bluuebunny/crossref_metadata_2025 huggingface dataset:
The incidence of concussion and risk of subsequent concussions in professional rugby league
Authors: Hodgson Lisa , Gissane Conor , Walker Peter , Maruff Paul , Darby David
Published: November 2017

Objective

Recognition and management of concussion within sport is a hot topic as research suggests that the mismanagement can lead to extended time out of play and morbidity after retirement. This study aimed to identify the incidence and risk following concussion within the Rugby Football League and if full recovery from concussion increases the risk of subsequent concussions.

Design

Retrospective study

Method

Participant players were those who held a professional contract between 2006–2012. It is mandatory to provide an annual baseline test and following any diagnosed concussion, with full symptom resolution, a valid return to play test. Concussion test data was provided by CogState Australia from tests performed over 7 seasons.

Results

Over the 7 seasons 4762 players suffered 470 concussion (2.65/1000 hours, 95% Confidence Interval 2.4 to 2.9). The odds of sustaining 1 concussion was 7%, the odds of receiving 2 or more was 1%, and 0.3% 3 or more concussions. The time between concussions for any individual who suffered two or more concussions was on average 355 days. The average return to play time was 1.46 days following the first return to play test.

Conclusions

This report is the first to follow rugby league players over a prolonged period and, the first to demonstrate the risk of subsequent concussions. In rugby league, concussions managed correctly and fully resolved were not shown to have detrimental effects on future concussions, and in general there is a lack of evidence linking appropriately managed concussions in other sports to detrimental future effects.

Competing interests

Lisa Hodgson, Conor Gissane, Peter Walker David Darby – None.

Paul Maruff – Full time employee of CogState.

David Darby – Former Founder and Director of Cogstate.
The incidence, risk factors predicting injury and severity of injuries sustained during professional mixed martial arts (mma) competition in africa
Authors: Venter Santa-Marie , Grant CC , Fletcher Lizelle
Published: November 2017

Objective

To determine the incidence of injuries and associated risk factors, as well as the severity of injuries sustained by professional male MMA athletes competing at the Extreme Fighting Championships Africa (EFC Africa) from 2010 to June.

Design

Results from this descriptive study were compared to a similar study done in the United States of America (USA).

Setting

Medical records of all professional events (2010–2014) were obtained from EFC Africa (custodian).

Participants

Data was obtained from 173 male competitors aged 18 to 44 years, participating in 300 professional MMA fights.

Outcome measures

Statistical analyses include descriptive statistics and a stepwise logistic regression. The odds of an injury were predicted with six independent variables: fight outcome, age, weight division, number of fights, injuries in preceding fight and years of fighter experience.

Main results

Injuries to the head, face and neck were most common (45.9%), followed by traumatic brain injuries (knock-outs) (16.6%) and hypoxic brain injuries (chokes) (10.2%). Losing a fight was a significant predictor of injury when a stepwise logistic regression model was employed (p=0.040). The odds ratio indicated that preceding fight injury almost doubled the risk of sustaining an injury in following fight (1.91; p=0.163). TBI in the SA group (16.6%) was substantially higher than the USA group (1.8%).

Conclusion

The high rate of TBI’s in SA competition is concerning. This could reflect superior refereeing in the USA group, as fights may be ended sooner by referee stoppage, versus allowing fights to continue until one fighter is knocked-out.

Competing interests

None.
The online concussion awareness training tool (catt)
Authors: Babul Shelina , Pike Ian
Published: November 2017

Objective

To support standardise concussion recognition, diagnosis, treatment and management through an evaluated online resource based upon the Zurich Consensus Statement on Concussion in Sport and other evidence-based resources. The online Concussion Awareness Training Tool (CATT–www.cattonline.com) includes three free toolkits providing training for: Medical Professionals–MP; Parents, Players and Coaches–PPC; School Professionals–SP.

Design

Pre-post intervention survey with sample size of at least 33 for power to detect a large effect size of 0.5.

Setting

British Columbia, Canada.

Participants

MP: 42 physicians and 33 nurses practising in BC; PPC: 35 parents in BC with a child registered in organised sport; SP: 43 K-12 teachers working in BC.

Intervention

CATT MP aims to standardise practice in a clinical setting with a focus on the paediatric patient. CATT PPC speaks to concussion identification and management, with Smartphone accessible resources:Concussion Response ToolandQuestions to Ask Your Doctor. CATT SP includesReturn-to-Learnprotocol and resources for teachers, administrators, counsellors and others in the school setting.

Outcome measures

Change in knowledge, attitudes and practices.

