bluuebunny/crossref_metadata_2025 huggingface dataset:
A - 23 Interpretation Consideration: Serial Baseline Performances on Core Executive Function Measures in Healthy Youth Athletes
Authors: Ellis-Stockley M , Adler J , Forbes B , Summers K , Tupou T , Eve H , Hirst R
Published: July 2024

Purpose

Sports participation in youth has demonstrated better core executive function (EF) abilities compared to those who do not participate (Contreras-Osorio et al., 2021). However, previous research has not observed a pattern of improvement across all EF abilities (M√∂hring et al., 2022), indicating EF development in childhood is not linear (Anderson, 2002). The present study compared baseline scores of cognitive flexibility, working memory, and inhibition at two timepoints among youth athletes.

Method

Data from the Delis-Kaplan Executive Function System Trail Making Letter-Number Sequencing (cognitive flexibility), Wechsler Intelligence Scale for Children Fourth Edition Working Memory Index, and Golden Stroop Color-Word Inhibition test were analyzed in a sample of youth athletes (n = 32), aged 8–16 years. Mean age difference between time 1 and 2 was 1.86 years. Paired-samples t-test examined the difference in core EF scores at two timepoints.

Results

Performance on a measure of inhibition significantly improved over time (p = 0.02; effect size [d] = 0.43). Performances on measures of working memory and cognitive flexibility did not significantly differ over time (p = 0.16 and p = 0.61, respectively).

Conclusions

Healthy youth athletes performed significantly better only on a measure of inhibition at baseline two than baseline one, suggesting clinicians should anticipate variation in scores when re-examining core EF abilities after two years. Further, clinicians should exercise caution when interpreting variation in baseline scores because it could be due to sports participation. Future research should investigate whether inhibition continues to improve overtime and whether significant changes are observed in other core EFs.
A - 24 Acute SCAT-3 Symptom Clusters and Risk for Prolonged Recovery from Concussion in College Athletes
Authors: Thomas G , Bradson M , Sakamoto M , Berkey K , Arnett P
Published: July 2024

Purpose

More severe symptomatology post-concussion is predictive of prolonged recovery; however, it is unclear whether certain symptom clusters are associated with increased risk for protracted recovery. This study examined the relationship between five symptoms clusters on the SCAT-3 and risk for prolonged recovery from sports-related concussion.

Method

1444 (F = 619) collegiate athletes completed post-concussion neuropsychological evaluation within 24 to 48 hours following injury. SCAT-3 scores were separated into clusters based on previous research (Cognitive, Physical, Emotional, Insomnia, Ungrouped). Given that the clusters consisted of different numbers of items, an average item score was created for each cluster. Athletes were separated into two groups based on number of days to return-to-play, using 28 days as the cutoff. Logistic regression was conducted with recovery type (Typical/Prolonged) as the outcome, and the five SCAT-3 symptom clusters as predictors.

Results

Only the SCAT-3 Physical cluster was significantly associated with recovery (p < 0.001). Specifically, athletes endorsing higher acute physical symptoms were at increased risk for prolonged return-to-play, such that a one-point increase in average item score on the SCAT-3 Physical symptom cluster was associated with 90.81% increased risk (O/R = 1.91) for prolonged recovery.

Conclusions

Athletes endorsing more severe physical symptoms 24 to 48 hours post-concussion were at significantly increased risk for prolonged recovery, though other symptom clusters did not infer the same risk. Findings suggest differential risk associated with symptom presentation; athletes endorsing significant physical symptoms in the acute phase of injury would likely benefit from targeted treatment to ameliorate these symptoms and, potentially, reduce risk for complicated recovery.
A - 25 Relationship between Post-Concussion Sleep Disturbances and Return-to-Play Timeline
Authors: Berkey K , Thomas G , Arnett P
Published: July 2024

Purpose

This study investigates whether post-concussion sleep symptoms affect return-to-play timelines following sports-related concussion. We predict that athletes in the prolonged recovery group will report higher sleep cluster (reflecting worse sleep) scores.

Method

53 athletes (F = 9.4%) completed a comprehensive neuropsychological battery within 14 days of being diagnosed with concussion. Symptomology was assessed using the Post- Concussion Symptom Scale (PCSS). Previous research demonstrated the utility of examining symptom clusters on the PCSS; PCSS Sleep Cluster was used to examine sleep disturbances in the current study. Athletes were divided into 3 groups based on their return-to-play timeline: Early (<14 days), Normal (14–28 days), and Prolonged (>28 days). Players were cleared to return-to-play by sports medicine.

Results

ANOVA results showed no differences between the Early, Normal, and Prolonged recovery groups in terms of sleep cluster symptoms, F(50) = 1.10, p = 0.34. These results are consistent with some previous research showing that athletes reporting high levels of sleep complaints do not perform worse on cognitive testing, which may explain, in part, why there are no differences in terms of return-to-play timelines.

Conclusions

Athletes with poor sleep at post-concussion did not show significant risk for an abnormal return-to-play time as there were no group differences. These findings are important as sleep complaints may not be a strong predictor for prolonged recovery. Instead, results suggest that poor sleep may influence symptom reporting but does not impede return-to-play timelines.
A - 26 A Survey of Sports Concussion Specialists’Clinical Criteria to Determine Concussion Recovery
Authors: Scolaro Moser R , Riegler K E , Uhrig C , Choi D , Broglio S , Mayer B , Boltz A , Master C L , Schatz P
Published: July 2024

Purpose

To identify criteria used by sports concussion specialists in determining recovery from sport-related concussion. We hypothesized differences in use of decision-making criteria among neuropsychologists, physicians, and certified athletic trainers (ATCs).

