

Active rehabilitation consisting of: aerobic exercise, coordination exercises and, education/motivation. The intervention was initiated with a Physical Therapist in the Concussion clinic continued as a daily home program. The independent variable was time to initiation of the active rehabilitation program measured in weeks (2, 3, 4, 5, 6+).

Outcome measure

Symptom severity measured by the PCS scale of the SCAT3 at follow-up visit, 2 weeks after initiation of intervention.Main results: Patients initiating active rehabilitation 2 weeks post-injury were significantly less symptomatic at follow-up (Mdn PCS score=5) compared to those starting five (Mdn=17) and six weeks or more (Mdn=17.5) (p=0.0002). Those starting at 3 (Mdn=9) and 4 (Mdn=10) weeks also had significantly less severe symptoms compared to those starting 6 weeks or later (p<0.05).

Conclusions

The findings suggest that children benefit more from active rehabilitation if it is initiated between two and four weeks post-injury, and have poorer outcomes if it is delayed beyond 6 weeks post-injury.

Competing interests

None.
Test-retest reliability of the kinarm end-point robot for assessment of sensory, motor and neurocognitive function in athletes
Authors: W Benson Brian , Cosh Madeline , S Mang Cameron , H Scott Stephen , Debert Chantel , Dukelow Sean
Published: November 2017

Objective

To determine the reliability of the KINARM robot in assessing sensorimotor and neurocognitive function in athletes.

Design

Test-retest reliability.

Setting

Sport Medicine Clinic.

Participants

Thirty-nine randomly selected athletes (mean age: 18±3 years) over 2011–2012 and 2014–2015 seasons.

Outcome measures

Sixty-three parameters from five robotic tasks (Visually Guided Reaching, Position Matching, Object Hit, Object Hit and Avoid, and Trail Making B) characterising sensorimotor and neurocognitive function. Each athlete was tested three times, with an average of 43±27 days between baseline (BL) and first retest (R1), and 306±32 days between R1 and second retest (R2). Reliability was assessed by intra-class correlation coefficients (ICCs) between BL and R1, and R1 and R2. Change in task performance between assessments was also evaluated with multivariate analysis of variance (MANOVA) and post-hoc comparisons within specific task parameters.

Main results

ICCs ranged from −0.03 to 0.94 and −0.52 to 0.93 for BL to R1 and R1 to R2, respectively. ICCs were moderate to high (≥0.5) for 46 of 63 parameters (68%) from BL to R1, and 48 of 63 parameters (76%) from R1 to R2. MANOVAs and post-hoc comparisons indicated improvements in performance on 12/63 parameters (19%) between BL and R1, and changes in performance on 11/63 parameters (17%) between BL and R2. No significant changes were revealed in parameter performance between R1 and R2 sessions.

Conclusions

Overall, results suggest moderate to good test-retest reliability for the majority of KINARM robot task parameters in measuring baseline sensorimotor and neurocognitive function in athletes.

Competing interests

Brian W Benson In the future may receive a small royalty from BKIN Technologies Ltd. in consideration for assisting with development and validation of the KINARM end-point robotic device for use in acute sport concussion assessment and management.

None.

Stephen H Scott Co-founder and CSO of BKIN Technologies that commercialises the KINARM robot.
Valid but invalid: suboptimal impact© baseline performance in university athletes
Authors: Walton Samuel , Broshek Donna , Freeman Jason , Cullum Munro C , Resch Jacob E
Published: November 2017

Objective

To investigate the frequency of valid yet suboptimal ImPACT© performance in college athletes.

Design

Descriptive.

Setting

Research Laboratory.

Participants

Division 1 University athletes (n=769) from 22 different sports.

Intervention

The Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to participants per the institution’s concussion management protocol at baseline in groups <2. Participants who scored <16th percentile compared to ImPACT normative data on any neurocognitive index (potentially suggesting suboptimal effort) were re-administered ImPACT up to two additional times.

Outcome measures

Descriptive analyses were used to examine validity indicators and individual Verbal and Visual Memory, Visual Motor Speed and Reaction Time ImPACT composite scores in initial and subsequent administrations.

Main results

Based on ImPACT’s validity criteria, 1% (9/769) of administrations were invalid and 14.6% (112/769) had one or more composite scores <16th percentile but were considered valid. After one re-administration 71.4% (80/112) achieved scores >16th percentile and an additional 18/32 scored >16th percentile after a third administration.

Conclusions

Approximately 16% of ImPACT records were flagged as invalid or had one or more composite scores <16th percentile, potentially indicative of suboptimal performance. Upon readministration, 88% of those participants scored >16th percentile. Clinicians must be aware of suboptimal ImPACT performance as it limits the clinical utility of the baseline assessment. Further research is needed to address factors leading to “valid” but invalid baseline performance.