Results

CATT MP was launched April 2013. Physicians demonstrated significant positive change in concussion practices (p=0.001), and significant change in knowledge by those treating more than 10 concussions per year (p=0.039). Nurses had significant positive change in practices (p=0.005) and attitudes (p=0.035). CATT PPC was launched June 2014. Parents demonstrated significant positive change in concussion knowledge (p=0.002). CATT SP was launched February 2016; evaluation in process.

Conclusions

CATT increases concussion knowledge and awareness among target audiences.

Competing interests

None.
Profiling head accelerations using triaxial accelerometery during ‘bodies in front’ training play: a preliminary study of the sport of rugby league
Authors: Atkins Stephen J , Bentley Ian , Hurst Howard T , Mark E Mark E , Richardson Cassandra , Sinclair Jonathan K
Published: November 2017

Objective

To provide unique descriptive information on head accelerations, both linear and rotational, during ‘bodies in front’ training play.

Design

A convenience sample were tested using a cross-sectional design. Players wore a triaxial accelerometer (XPatch, X2 Biosystems, Seattle) during two sessions of training gameplay (session duration 142±26 min). Accelerometers were affixed on the left side of the head, at a point approximate to the external occipital protuberance.

Setting

Testing was undertaken at an elite performance training centre.

Participants

20 elite, professional, rugby league players.

Main outcome measures

Minimum recordable accelerations were set at 10 g (linear acceleration) and 25 rads s-2(rotational acceleration).

Results

A total of 1256 recorded ‘hits’ were analysed, excluding evident artefacts. No player was reported to have suffered a concussion. Player ‘loading’ was 46±33 hits per session (range 7–170). Average linear (14.9±8.8 g) and rotational (532±347 rads s-2) accelerations were not significantly different between training sessions (P>0.05). Frequency of hits are summarised in the table below.

Abstact 20 Table 1Linear acceleration (g)Cumulative%Rotational acceleration (rads s–2)Cumulative%10–2092.625–50064.721–405.4501–100027.541–600.71001–20005.461–800.52001–30001.681–1000.43001–40000.8>1010.4>40010

Conclusions

The majority of head accelerations occurred within lower ‘sub-concussive’ zones. This confirms existing research findings from other sports. Whilst few accelerations occurred in higher zones, there were a number of very high loading impacts observed in ‘hit up forward’ positions. Our research confirms the suitability of using portable accelerometers in determining head accelerations in full-contact, ‘armourless’, invasion games.

Competing interests

None.
Defining the paralympic athlete: normative values for scat major components in healthy paralympic athletes
Authors: J Moreau William , Walden Taylor , Nabhan Dustin
Published: November 2017

Objective

Describe normative baseline SCAT 2 and 3 (SCAT) performance in elite Paralympic athletes.

Design

Retrospective cohort.

Setting

United States Olympic Committee Sports Medicine Clinics.

Participants

Sixty-nine SCAT baseline evaluations were performed on a population of 60 elite athletes Paralympic (17 women and 43 men, mean age 30.1±7.3 years) representing 5 Summer and Winter Olympic sports as part of multimodal concussion programing.

Intervention

No intervention was applied. The SCAT evaluations were administered as a component of a baseline testing on healthy athletes.

Main outcome measurements

Baseline SCAT performance on major components is described. T-tests were used to compare differences in baseline performance by sex.

Results

During baseline evaluations, elite Paralympic athletes reported a mean (95%CI) of 2.2 (1.1–3.3) symptoms with an average symptom severity score of 4.7 (2.8–6.6). Mean scores on SCAT components in this population were; orientation 4.9 (4.8–5.0), immediate memory 14.3 (13.9–14.8), concentration 4.0 (3.7–4.2), tandem gait 15.4 (12.3–18.6), delayed recall 3.7 (3.4–4.0), balance 4.4 (1.9–7.06), SAC total 26.6 (25.8–27.4). This group reported a history of 2.6 (1.4–3.8) previous concussions. There were no significant differences between males and females in components of the SCAT.

Conclusions

Population specific normative values for baseline SCAT performance in a population of elite Paralympic athletes are presented in this cohort study.

Clinical relevance

Paralympic athletes are an understudied population. Clinicians are encouraged to reference population specific normative values when interpreting SCAT performance. For athletes with impairments, individual baselines may be preferred to the wide distribution of functional capacity.

Acknowledgements

None.

Competing interests

None.
Do neurocognitive scat3 test scores differ between non-concussed national footballers living with and without disability? a cross-sectional study
Authors: Weiler Richard , Van Mechelen Willem , Fuller Colin , Ahmed Osman , Verhagen Evert
Published: November 2017

Objective

To determine if cross-sectional differences exist using SCAT3 scores for non-concussed England footballers with and without disability.