Method

143 sports concussion specialists (neuropsychologists = 45, physicians = 41, and certified athletic trainers (ATCs) = 57) completed a survey rating the importance of specific criteria for determining concussion recovery in youth and adult athletes. Differences between specialist groups were examined with Kruskal-Wallis tests.

Results

There were significant differences in criteria ratings across specialist groups regarding youth and adults for “use of neurocognitive test scores,”“balance testing,”“physical examination,”“no symptom provocation with neurocognitive testing,”“athlete report of anxiety about return to sport,“and “family member’s report of recovery,“all p’s < 0.001. For youth and adults, physicians ranked “use of neurocognitive test scores”and “no symptom provocation with neurocognitive testing”as less important than other providers, while “physician examination”was ranked as more important. Neuropsychologists ranked “balance testing”and “athlete report of anxiety about return to sport”as less important than other providers; and ATCs ranked “family member’s report of recovery”as less important than other providers.

Conclusions

Our results advance understanding of multidisciplinary standards of care in determining recovery from sports concussion and suggest the importance of collaboration in establishing clinical criteria common to all sports concussion health care providers.
A - 27 A Preliminary Investigation of the Relationship between Sleep Symptoms and Post-Concussion Cognitive Performance in Adolescents
Authors: Riegler K E , Scolaro Moser R
Published: July 2024

Purpose

To explore the relationship between self-reported sleep symptoms and post-concussion cognitive test performance in adolescents on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT).

Method

54 adolescents (ages 12–16) referred to a specialized sports concussion private practice completed post-concussion ImPACT. Five symptom clusters were derived from the post-concussion symptom scale: sleep, physical, cognitive, affective, and headache. Two-factor cognitive composites from the ImPACT (memory and speed) were the outcome variables. Multivariate linear regression was conducted to examine the relationship between cognitive variables and sleep symptoms. Post-hoc forward stepwise linear regressions were used to explore the following potential additional predictors of cognitive outcomes: age, number of previous concussions, sex, hours slept the night before, and five symptom clusters.

Results

Sleep symptoms were significantly associated with cognitive performance, F(1,52) = 9.95, p < 0.001, ƞ2 = 0.28. Higher sleep symptom cluster scores were associated with worse memory, F(1,53) = 13.68, p < 0.001, ƞ2 = 0.21, and speed performance, F(1,53) = 17.84, p < 0.001, ƞ2 = 0.26. Results of post-hoc forward stepwise linear regressions revealed that a final model for speed performance included only the sleep symptom cluster, explaining 16.6% of the variance. The final model for memory performance included only the headache rating, explaining 20.1% of the variance.

Conclusions

Our results indicate that severity of self-reported sleep symptoms post-concussion are associated with cognitive performance in domains of memory and speed. After considering additional predictors, more severe sleep symptoms were significantly associated with worse speed performance and worse headache severity was significantly associated with memory performance.
A - 28 Relationship between Sleep and Symptom Severity during Initial Post-Injury Testing in High School Athletes
Authors: Volpe C , Trask C , Levings I , Jackson A
Published: July 2024

Purpose

Examine the relationship between reported symptom severity and hours of sleep the night before completing the ImPACT Post-Injury 1 (PI-1) Post-Concussion Symptom Checklist.

Method

A sample of 414 high school (ages 14–17) athletes (188 females, 226 males) who completed the PI-1 pre-test ImPACT Post-Concussion Symptom Checklist and reported hours of sleep the night before testing, from 2019 to present, was analyzed. Responses were divided into two groups, ‚â§8 hours sleep (n = 253) and ≥ 8 hours sleep (n = 246), and compared to ratings of pre-test total symptom score (TS) and 22 individual symptoms (IS) using a correlation test (Pearon’s r). A quadratic regression analysis was completed combining both sleep groups (n = 414) to assess for a curvilinear relationship between reported sleep, IS, and TSS.

Results

There was a statistically significant negative correlation between ‚â§8 hours sleep and 15 IS (r = −0.292 to −0.141, p = <0.001 to 0.024) and TS (r = −0.272, p = <0.001). A statistically significant positive correlation was found between ≥8 hours sleep and 10 IS (r = 0.138 to 0.261, p = <0.001 to 0.030) and TS (r = 0.193, p = 0.002). A quadratic regression analysis confirmed a statistically significant quadratic relationship between hours of sleep and TSS (coefficient for the quadratic term was 1.030, p = <0.001) and for 15 IS (all p = <0.001).

Conclusions

A significant U-shaped relationship was found between high school athletes’reported hours of sleep and reported symptom severity at first post-concussion assessment. This is consistent with other research indicating that too much or too little sleep can be problematic.
A - 31 Relationship between Self-Reported Concussion History, Cognition, and Mood among Former Collegiate Athletes
Authors: Datoc A E , Sanders G D , Tarkenton Allen T , Schaffert J , Didehbani N , Cullum C M
Published: July 2024

Purpose

Long-term concussion sequelae have been increasingly studied in former professional athletes, and less is known about those who participated in sport at the collegiate level. This study explores the relationship between concussion history and cognition/mood in former collegiate athletes in middle-to-later adulthood.