Competing interests

None.
A comparison of healthcare professional and school personnel perceptions and familiarity of academic adjustments for concussed adolescents
Authors: Welch Bacon Cailee E , Register-Mihalik Johna K , Kasamatsu Tricia M , Valovich McLeod Tamara C
Published: November 2017

Objective

To compare healthcare professionals (HCPs) and school personnel (SP) perceptions of and familiarity with academic adjustments for adolescents following a concussion.

Design

Cross-sectional.

Setting

Self-reported online survey.

Subjects

4,376 participants (1,095 males, 2,003 females, 1,278 missing sex; 2,209 HCPs, 2,156 SP; age=47.5 ± 14.8) from a convenience sample of 51,507 individuals (8.5% response rate) completed theBeliefs, Attitudes, and Knowledge of Paediatric Athletes with Concussions(BAKPAC) survey.

Outcome measures

The independent variable was role (2 levels: HCP, SP). The dependent variables were participants’ responses to the survey items. Mann WhitneyUtests (P<0.05) were used to determine group differences.

Results

Both HCPs and SP agreed that concussions can affect school performance (3.7/4.0±0.9;P=0.08) and that concussed adolescents are eligible for consideration under the Americans with Disabilities Act (3.0/4.0±1.0;P=0.81). 57.3% of HCPs and 57.0% of SP reported that they have managed a concussed adolescent who experienced decreased school performance, while 61.0% of HCPs and 57.5% of SP noted concussed adolescents received academic adjustments. Familiarity with individualised education plans (IEPs;P≤.001) and 504-plans (P≤.001) differed among groups. SP were moderately to extremely familiar with IEPs (3.5/4.0±0.71) and 504-plans (3.3/4.0±0.91), while HCPs were only minimally to moderately familiar (IEP: 2.8/4.0±1.2; 504-plans: 2.6/4.0±1.4).

Conclusions

HCPs and SP must collaborate to ensure proper concussion management for concussed adolescents. These results suggest the need for targeted education for HCPs and SP concerning academic adjustments to promote a safe return-to-learn.

Competing interests

None.
Early vestibular and visual dysfunction predicts prolonged symptomatology following paediatricpediatric concussion
Authors: Master Christina L , Grady Matthew F , Storey Eileen , Podolak Olivia , Lockyer Julia , Wiebe Douglas
Published: November 2017

Objective

Vestibular and visual dysfunction, including accommodation disorder, symptoms with vestibular ocular reflex (VOR) testing, or receded near point of convergence, are common following concussion and have been associated with prolonged concussion symptomatology. The objective of this study was to determine whether vestibular and visual information contributed significantly to a model predicting the likelihood of having persistent concussion symptoms at 28 days after injury.

Design

Retrospective cohort study

Setting

Sports medicine concussion program within a large regional paediatric healthcare network.

Participants

274 consecutive patients aged 3-18 years with the diagnosis of concussion seen in the concussion program

Independent Variables

Standard demographic and clinical data, as well as vestibular and visual examination findings at presentation

Outcome measures

Symptom recovery from concussion, defined as a symptom score=0 on the Post Concussion Symptom Scale at 28 days

Main results

Study subjects were 3–18 years (median=14), presenting a median of 14 days from injury. Applying a stepwise regression approach using traditional demographic and clinical variables (age, gender, past medical history, symptoms and balance testing) as well as information from vestibular and visual testing, we found that VOR testing is a statistically significant component (p=0.02) of the final predictive model. Furthermore, in the subset of patients presenting within 14 days of injury, positive VOR testing (p=0.02) and vision problems (p=0.01) significantly contribute to predicting ongoing symptoms at 28 days.

Conclusions

Symptoms with VOR testing and vision problems upon presentation within 14 days of injury contributed significantly to the prediction model for prolonged symptoms following concussion and warrant further study.

Competing interests

None.
Education in action: evaluating kids concussion infographics
Authors: Provvidenza Christine , Carmichael Jason , Reed Nick
Published: November 2017

Objective

To assess the impact of infographics on enhancing concussion knowledge and their effectiveness as a knowledge translation (KT) strategy.

Design

Prospective, post-survey design to assess a KT strategy.

Setting

Community and hospital based education events.

Participants

Individuals across various stakeholder groups were invited to provide feedback on six infographics. Data (N=106) was collected from youth (52%) and adults (48%), representing five stakeholder groups: athletes, students, teachers, healthcare trainees and healthcare professionals.

Intervention

Six infographics were created to provide salient information about concussion for a multi-stakeholder audience.

Outcome measures

A survey was designed to gather information about the value and utility of the infographics as a KT strategy and to determine additional knowledge needs.