Design

Cross-sectional between group comparison of first-time collected SCAT3 scores.

Setting

All England team doctors and physiotherapists commenced between 1st August 2013 and 31st July 2014 standardised annual SCAT3 testing on England footballers following the Zurich 2012 concussion guidelines.

Participants

A convenience sample of England national football team players (total: 249; male: 174, female: 75), of whom 185 were athletes without disability (male: 119; female: 66) and 64 athletes with disability (male learning disability: 17; male cerebral palsy: 28; male blind: 10; female deaf: 9).

Assessment and outcome measures

Comparison between groups of median SCAT3 section scores was made with the non-parametric Mann-Whitney-Wilcoxon ranked-sum test.

Main results

Compared to male footballers without disability, male footballers with disability scored significantly higher for total number of symptoms and symptom severity. However, male footballers with learning disability demonstrated no difference with total number of symptoms and scored significantly lower on immediate memory and delayed recall . Male blind footballers scored significantly higher for total concentration and delayed recall. Male footballers with cerebral palsy scored significantly higher on balance testing and significantly lower on immediate memory.

Conclusions

The results of this study suggest that significant cross-sectional between-group variability exists in SCAT3 section scores when non-concussed footballers with disability are compared to footballers without disability. Future concussion consensus guidelines should recognise these between group differences and generate separate SCAT3 guidelines for the growing number of elite athletes living with disability.

Competing interests

None.
Neurocognitive changes as measured by impact and the scat3 in women’s soccer players without diagnosed concussion
Authors: Bowman Thomas G , Breedlove Katherine M , Leahy Theresa E
Published: November 2017

Objective

Neurocognitive changes have been found in football players without documented concussion raising concerns regarding the long term consequences of subconcussive head impacts in sport. It remains unknown if similar neurocognitive changes are found in female soccer athletes without concussion. Females have been found to have higher concussion rates compared to males and soccer is the most popular sport internationally providing a compelling area of study.

Design

Observational study.

Setting

American collegiate women’s soccer team.

Participants

16 National Collegiate Athletic Association Division III women’s soccer athletes (19.88±1.1 years old, 163.7±4.9 cm, 61.2±4.9 kg) volunteered and provided consent for the study.

Assessment of risk factors

We measured head impacts during practices and games throughout the 15 week season with the xPatch (X2 Biosystems, Seattle, WA, USA). All participants completed ImPACT and the Sport Concussion Assessment Tool – 3rdEdition (SCAT3) prior to the season’s start and at the end of the season.

Outcome measures

The xPatch stored location, frequency, and magnitude (linear and rotational accelerations) of head impacts. Event film was used to verify each head impact. Changes in neurocognitive function were determined by comparing the baseline ImPACT and SCAT3 scores with the post-season scores.

Main results

A stepwise regression found a significant relationship between weekly head impact frequency during practices and the ImPACT measures of Visual Motor Speed (P=0.03) and Symptom Score (P=0.03).

Conclusions

Soccer activity may lead to lower visual motor speed and higher symptom scores. Future studies should use additional screening tools to verify these preliminary findings.

Competing interests

None.
Stability of the scat3 and association with game day head impacts in non-concussed amateur australian rules football players
Authors: Wilmott Catherine , McIntosh Andrew S , Howard Teresa , Mitra Biswadev , Dimech-Betancourt Bleydy , Rosenfeld Jeffrey V
Published: November 2017

Objective

This pilot study investigated SCAT3 from baseline to post-game among non-concussed amateur Australian Rules footballers, and association with game day head impacts.

Design

Peak linear acceleration (PLA) of the head (>10g) was measured by wearable impact sensor X2Biosytems xPatch. SCAT3 was administered at baseline and post-game.

Participants

Amateur Australian Rules footballers n=68.

Main results

Common symptoms at baseline: fatigue, trouble falling asleep & neck pain. N=57 sustained 2088 impacts>10g(Mean PLA=14.40g, range 10–115.78g). Measured PLA among males (M=15.11g, SD 3.51) and females (M=16.60g, SD 4.04), U=288.00, z=−1.24, p=0.217 did not differ, however, males (M=46.13, SD=50.4) sustained significantly more impacts than females (M=17.63, SD=13.20), U=214.00, z=−2.46, p=0.013. Greater symptom severity was found post-game (M=6.16, SD=8.17) compared to baseline (M=4.04, SD=6.34), z=−0.32, p=0.001, along with greater symptom total (p=0.011). Those with higher mean PLA demonstrated slower tandem gait. A similar pattern of SCAT change was observed for the No Impact group, and there were no significant group differences in SCAT change scores.