Method

422 former collegiate athletes over age 50 (M = 61.5; 62% male) completed the College Level Aging Athlete Study (CLEAATS) including the Cognitive Function Instrument (CFI), Telephone Interview for Cognitive Status-Modified (TICSm), and self-report questionnaires including concussion history and current mood. Pearson correlations and multiple regression analyses examined the relationship between concussion history, subjective and objective cognitive status, and mood.

Results

54% of the sample reported a history of concussion (M = 1.2, SD = 1.7). Number of concussions was marginally associated with subjective cognitive complaints (r = 0.13, p = 0.004) and depression (r = 0.14, p = 0.002), but not objective cognition (p = 0.39) or anxiety (p = 0.33). Regression models including demographic factors and mood were significant and explained 32% and 17% of the variance in subjective and objective cognition, respectively. Concussion history was not a significant predictor in either model, whereas depression (Β = -0.12) was associated with poorer subjective cognition only.

Conclusions

Concussion history was not associated with subjective or objective cognitive changes in former collegiate athletes. Although a very small relationship between concussion history and depression was found, depression was associated with more subjective cognitive complaints. This suggests mood symptoms have greater impact on subjective cognitive status than concussion history. These findings highlight the importance of considering the effect of current mood symptoms when evaluating former athletes who present with cognitive complaints.
A - 33 Examining Neurocognitive Effects of Contact Exposure in High School Athletes
Authors: Hautmann A , Lemke J , Bailey C
Published: July 2024

Purpose

Concerns have been raised about the effect of repetitive head impacts and subconcussive blows in contact sports, though studies have largely focused on the effect in late-life or retired professional athletes. We examined the effect of extended participation (months-to-years) in low/non-contact vs high contact/collision sports within a sample of high school athletes on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT).

Method

A multisport sample of 1650 athletes (34% Female; 1088 contact, 528 non-contact; age 14–18) without a history of concussion completed baseline ImPACT testing across two times points (time between administrations ranging from 7–45 months; M = 20.40), with active sport participation between administrations.

Results

Repeated mixed-measure ANOVA revealed increased performance across ImPACT administrations for all composites (p < 0.001; partial Œ∑2 = 0.02–0.23). With the exception of a very small effect on Impulse Control composites (partial Œ∑2 = 0.003), there was no statistically significant difference between high contact and low contact sport groups across composite scores (p < 0.05).

Conclusions

Our findings showed no meaningful changes in neurocognitive performance in high school athletes exposed to high degrees of contact sports for months/years, with both contact groups demonstrating a consistent mild–moderate practice effect over time. This also aligns with the recent systematic literature review finding no increased risk of neurological/neurocognitive disease in amateur contact athletes in later life (Iverson et al, 2023). Future prospective studies with longer follow up and incorporation of additional measures (e.g., mental health, expanded testing, and biomarkers) will be important to improve our understanding of the risk of contact exposure in athletes.
A - 34 Differences in Symptom and Well-Being Report at Initial Post-Injury Concussion Medical Evaluations
Authors: Naidu D , Mrazik M , David C V , Hansen J , Ree-Fedun Q
Published: July 2024

Purpose

To investigate differences in subjective symptom report and percentage ratings of subjective well-being (SWB) at initial post-injury concussion medical evaluations in professional football players.

Method

A retrospective, quasi-experimental design was used for the study. Participants included Canadian Football League players who underwent initial locker room post-injury medical evaluations. CFL concussion protocol requires any player suspected of a concussion to undergo a full evaluation including SCAT5. There were 2 groups including 43 players subsequently diagnosed with concussions who were compared with 22 players not diagnosed with concussion. Data included total symptom score from the SCAT5 and SWB (ratings out of 100%). T-tests and descriptive statistics evaluated differences between groups.

Results

At baseline, there were no significant differences on ratings of SWB between groups. In contrast, there was a significant difference in ratings of subjective well being between concussed players (M = 75.5%, SD = 19.5) and non concussed players (M = 92.7, SD = 7.7); t(63) = [3.8], p = [0.1]. Furthermore, significant differences on total symptom report from the SCAT5 were identified between concussed players (M = 16.9, SD = 15.4) and non concussed players (M = 3.5, SD = 5.7); t(63) - [3.9], p = [<0.01]. The sensitivity was 85% with a specificity of 63% using a post-injury SWB score of 75%.

Conclusions

Results indicated that at initial post-injury concussion evaluations, players subsequently diagnosed with concussion have lower SWB. Further research is needed to determine whether this metric would be helpful in the diagnosis of concussion.
A - 35 Subjective and Objective Cognitive Functioning Differences among University Athletes
Authors: Hansen J , Mrazik M , David C , Ree-Fedun Q , Wagner R , White R , Naidu D
Published: July 2024

Purpose

To investigate the differences between objective cognitive scores and self-reported cognitive symptoms among university athletes.

Method

A prospective, quasi-experimental design was used for the study. Participants included athletes from a Canadian university over consecutive seasons who were diagnosed with a Sports Related Concussion (SRC) and underwent a post-injury assessment within 24–48 hours. Nineteen male and female athletes (ages M = 25.11, SD = 3.63) with complete data from the Sideline Concussion Assessment Tool (SCAT-5) were included. An independent T-test and correlational analysis were used to evaluate the relationship between subjective symptoms (memory and concentration) and objective cognitive functioning.

Results

There were no significant differences between baseline and post-injury testing on SCAT-5’s learning, concentration and delayed recall tests (p > 0.05) but significant differences between baseline and post-injury symptom report of concentration t(36) = −3.4, p < 0.001 and memory t(36) = −3.0, p < 0.001.