Main results

Ninety percent of participants identified that the infographics met their knowledge needs, and 84% of participants indicated that the infographics gave them new knowledge related to sleep, myths and facts, and signs and symptoms. Participants indicated that they intend to use the infographics to build knowledge (91%), educate others (52%), and cope with concussion (26%). Feedback provided about the infographic format was positive, and suggestions for future topics were offered.

Conclusions

Infographics are a potentially effective KT strategy that meets knowledge needs and appeals to many different audiences. Participants identified that they want to learn more about areas including concussion recovery and management. Data collection is ongoing and continues to inform the value of infographics as a KT strategy. This study is part of a broader education initiative to optimise paediatric concussion knowledge.

Competing interests

None.
The association between psychological distress and concussion history in college athletes
Authors: Combs Patricia R , Wasserman Erin B , Rodrigo Corey J , Guskiewicz Kevin G , Mihalik Jason P
Published: November 2017

Objective

To examine how baseline measures of psychological distress, including depression, anxiety, and somatization, in college athletes are affected by concussion history.

Design

Cross-sectional study.

Setting

A National Collegiate Athletic Association Division I university.

Subjects

Division I college athletes (age=20.6±1.4 years) with a self-reported history of 1 or more concussions (n=128; 52 (41%) females; 76 (59%) males) and with no self-reported concussion history (n=286; 100 (35%) females; 186 (65%) males). An additional 67 student-athletes were excluded due to incomplete demographic information.

Intervention

Athletes self-reported concussion history on a questionnaire completed during pre-season baseline testing.

Outcome measures

All participants completed the Brief Symptom Inventory18 (BSI-18) during the same pre-season baseline assessment.

Results

There were no significant differences in total BSI-18 scores (P=0.47) between participants with a concussion history (median BSI-18 score=0, IQR=0–2) and those with no concussion history (median BSI-18 score=0, IQR=0–3). Additionally, there were no significant differences found between groups for any BSI-18 subset score (Depression:P=0.99; Anxiety:P=0.53, Somatization:P=0.07).

Conclusions

A history of 1 or more concussions does not influence baseline psychological distress measures in college athletes. While associations between concussion history and increased risk of clinical depression in retired professional athletes have been reported, our data do not support this association at the college level. Our results may underscore the need to develop more sensitive questionnaires to assess psychological distress among otherwise young healthy emerging adults. Future research should explore more diverse samples, and explore the utility of psychological distress measures during post-injury recovery.

Competing interests

None.
Predicting protracted recovery in professional rugby union: what can the symptoms, signs and modifiers of concussion tell us?
Authors: Matthew Cross , Stokes Keith , Kemp Simon , Smith Andy , Trewartha Grant
Published: November 2017

Objective

To investigate the association between the signs, symptoms and modifiers of concussion and protracted recovery in professional Rugby Union players.

Design

Prospective cohort.

Setting

The English Premiership (the highest level of competition in England).

Participants

810 professional Rugby Union players over two seasons (2012/13 and 2013/14). 150 players reported 181 concussions for which 100 provided data for this analysis (80 concussions had insufficient follow up and 1 player left the study).

Independent variables

Symptoms were grouped into 4 domains (head, cognitive, sleep and neuropsychological) previously demonstrated to have adequate internal consistency (Pardini et al., Brit J Sports Med: 38, 661–662, 2004). Symptom burden and standardised assessment of concussion (SAC) scores alongside signs and modifiers (amnesia, loss of consciousness, previous concussion history and balance error score) were also reported.

Dependent Variable

Time (days) to return to play (RTP). Protracted recovery was defined as >14 days.

Main results

Eighteen percent of players did not RTP within 14 days. Higher symptom burden (OR 1.17, 95% CI 1.01–1.31) and higher balance error scores (OR 1.33, 95% CI 1.06–1.66) were associated with protracted recovery. A higher number of self-reported ‘head cluster’ symptoms were associated with a shorter (<14 days) recovery time (OR 0.90, 95% CI: 0.82–0.98).

Conclusions

Clinicians should pay particular attention to higher symptom burden and balance error scores as part of a multimodal assessment to aid early identification of protracted recovery. The association between balance and protracted recovery suggests that targeted rehabilitation programs to improve the vestibular system warrant further investigation.

Competing interests

Dr. Matthew Cross – Employed by the Rugby Football Union who part funded the PhD (stipend and fees) that this study was part of

Dr. Keith Stokes – Receives research funding from the Rugby Football Union

Dr. Simon Kemp – Employed by the Rugby Football Union

Dr. Andy Smith – Employed by Premiership Rugby who part funded the PhD (stipend and fees) that this study was part of

Dr. Grant Trewartha – Receives research funding from the Rugby Football Union