Conclusions

Consistent with previous findings players were not asymptomatic at baseline. Increase in symptom severity post-game was generally independent of head impact. Furthermore, the lack of association between PLA and SCAT3 change scores in this non-concussed Impact group suggests that other factors may contribute to such changes.

Competing interests

None.
The effect of age on symptom reporting on the adult and child post concussion symptom scale in youth ice hockey players
Authors: Black Amanda M , Schneider Kathryn J , Palacios-Derflingher Luz , Meeuwisse Willem H , Emery Carolyn A
Published: November 2017

Objective

To determine symptom reporting differences for children completing the adult and child version of the Post-Concussion Symptom Scale (PCSS) on the Sport Concussion Assessment Tool 3 (SCAT3).

Design

Cross-Sectional study.

Setting

Community ice hockey teams, Alberta, Canada.

Participants

Youth hockey players (n=891; 91.58% male, 10–14 years) who completed the PCSS on the Adult and Child version of the SCAT3 during a preseason baseline assessment.

Assessment of risk factors

Adult versus child PCSS stratified by categorical age (10–12, 13–14).

Outcome measures

Total number of symptoms, symptoms reported, and proportion equally reporting symptoms (0, ≥1) on both PCSS scales.

Main results

Participants reported a median of 2 symptoms [Interquartile Range (IQR):0–21] on the adult scale (/22) and 5 (IQR:0-20) on the child scale (/20). There was no evidence of a difference in the proportion of participants reporting symptoms (0, ≥1) on both scales between age groups 10–12 (525/729, 72.02%) and 13–14 (121/160, 75.63%) (difference: −3.61% (95% confidence interval (−11.40%, 4.18%)). The most frequent symptoms reported on the adult PCSS by participants with no symptoms on the child PCSS were nervousness (11.27%) and neck pain (10.56%). Participants with no symptoms on the adult PCSS most commonly reported being easily distracted (45.29%) and forgetful (39.49%) on the Child PCSS.

Conclusions

A greater number of symptoms were endorsed for all 10-14 year old subjects when using the Child SCAT3 PCSS. Neck pain was a commonly reported symptom for all age groups on the Adult SCAT3 PCSS, but this symptom is absent from the Child SCAT3.

Competing interests

None.
The utility of individual baseline versus normative reference values for the scat3 following concussion 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 whether individual SCAT3 baseline scores are more useful than normative reference values following acute concussion.

Design

Prospective cohort.

Setting

Finnish professional male ice hockey league.

Participants

SCAT3 baseline testing has been mandatory in the 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.

Outcome measures

Measures included: the individual baseline and day of concussion scores of the injured players; The league’s normative reference values [based on 2013–2014 preseason baselines (n=304)]; and the limits of normal variation on SCAT3 [based on league’s preseason baselines 2013–2014 and 2014–2015 (n=179)]. The post-injury performance was ruled as abnormal if (i) the player scored within the worst 10th percentile of the normative reference values or (ii) the score differed from the player’s own baseline more than the cut offs for 90% normal variation.

Main results

The percentages of the players who performed abnormally on post-concussion testing (scores compared to individual baseline vs. normative reference values) were as follows: Symptoms: 96% vs. 100%; SAC: 31% vs. 22%; M-BESS: 50% vs. 50%; Tandem gait: 18% vs. 29%; Coordination: 7% vs. 7%.

Conclusions

Post-concussion testing conducted with individual baseline seems to be as sensitive as assessment compared to normative reference values in acute concussion recognition. Symptoms were the most sensitive SCAT3 component.

Competing interests

Timo Hnninen, Markku Tuominen, Jari Parkkari, 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.
Use of the scat-3, child scat3, and king-devick in concussion assessment of youth hockey players
Authors: Herceg Mark
Published: November 2017

Objective

Currently youth sports hockey programs do not adhere to concussion protocols. The purpose of this study was to examine the relations between performance of two sideline assessments.

Design

Retrospective analysis of two measures given as part of a youth travel hockey program.

Setting

Ice hockey skating facility in Westchester County, NY (USA).

Participants

A sample of 121 youth hockey players participated. All of the athletes were administered the King-Devick, SAC (ages 13-18) and Child SAC (ages 10-12) at baseline, sideline, and once symptom free.