At baseline, there was a significant negative correlation between memory total score and the reported cognitive symptoms, (r = −0.61, p < 0.05) and between total cognitive score and self-reported symptom report (r = −61, p < 0.05). In contrast, at post-injury, there were no significant correlations between the memory total score or total cognitive scores and the reported symptoms (r = 0.7, p = 0.79; r = 0.11, p = 0.67).

Conclusions

Participants endorse a significant increase in symptoms at post injury in spite of no significant changes in their cognitive performance. Psychological distress at injury may impact perceptions of cognitive difficulties.
A - 36 Long-Term Psychological Symptoms Following Concussion in Adolescent Ice Hockey Players
Authors: David C V , Mrazik M , Yeates K O , Galarneau J-M , Emery C A
Published: July 2024

Purpose

Concussion symptoms typically resolve within 30 days from injury; however, in up to 35% of cases, symptoms may be prolonged and continue months, or even years, and may be associated with longer-term mental health problems. This study aimed to assess long-term psychological and emotional symptoms in adolescent youth ice hockey players after medical clearance to return to play.

Method

This study used data collected prospectively as part of a larger longitudinal cohort study involving injury surveillance in hockey players (11-18 years), conducted over five seasons from 2013 through 2018. Pre-season baseline measures of psychological and emotional functioning were compared across two consecutive time points, for youth with an intervening concussion, musculoskeletal.

(MSK) injury, or no intervening injury. Random intercept models with players nested by team and individuals, captured the effects of players contributing to the analysis multiple times. Covariates included age, sex, and body checking policy.

Results

Adolescent ice hockey players who sustained a concussion showed no evidence of worsening self-reported psychological and emotional symptoms after injury, compared to youth with MSK injury or no injury. Compared to athletes with MSK or no injury, athletes who sustained a concussion also showed no worsening symptoms based on parent ratings.

Conclusions

The present study found no evidence of worsening psychological and emotional symptoms among adolescent ice hockey players up to one-year post-concussion, compared to youth with MSK injury or no injury. These findings support the expected recovery trajectory timeline of concussions and support current return-to-play policies for this group.
A - 37 Baseline Mental Health Functioning in University Student Athletes.
Authors: Ree-Fedun Bradyn Quinn , Hansen Jessica , David Claire , White Ryan , Mrazik Martin
Published: July 2024

Purpose

Examine the prevalence of mental health difficulties in university student-athletes during baseline concussion assessment.

Method

Two hundred and forty-three university athletes (male = 163, female = 80) completed the.

Sideline Concussion Assessment Tool, 3rd Edition (SCAT3) Symptom Evaluation scale and the Brief Symptom Inventory (BSI-18) self-report questionnaire at baseline evaluation across two consecutive seasons. The BSI-18 measured psychological distress using 5-point rating scales to calculate three emotional scales (Somatization, Depression, Anxiety) and one total scale (Global Severity Index). The four psychological symptoms from the SCAT3 Symptom Evaluation scale (more emotional, irritability, sadness, and nervous or anxious) were selected to calculate a total psychological symptom score out of 24. Existing normative data informed the SCAT3 symptom severity, including classifications of mild (1–2), moderate (3–4), and severe (5–6).

Results

Descriptive statistics indicated that 7.5% of athletes reported depressive symptoms and.

9.5% reported anxious symptoms on the BSI-18. The SCAT3 psychological symptoms score showed that 6.5% of athletes were within the mild range. Significant correlations existed between the SCAT3 total psychological symptom score and the BSI’s Anxiety, Depression, Somatization, and Global Severity Index scales (p < 0.01).

Conclusions

A small but significant number of collegiate athletes reported experiencing psychological symptoms during baseline concussion evaluation. These results indicate that the psychological symptoms of the SCAT’s Symptom Evaluation scale may help identify players with more significant mental health concerns who will likely benefit from mental health support.
A - 38 Examining Persisting State Anxiety and Concussion Clinical Outcomes across Concussion Recovery
Authors: Durfee K J , Jennings S , Womble M N , Amalfe S , Elbin R J
Published: July 2024

Purpose

Document changes in state anxiety over the course of recovery from concussion and examine the effect of persisting state anxiety on concussion clinical outcomes.

Method

Patients (ages 15–51 yrs) seeking care for a sport or non-sport-related concussion within 1–7 days post-injury were included in this study. Participants completed a self-report measure of state anxiety (STAI) at each clinical visit. Differences in STAI scores from visit 1 and visit 2 were calculated and used to categorize patients into a PERSIST (scores stayed the same or got worse) and an IMPROVE group (scores improved). Changes in STAI scores across two clinical visits were examined with a paired samples t-test, and a series of independent samples t-tests and chi-square analyses were used to examine between-group differences in clinical outcomes (symptom score, neurocognitive scores, vestibular/ocular motor symptoms and impairment, and recovery time).

Results

187 participants (M = 22.37, SD = 10.67 yrs, 65% female) completed study measures at 4.25 (SD = 1.68) (visit 1) and 13.20 (SD = 28.65) (visit 2) post-injury. STAI scores significantly differed between first (M = 20.99, SD = 6.05) and second visit (M = 17.41, SD = 6.21, p < 0.001). The PERSIST group (n = 41, M = 25.90, SD = 20.03) had significantly higher total symptom scores at visit 2 compared to those in the IMPROVE group (n = 122, M = 16.23, SD = 16.17, p = 0.002). There were no significant differences in other clinical outcomes between those with and without persisting state anxiety.

Conclusions

State anxiety changes throughout concussion recovery and individuals with persisting state anxiety exhibit higher symptom scores at visit 2. Assessment, reassurance and recognition of anxiety is important for overall symptom recovery.
A - 39 Self-Reported Behavioral Regulation and Post-Concussion Symptom Burden
Authors: Amalfe S , Jennings S , Womble M , Durfee K , Elbin R J
Published: July 2024

Purpose

Examine the effects of self-reported behavioral regulation adherence levels on post-concussion symptom burden in individuals with sport-related concussion (SRC).

Method

A retrospective chart review of patients (ages 15-25 yrs) seeking care for a SRC within 90 days post-injury were included in this study. Participants completed a self-report, 4-point Likert scale (0-Never, 3-Most of the Time) questionnaire that assessed the previous week’s frequency of Sleep, Physical Activity (PA), Diet, Hydration, and Stress Management (Stress) behavioral regulation domains. Scores were divided into HIGH (Most of the Time) and LOW (Some of the Time - Never) regulation groups for each domain. A series of independent samples t-tests and analyses of covariance (ANCOVA; controlling for sex, history of anxiety/depression) were used to compare groups on Post-Concussion Symptom Scale (PCSS) total score at first clinical visit.

Results

Five-hundred thirty-seven participants (M = 15.35, SD = 2.40 yrs, 54% female) completed the study measures at 9.38 days post-injury (SD = 10.33). Participants in the HIGH behavioral regulation groups for Sleep (F (1, 537) = 68.16, p < 0.001), Diet (F (1, 537) = 22.42, p < 0.001), PA (F (1, 537) = 15.47, p < 0.001), and Stress (F (1, 537) = 6.70, p < 0.01), demonstrated significantly lower total symptom scores than the LOW groups. There were no significant between-group differences for Hydration (F (1, 537) = 3.62, p = 0.06).

Conclusions

Effectively engaging in light PA, stress management, and consistent sleep and diet following SRC affects post-concussion symptom severity and should be considered an acute treatment plan. Hydration appears less influential in reducing symptom burden at initial clinical visit.
A - 40 The Impact of Early Access on Sports-Related Concussions in Youth Hockey Players
Authors: Bouchard H , Weis L , Vasquez D , Caze T
Published: July 2024

Purpose

Sports-related concussions are the most common setting for adolescents to sustain a concussion. Delayed access to care is a risk factor for recovery and youth athletes have limited access to early intervention often due to lack of athletic trainer coverage. The purpose of this study was to evaluate the effect of early access on sports-related concussions in youth hockey players.

Method

Participants (n = 67) included youth athletes from hockey organizations who partnered with a local specialty concussion clinic. Athletes presented to clinic for care (median = 2 days) after sustaining a concussion. We examined whether the number of days since injury to initial exam (DSI) significantly predicted recovery time while controlling for common injury modifiers, such as symptom severity, anxiety sensitivity, and age. Recovery was measured in number of days since injury to the date of medical clearance.

Results

Multivariate general linear analyses indicated that DSI (M = 4.96, SD = 8.90), significantly predicted the number of recovery days (M = 12.85, SD = 9.47), with each day earlier to initial exam predicting almost one day faster recovery (B = 0.92; p < 0.001; Œ∑p2 = 0.813). Variables of age (M = 13.78, SD = 2.59), anxiety sensitivity (M = 8.91, SD = 9.69), and concussion severity (M = 19.22, SD = 8.90), were not predictive recovery.

Conclusions

Early access resulted in faster medical clearance. This sample of youth hockey players do not have access to an athletic trainer to provide early intervention. Our results suggest that the ability to have early intervention through a specialty concussion clinic partnership resulted in faster recovery, highlighting the importance of continuing to explore and cultivate these relationships with youth sports.
A - 41 Relationship between Fear-Avoidance Behavior, Clinical Outcomes, and Recovery Time in Adults Following Concussion
Authors: Zynda A J , Perry C , Reed A , Collins M W , Kontos A P , Trbovich A M
Published: July 2024

Purpose

To examine the relationship between fear-avoidance behavior, clinical outcomes, and recovery time in adults following concussion.

Method

This prospective study included patients aged 18–50 years who presented to a specialty clinic 5–30 days post-concussion. Participants completed a clinical intake (e.g., demographics/medical history), multidomain clinical assessment (Clinical Profile Screen [CP-Screen], Immediate Post-concussion Cognitive Testing [ImPACT], Vestibular/Ocular Motor Screen [VOMS], Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7]), and the Fear-Avoidance Components Scale (FACS). Recovery time was ascertained at a subsequent visit(s). Fear-avoidant (FA) and non-fear-avoidant (NFA) groups were classified using cutoffs from the FACS (FA = 41–100; NFA = 0–40) and compared using independent samples t-tests, X2 tests, and analyses of covariance.