Main results

Mean age was 13.2 (SD=1.2) and there 118 were boys (97.5%). The majority of sample had zero self-reported past concussion (n=113; 93.3). Fourteen athletes sustained concussions. Worse King Devick scores were associated with overall worse SAC and Child SAC Concentration and Delayed Memory scores. For every 1-point reduction in SAC Delayed Memory Score, there was a worsening of King Devick time score of 5.3 seconds (95% CI 5.0, 9.5, p<0.001) for children ages 13–18, and a time score difference of 5.8 seconds for children ages 10–12 (95% CI 5.9, p<0.001). In examining SAC total score, a 1-point decrease was associated with King Devick score worsening of 2.0s (95% CI 0.5, 4.0, p=0.01). Most common symptoms were headache and fatigue for all ages. Once symptom free, there was a trend toward improvement on both measures compared to baseline.

Conclusions

This study reaffirms prior studies that both King Devick and SAC are effective combination clinical tools that assess athletes with suspected concussion.

Competing interests

None.
Impact monitoring and king-devick ocular testing provide a relatively simple process for objectively identifying and managing concussion in sports participants
Authors: Cohen Adrian , King Doug , Pearce Alan J
Published: November 2017

Objective

This study presents data using multimodal assessment via impact sensors and oculomotor function to quantify neurophysiological changes in the acute period following concussion.

Design

Cohort study.

Participants

Data on impact magnitude and frequency were collected with a wireless head impact sensor (XPatch1) worn by senior amateur rugby players participating in a domestic season. King-Devick Tests2 were performed pre-season and after significant impact scores (PLA>100 g, PRA>10,000 rads/sec/sec).). Participants underwent a one hour baseline assessment of balance, cognition and transcranial magnetic stimulation testing. Following concussive episodes or significant head impacts (as measured by impact sensors), players were re-tested to elicit any differences and to assist in providing objective criteria for the return to play process.

Interventions

Any impact that resulted in a witnessed concussion or that was suspected on the basis of significant impact scores required post-match testing utilising the King-Devick test to help determine appropriate return to play readiness.

Outcome measures

Impact number, peak linear and peak rotational acceleration, risk weighted exposure. Time and errors completing the King-Devick test.

Main result

20 concussions were detected in all, of which only 3 were witnessed (2 players unconscious on the field, one with balance disturbance resulting in removal from play).

Conclusions

A combination of regular impact monitoring and King-Devick Ocular testing provides a relatively simple process for objectively identifying and managing concussion in sports participants.

Competing interests

AJP is supported, in part, by a research grant by the Australian Football League
Pre-season concussion testing in high school students with academic difficulties or attention deficit hyperactivity disorder
Authors: Herceg Mark , Wojtowicz Magdalena , Iverson Grant
Published: November 2017

Objective

Learning disabilities and/or ADHD are considered to be important risk factors or modifiers for concussion assessment and management. The purpose of this study was to examine cognition and symptom reporting in high school students with academic difficulties or ADHD and compare to those without at baseline.

Design

Retrospective analysis of three measures routinely given as part of a high school yearly concussion baseline protocol.

Setting

The library of a high school in Westchester County, NY.

Participants

A sample of 143 high school students who participate in collision/contact sports [Age M (SD)=15.4 (1.2); Boys=78, 54.5%] completed baseline testing.

Main results

Non-parametric tests were used because of violations of normality. High school students with academic difficulties or ADHD (n=21) were compared to controls (n=122) on King- Devick, SAC, ImPACT Cognitive Composite scores, and Total Symptom ratings. Students with LD or ADHD performed significantly more poorly on King-Devick (p=0.003; d=0.79), Visual Motor Speed Composite of ImPACT (p=0.007; d=0.79), and reported more symptoms at baseline on the Post-Concussion Scale (p=0.005; d=0.59). No significant differences found between groups on SAC (p=0.11; d=0.36) or ImPACT Verbal Memory (p=0.54; d=0.16), Visual Memory (p=0.20; d=0.26), or Reaction Time (p=0.14; d=0.55) Composites.

Conclusions

To our knowledge this is the first study to examine performance on three different baseline measures. High school students with academic difficulties or ADHD performed more poorly on King-Devick, the Visual Motor Speed Composite of ImPACT, and reported more symptoms at baseline. Findings suggest these students need to be monitored for specific post injury changes.

This study was approved by the Committee for Human Rights Research, Burke Rehabilitation Hospital, White Plains, NY, USA. Protocol # BRC-455.

Competing interests

None.
Video analysis of the evidence of concussive signs in national rugby league (nrl) match play
Authors: Gardner Andrew J , Levi Christopher R , Iverson Grant L
Published: November 2017

Objective

A video analysis of 201 National Rugby League (NRL) matches to document all signs of possible concussion during the 2014 season.