Results

Seventy-two participants (M = 28.7¬ ± 8.5 years, 69.4% female) were included: 37 (51.4%) in the FA and 35 (48.6%) in the NFA group. Groups did not differ on demographics, medical history, injury characteristics, or CP-Screen. A greater proportion of the FA group had the anxiety/mood profile (62.2% vs 31.4%, p < 0.01). The FA group had worse ImPACT reaction time (t(68) = −2.7, p < 0.01, d = −0.7), VOMS visual motion sensitivity (t(67) = −2.3, p = 0.03, d = −0.5), GAD-7 (t(70) = −3.9, p < 0.01, d = −0.9), and PHQ-9 (t(69) = −2.8, p < 0.01, d = −0.7) scores, and longer recovery (t(24) = −2.8, p = 0.01, d = −0.9), even when controlling for age and time to clinic (F[1, 22] = 4.6, p = 0.04, ηp2 = 0.17).

Conclusions

Adults who reported high fear-avoidance (e.g., avoiding activity, catastrophizing) had worse clinical outcomes and longer recovery following concussion compared to non-fear-avoidant adults, despite no differences in demographics, medical history, injury characteristics, or symptoms. Clinicians should screen for and counsel adults post-concussion against engaging in fear-avoidance behaviors to improve recovery outcomes.
A - 42 Differences in Exercise Tolerance and Autonomic Function Based on Concussion Clinical Profile
Authors: Burley C , Zynda A J , Kehinde F , Trbovich A , Holland C , Womble M , Collins M W , Elbin R J , Kontos A P
Published: July 2024

Purpose

This study examined differences in clinical profiles (e.g., post-traumatic migraine, vestibular, anxiety/mood, oculomotor, and cognitive) between exercise tolerance groups determined by the Buffalo Concussion Bike Test (BCBT). We hypothesized the exercise-intolerant group would be more likely to have anxiety and/or vestibular profiles.

Method

Patients (18–49 years; 8 days to 6 months from concussion) completed demographic and medical history, the Clinical Profile Screen, Brief Symptom Inventory-18, and BCBT. Participants were adjudicated into one or more clinical profiles and classified as exercise tolerant or intolerant. Independent-sample t-tests and chi-square tests were used to compare demographics, clinical profiles, reasons for stopping the BCBT, and ANS metrics.

Results

One hundred six participants (mean age = 27.9¬ ± 8.1, 62.3% female) were included in the study (71 exercise-intolerant; 35 exercise-tolerant). No demographic or medical history differences were noted between groups. The exercise-intolerant group had significantly lower odds of having an adjudicated headache profile (OR = 0.39, 95%CI = 0.16–0.93, p = 0.03) and significantly greater odds of having an adjudicated autonomic profile (OR = 2.28, 95%CI = 1.01–5.21, p = 0.04). A greater proportion of those with the vestibular profile stopped the BCBT due to symptom exacerbation than those without (90.5% vs. 9.5%, p = 0.04).

Conclusions

Adjudicated clinical profiles and ANS metrics were similar between exercise-tolerant and intolerant groups. Vestibular sensitivities have a considerable contribution to symptom provocation during the BCBT, as a significant proportion of participants with the vestibular profile discontinued the BCBT due to symptom exacerbation. These findings corroborate previous research and suggest that exercise intolerance is pervasive across all concussion clinical profiles and should be considered in all evaluations.
A - 43 Impact of Pre-Existing Attention-Deficit/Hyperactivity Disorder on Vestibular/Ocular Motor Outcomes Following Concussion
Authors: Guercio H A , Zynda A J , Todd M , Bunker N , Burley C , Patel S , Ramirez N , Fazio V , Kegel N , Collins M W , Kontos A P
Published: July 2024

Purpose

The purpose of this study was to examine differences in post-injury VOMS outcomes in athletes with and without pre-existing ADHD. The authors hypothesized individuals with pre-injury ADHD would demonstrate greater NPC distance as well as increased headache and dizziness on the VOMS.

Method

This prospective cohort study included patients aged 11–29 years who presented to a specialty concussion clinic within 30 days of a diagnosed concussion, categorized into groups with and without pre-existing ADHD. Independent samples t-tests and chi-square tests examined differences between groups in demographics, medical history, injury mechanism, and VOMS outcomes. A follow-up analysis of covariance was performed to determine the influence of significant covariates on VOMS outcomes.

Results

One hundred eighty-nine participants (107 male; age = 15.9 ¬ ± 2.5 years) were included; 160 (83.3%) without ADHD and 29 (15.1%) with pre-existing ADHD. Participants with pre-existing ADHD demonstrated significantly greater NPC average (5.29 vs. 2.87, p = 0.04) and total dizziness (14.32 vs. 9.54, p = 0.03). When controlling for sex, race, and history of anxiety, only VOMS dizziness total remained significantly different between groups (F(1, 177) = 4.56, p = 0.03).

Conclusions

Results indicate patients with pre-existing ADHD report higher levels of dizziness during post-injury VOMS when compared to patients without ADHD history. Notably, group differences in NPC were attenuated when controlling for demographic information. Findings reinforce the importance of comprehensive evaluation and assist in interpretation of post-injury vestibular screening for patients with ADHD. Future research should examine recovery trajectories, efficacy of targeted treatments, and influence of post-injury anxiety among individuals with ADHD in order to provide effective treatment recommendations.
A - 44 A Comparison of Multi-Domain Clinical Assessment Outcomes in Older Adults Following Concussion
Authors: Ramirez N R , Zynda A J , Perry C , Burley C , Patel S , Guercio H , Bunker N , French J E , Trbovich A M , Collins M W , Kontos A P
Published: July 2024

Purpose

To examine differences in demographics, medical history, injury characteristics, and multidomain clinical assessment outcomes between different age groups of older adults following concussion.