Setting

All match play from the 2014 NRL season.

Participants

All professional players participating in the 2014 season

Outcome measures

The total frequency of six concussion signs (unresponsiveness/loss of consciousness, slow to get up, clutching head, unsteadiness of gait, vacant stare, and seizure).

Main results

The concussion interchange rule was used 156 times, with 60 medically diagnosed concussions. The incidence rate for concussion was 17.26 (95% CI=13.44–22.16) per 1,000 player match hours, or approximately one concussion every 3.35 games. There were 127,062 tackles reviewed in the 201 matches, for an average of 632.1 tackles per match. Being slow to get up was observed 2,240 times, clutching the head 361 times, unsteadiness of gait 102 times, vacant stare 98 times, possible loss of consciousness (LOC) 52 times, and a seizure 4 times. Of the 2,240 instances of being slow to get up following a tackle, only 2.7% of those cases involved a medically diagnosed concussion. Of the 52 instances in which a player appeared to have brief LOC, 50 players were removed under the concussion interchange rule (96.2%). Of those 50, 24 were medically diagnosed as having sustained a concussion (48%).

Conclusions

Reviewing match video footage can be a useful addition to the sideline assessment of concussion.

Competing interests

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 Australia 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 funded through the HMRI, supported by Anne Greaves.

Grant 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).

Christopher Levi none.
Relationship between king devick TEST, SCAR3 and 3D mot in cognitive assessment
Authors: Oslund Kimberly R , Cullen Hilary M , Kowalski Kristina , Christie Brian
Published: November 2017

Objective

To examine the relationship between aspects of the Sport Concussion Assessment Tool 3 (SCAT3), the King-Devick Test (KDT) and Three-Dimensional Multiple Object Tracking (3D MOT) at baseline.

Design

Prospective design.

Setting

University resarch laboratory.

Participants

A convenience sample of 304 healthy, non-concussed, athletic participants (101 females, 203 males) ranging in age from 11.69 20.41 years (mean age=16.05 + 4.36) were included in the analysis.

Outcome measures

Participants completed the SCAT3, KDT and 3D MOT in a single visit. A regression analysis was performed to see if any aspects of the SCAT3 (immediate memory (IM), coordination (COOR), and delayed recall (DR)), and/or the KDT, predicted 3D MOT scores.

Main results

A multiple linear regression was calculated to see if KDT, IM, DR and COOR predicted the speed of the 3D MOT. The assumptions of multivariate regression were tested and corrections were applied as needed. Using the stepwise method, it was found that KD, DR and COOR explain a significant amount of the variance in the speed of the 3D MOT (F(3, 256))=11.82, p<0.000 with an R2 of 0.12. Participants predicted 3D MOT score is equal to 1.05 –0.01 KD + 0.07 DR + 0.23 COOR, where KDT is measured in seconds, DR is measured in units between 0–5, and COOR is measured as 1=successful, 0?= not successful. The analysis shows that KD (Beta=–0.01, p?< 0.000), DR (Beta=0.07, p<0.02), and COOR (Beta=0.23, p<0.03), were significant predictors of 3D MOT scores.

Conclusions

Results suggest that King Devick Test, Delayed Recall, and Coordination tests share predictive validity of the 3D MOT in an athletic population between the ages of 6-29 at baseline. Future studies should examine these relationships post-injury and through concussion recovery. This could provide valuable information to better inform clinicians responsible for making Return to Play determinations.

Competing interests

None.
Biomechanical differences during a jump cut motion in those with and without a concussion history
Authors: Lapointe Andrew P , Nolasco Luis , Sosnowski Aniela , Andrews Eva , Martini Douglas N , Gates Deanna H , Broglio Steven P
Published: November 2017

Objective

To evaluate differences in biomechanics between young adult participants with and without a history of concussion during a jump cut manoeuvre.

Design

Case control

Setting

Laboratory

Subjects

7 controls (4 males, 3 females) and 7 concussed (4 males, 3 females) subjects, between the ages of 18 and 26, capable of engaging in a jump cut motion. Concussed subjects were tested on average 2.4 years post injury (SD=0.23 years).

Intervention

Participants jumped forward with both feet onto a force platform landing on their dominant leg, and directed their cut in response to the centre arrow of the Flanker task. A total five trials were performed. Kinematic variables were captured during the manoeuvres via motion capture.

Outcome measures

Peak knee flexion, abduction, and axial rotation

Results

Concussed subjects showed lower peak flexion of the knee on their non-dominant leg [F=25.455, p<0.01,R=0.240] and greater peak external rotation of the knee on their dominant leg [F=9.97, p<0.01, R=0.145]. Concussed subjects also showed a lower vertical centre of mass during the task [F=9.985, p<0.05, R=0.119].

Conclusions

There is a growing body of literature linking orthopaedic injury in those no longer displaying the acute signs and symptoms of concussion. This is the first study evaluating kinematic changes with findings demonstrating kinematic abnormalities long after clinical signs and symptoms have passed.

Competing interests

This project was funded by the Carl and Joan Kreager research fund.

None.
Validation of the kinarm end-point robot for clinical assessment of acute sport concussion sensory, motor, and neurocognitive impairment in athletes
Authors: Brian W Benson , Madeline Cosh , Cameron S Mang , Scott Stephen H. , Chantel Debert , Sean Dukelow
Published: November 2017

Objective

To determine if there is a significant association between KINARM robotic sensorimotor and neurocognitive measurements at baseline, ≤10 days post-concussion (IPC), and when clinically asymptomatic (CA).

Design

Double-blind, prospective case series.

Setting

Four athletic seasons (2011–2015).

Participants

1,214 elite athletes (904 males, 310 females, mean age: 18 and 20 years, respectively).

Outcome measures

Fifty-seven parameters from five robotic tasks (Visually Guided Reaching (VGR), Position Matching (PM), Object Hit, Object Hit and Avoid, Trail Making B (TMB)) characterising sensorimotor and neurocognitive function. Linear regression was used to determine if there was a significant association between baseline, IPC, and CA measurements, adjusting for potential predictors (age, sex, concussion history, recurrent concussion during study, number of baseline assessments, method (seated versus standing), Post-Concussion Symptom Scale Score (PCSS), days post-concussion at testing) and learning effect.

Main results

95 athletes sustained 102 concussions. There was a clear reduction in performance in concussed athletes on individual parameters compared to non-concussed repeat performance. Significant predictors of impairment were: 1) higher PCSS for VGR (IPC): Reaction Time (p<0.001), Min-Max Speed Difference (m/s) (p=0.001), Path Length Ratio (p=0.001), and TMB (CA): Test Time (p=0.003), Dwell Time (p=0.003); 2) older athletes for VGR (IPC): Speed Maxima Count (p<0.01); 3) less days post-concussion at IPC testing for PM Contraction/Expansion Ratio XY (p=0.005); and 4) recurrent concussion during study period for non-dominant PM Shift Y (p=0.005).

Conclusions

Results of this large prospective study suggest the KINARM robot is a valid, objective tool for quantifying sensorimotor and neurocognitive impairment in concussed 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.

Co-founder and CSO of BKIN Technologies that commercialises the KINARM robot.
Clinical affect and sensory correlates in adolescent sports concussions
Authors: Han Dong (Dan) Y , Koehl Lisa , Camargo Fernanda C , Mattacola Mattacola
Published: November 2017

Objective

Identifying risk factors is important in adolescent sports concussions. This study aimed to explore the relationship between affective symptoms and physical symptoms in youth concussions.

Design

Athletes were split into two groups: self-reported emotional symptoms (irritability/aggression, anxiety, depression, apathy, and/or labile mood; EMO, n=22) and a control group without emotional symptoms (CON, n=15). Groups were examined for differences between post-concussive symptoms and peri-concussive factors.

Setting

Outpatient clinic.

Participants

37 concussed adolescents age 12–17 with persisting concussion symptoms were assessed. Concussion diagnoses were indicated by traumatically induced alterations in mental status (with or without LOC), disruption in brain functioning (memory loss/neurological deficits), and other physiologic symptoms post-concussion. Those with baseline psychiatric history and/or special education were excluded.

Assessment of risk factors

Post-concussive symptom variable relationships were assessed.

Outcome measures

group differences were analysed using ANOVAs.

Results

No differences between positive LOC, positive amnesia, or post-concussive criteria existed, indicating likely comparable severity. While there were no group differences for number of concussions, headaches, or nausea, those in EMO were significantly more likely to endorse photo-sensitivity (p=0.003, F=10.155) and phono-sensitivity (p=0.007, F=8.108). Both anxiety and irritability/aggression were significantly (p<0.05) correlated with endorsement of attention difficulties (r=0.332, r=0.474, respectively). Family psychiatric history was not correlated with emotional difficulties post-concussion.

Conclusions

Results indicate that adolescents who self-report emotional difficulties following sports concussion are more likely to endorse some physical symptoms, particularly photo-sensitivity and phono-sensitivity. Those experiencing anxiety or irritability are also more likely to experience increased attentional difficulties.