Method

This prospective study included participants aged 50+ years with a diagnosed concussion (<12 months) who presented to a specialty concussion clinic. Participants completed a clinical intake/interview (e.g., demographics) and a multidomain clinical assessment comprising symptoms (Clinical Profile Screen [CP-Screen]), cognitive (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]), psychological health (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disoder-7 [GAD-7]), vestibular/ocular (Vestibular/Ocular Motor Screen [VOMS]), and quality of life (Neurological Quality of Life [Neuro-QoL]) at an initial visit. Older adults aged 50–59 and 60+ years were compared using independent samples t-tests, X2 tests, and analyses of covariance.

Results

76 participants (M = 59.6¬ ± 6.3 years, 55.3% female) were included, 41 (53.9%) aged 50–59 and 35 (46.1%) aged 60+ years. The 50–59-year group had a greater proportion of females (68.3% vs. 40.0%, p = 0.01) and a history of anxiety (39.0% vs. 17.1%, p = 0.036). The 50–59-year group had worse Neuro-QoL (F[1, 72] = 5.1, p = 0.03, ηp2 = 0.10), RBANS recall (F[1, 72] = 7.1, p < 0.01, ηp2 = 0.09), RBANS fluency (F[1, 72] = 5.0, p = 0.03, ηp2 = 0.06), and RBANS list recognition (F[1, 72] = 4.1, p = 0.04, ηp2 = 0.06), controlling for sex and history of anxiety.

Conclusions

This study demonstrated that adults aged 50–59 years were more likely to be female and have a history of anxiety compared to adults 60+ years. Interestingly, older adults 50–59 years demonstrated greater perceived difficulties in their cognitive abilities post-concussion, which was reflected in impairments on cognitive testing compared to adults 60+ years.
A - 47 Missed Steps: Collegiate Athletes’ Beliefs Towards Physical Activity and Kinesiophobia after Acute Concussion
Authors: Rosenblum D J , Smetana R M , Broshek D K , Resch J E
Published: July 2024

Purpose

Physical activity (PA) may support recovery following concussion in collegiate athletes. Fear of PA (i.e., kinesiophobia), may influence recovery from concussion. The purpose was to examine perception of PA, as well as how biological sex and mood history, influenced kinesiophobia values after concussion.

Method

Division I collegiate athletes (n = 183[42% female], 20.1+/−1.5 years of age) participated in this descriptive cohort study. Participants completed the Tampa Scale of Kinesiophobia-17 (TSK) within 72 hours of concussion. The TSK’s fourth, twelfth, and fourteenth items query: “My pain would probably be relieved if I were to exercise”, “Although my condition is painful, I would be better off if I were physically active”, and “It’s really not safe for a person with a condition like mine to be physically active”, in relationship to PA after concussion on a four-point Likert scale. Mann Whitney U tests were used to compare total TSK values by biological sex and history of anxiety/depression.

Results

Most participants (72% and 63%) disagreed with the fourth and twelfth items, respectively. Fifty-three percent of participants agreed with the fourteenth item. On median [interquartile range], females had significantly higher (p < 0.001) kinesiophobia (38.0[9]) than males (34.0[8.0]). Participants with (40.0[7.5]) compared to those without (34.5[9.0]) a history of anxiety/depression had significantly higher (p < 0.001) kinesiophobia values.

Conclusions

The majority of collegiate athletes indicated that PA would not support recovery from concussion. Total kinesiophobia scores were also influenced by biological sex and a history of anxiety/depression. Misconceptions of PA after concussion should be addressed by clinicians to facilitate recovery from the injury.
A - 50 The Role of Family Functioning on Concussion Recovery in Adolescents and Young Adults
Authors: Bunker N , Zynda A J , Walzer K , Hirsh M , Guercio H , Burley C , Patel S , Ramirez N , Kegel N , Trbovich A M , Kontos A P
Published: July 2024

Purpose

This study examined the role of overall family functioning (FF) in concussion recovery among adolescents and young adults. The authors hypothesized that participants with unhealthy FF would demonstrate prolonged recovery times compared to participants with healthy FF.

Method

A prospective cohort study assessed FF and concussion recovery in a university laboratory setting. Participants completed demographics, medical history, injury characteristics, Sport Concussion Assessment Tool-5 (SCAT5), and the General Functioning Scale of the Family Assessment Device (GF-FAD) at two visits. Participants were categorized into healthy (<2) and unhealthy (>2) FF groups based on their GF-FAD composite score.2 Chi-square tests compared categorical data, and Mann–Whitney U tests compared continuous data between groups.

Results

One hundred one participants (52 female; age = 20.5 ¬ ± 2.5 years) were included in the unhealthy FF group. When controlling for demographic and medical history, both days to symptom resolution (F(1, 87) = 4.7, p = 0.03) and days to medical clearance (F(1, 87) = 5.4, p = 0.02) were significantly different between groups. The unhealthy group experienced significantly longer time to symptom resolution (12.5 days vs. 8.0 days, p = 0.004) and time to medical clearance than the healthy group (15.0 days vs. 12.0 days, p = 0.006).

Conclusions

Participants in the unhealthy FF group demonstrated significantly longer times to symptom resolution and medical clearance compared to those in the healthy FF group. Results highlight the importance of a comprehensive clinical interview during the initial visit, as these factors may contribute to prolonged recovery. Future studies should examine how access to healthcare and adherence to treatment moderate the relationship between FF and concussion recovery.
A - 51 Examining the Role of Cognition in Lower Extremity Musculoskeletal Injury and Concussion Risk in Elite Athletes
Authors: Sewell I J , Romeas T , Deslauriers J , Leclerc S , Wojtowicz M
Published: July 2024

Purpose

Recent evidence suggests a relationship between cognitive performance and the risk of lower extremity musculoskeletal (LEMSK) injury, and that concussion may also increase the risk of subsequent LEMSK injury, though these relationships have been largely examined in isolation. This study examined associations between pre-season cognitive performance and the risk of subsequent LEMSK injury and concussion among elite athletes.

Method

An observational study of elite/international-level athletes from a Canadian national sport institute. 146 athletes (female = 87) across six different sports completed pre-season cognitive testing (Vienna Test System) between 2018 and 2023. Subsequent LEMSK injuries and concussions during the year following pre-season cognitive testing were documented via an injury surveillance program.

Results

Pre-season cognitive performance was similar in athletes with (n = 24) and without (n = 122) a subsequent concussion, and those with (n = 100) and without (n = 46) a subsequent LEMSK (ps > 0.05). Athletes with both a subsequent LEMSK and concussion had slower baseline reaction time on a task of stress reactivity (n = 16; median RT = 0.74 s) compared to athletes with only a subsequent LEMSK (n = 84; median RT = 0.69 s; V = 900.5, p = 0.019). Concussion history was a significant predictor of both subsequent LEMSK (B = 0.94, p = 0.017) and the number of subsequent LEMSK (B = 1.23, p < 0.01). Faster RTs on inhibition tests were predictors of subsequent number of LEMSK, while controlling for concussion history (B = -10.21, p = 0.045; B = -10.60, p = 0.017).

Conclusions

Identifying risk factors for LEMSK injuries and concussions is critical for preventing future injuries. These preliminary results suggest a relationship between baseline reaction time performance and combined subsequent LEMSK and concussion injury.
A - 52 Post-Pandemic Mental Health Symptom Presentations In Canadian Varsity Athletes
Authors: Fabiano G F , Wilson A , Wojtowicz M
Published: July 2024

Purpose

Mental health (MH) symptoms are often intertwined with concussion symptoms and affect recovery trajectories. Recent studies indicate that the COVID-19 pandemic had a negative impact on athletes’MH, further highlighting the need to understand pre-season baseline MH. This study’s objective was to compare MH symptom frequency and profiles of symptomatology between cohorts of athletes captured pre and post COVID-19.

Method

Pre-season baseline data from varsity athletes at a Canadian university was collected in 2019, 2022, and 2023 (n = 444) aged 17–25 years (49.8% female). Athletes completed a series of demographic, concussion history, and psychological questionnaires [i.e., Post-Concussion Symptom Scale (PCSS), Generalized Anxiety Disorder Index-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9)].

Results

The post-pandemic cohort reported greater numbers of symptoms on the PCSS (M = 4.36, SD = 5.41) compared to the pre-pandemic cohort (M = 2.55, SD = 3.74; p = <0.001); as well as greater symptom severity (M = 7.75 SD = 11.45) compared to the pre-pandemic cohort (M = 4.34, SD = 7.9; p = <0.001). Greatest endorsement differences were observed in anxiety, depression, cognitive, nausea, and “don‚Äôt feel right”symptoms (ps < 0.001). However, frequency of mild to severe symptom reporting was similar on the PHQ-9 (pre-pandemic: 23.6%, post-pandemic: 20.3%) and GAD-7 (pre-pandemic: 20.9%, post-pandemic: 21.6%; ps >0.05).

Conclusions

Post-pandemic athletes appear to endorse greater baseline symptoms of anxiety and depression, as well as cognitive and physical symptoms, though these do not appear to meet clinical levels. The study demonstrates a need to improve surveillance in varsity athletes’MH that may help identify athletes at risk of MH illness.
A - 54 Changes in the Blink Reflex after a Sport-Related Concussion: Test–Retest Reliability of a Blink Reflexometer
Authors: Dugan J E , Jo J , Long C C , Williams K L , Zuckerman S L , Terry D P
Published: July 2024

Purpose

The blink reflex may be affected by concussion, but psychometric analyses examining devices that measure the blink reflex are limited. This study assessed the test–retest reliability of the Blinkcns EyeStatTM device at two pre-season baseline time points in a cohort of healthy high school athletes.

Method

During pre-season, high school athletes completed the EyeStatTM scanning twice, 15-minutes apart. Pearson/Spearman correlations and Intraclass Correlation Coefficients (ICC, i.e., the measure of test re-test reliability) were calculated across 10 different parameters (e.g., latency, total blink time, oscillations, time to open/close). Additionally, t-tests examined if these parameters differed based on biological sex, sleep status (i.e., <8 vs. ≥8 hours the night before), and prior concussion history (i.e., 0 vs. ≥1 prior concussions).

Results

Of the 48 athletes (age, M = 16.0¬ ± 1.2 years), 35.4% were female. Correlations ranged from 0.45–0.82 (all p-values<0.001) between the two assessments, and ICCs were 0.46–0.87 (all p-values<0.02). Additionally, none of the Eyestat parameters were significantly associated with biological sex, sleep status, or prior concussion history (all p-values>0.05).

Conclusions

This study suggests substantial test–retest reliability of the EyeStatTM device across 10 parameters in a cohort of healthy high school athletes. The findings support the potential utility of the EyeStatTM device as a reliable baseline measure for assessing the blink reflex among young athletes.