Competing interests

None.
Experience with canada’s first school-based concussion policy, and overall evaluation using a modified delphi methods
Authors: Mylabathula Swapna , Charles Tator
Published: November 2017

Objective

Ontario is the first province in Canada to implement a school-based concussion policy, Policy/Program Memorandum (PPM) 158. It requires all public school boards to develop a concussion strategy. The aim of this research was to conduct a pilot assessment of PPM 158 implementation in one large school board, and then to develop a novel policy evaluation tool to evaluate how well all 72 school board concussion strategies align with best practices identified through a modified Delphi method.

Design

Descriptive.

Setting

Ontario public school boards (n=72).

Participants and main results

In the pilot assessing PPM 158 implementation, there were 39 respondents of 109 high school principals in the Toronto District School Board (TDSB). 92% of schools provided education to students in the TDSB, and fewer educated staff (85%) or parents (43.6%). Most schools had return-to-play protocols (92%) and fewer had return-to-learn protocols (77%).

Outcome measures

As a result of the pilot study, it was decided to develop the following outcome measures: stakeholder concussion education for staff, parents and students; mode of education; and existence of return-to-play and return-to-learn protocols. Policy evaluation will comprise the following: score achieved on the policy evaluation tool to be developed through a modified Delphi method, which reflects how each policy compares with best practices recommendations.

Conclusions

Significant progress has been made in developing school-based concussion in the single board assessed, but there are deficiencies in certain areas of implementation. This research has informed policies that target childhood concussions in Ontario and beyond.

Competing interests

None.
Brain network activation (bna) analysis as a biomarker for concussion assessment and management
Authors: Reches Amit , Kutcher Jeffrey , Elbin RJ , Or-ly Hadas , Greer Jacob , McAllister DJ , Kontos Anthony P
Published: November 2017

Objective

There is a need for objective biomarkers to help identify concussion, monitor recovery, and assist clinicians in managing patients. Brain network activation (BNA) analysis is a high-density, multi-channel mapping and analysis technology that uses a subject’s event-related potentials to describe cortical activity and functional connectivity. The current study describes BNA analysis in three patients who sustained a concussion.

Design

Case series.

Setting

Three primary concussion clinics in the USA.

Participants

Three subjects who sustained a concussion, ages 16 to 31 years, one male and two females.

Outcome measures

BNA score, a measure of the how similar the subject’s brain activity was to a normative population (0%=no similarity, 100%=complete similarity); Patient-reported symptoms.

Main results

In the acute time period following their concussion, each patient’s BNA score decreased to 10–20%, indicating little similarity to brain activity and connectivity of normative populations. The immediate reduction in BNA score during this time period was accompanied by concussion-related symptoms reported by each patient. In a longitudinal BNA analysis, the patients’ BNA scores returned to within a normal range between 23 and 30 days following concussion. In contrast, the recovery trajectory of patients’ symptoms varied, with one patient no longer reporting symptoms of concussion though the BNA score was still outside the normal range, while another patient continued to report symptoms of concussion after the BNA score returned to the normal range.

Conclusions

BNA analysis could provide a biomarker to augment current approaches to assessing and managing patients with concussion.

Competing interests

AR and HO are employed by ElMindA, the company that manufacturers the BNA technology.

APK acts as a consultant for ElMindA, the National Basketball Association, National Hockey League Players’ Association, National Football League Players’ Association, and US Ski and Snowboard Association.

JK, RJE, JG, and DJM None.
Increased symptom reporting in middle school athletes based on history of previous concussions
Authors: Scolaro Moser Rosemarie , Schatz Philip
Published: November 2017

Objective

Given findings of increased symptomatology in high school, college, and professional athletes with history of multiple concussions, we sought to identify incidence of symptom reporting at baseline, in middle-school youth athletes on the basis of concussion history.

Design

Pre-test only.

Participants

A multi-centre sample of 2,600 middle-school athletes, ages 10–14, who completed baseline evaluations, were assigned to groups on the basis of concussion history: None (N=1210), One (N=1191), Two or more (N=199).

Intervention

The Post-Concussion Symptom Scale (PCSS) was administered during athletes’ pre-season baseline evaluations. Cross-sectional analyses (ANOVAs) were used to examine symptoms reported at the time of baseline testing by concussion history group

Main results

Otherwise healthy middle school athletes with a concussion history were statistically (p<0.001) more likely to report symptoms of headache, light sensitivity, irritability, drowsiness, difficulty falling asleep, and sleeping less than usual, than middle school athletes with no history of concussion. Analysis of symptom clusters revealed increased endorsement of symptoms in physical and sleep clusters on the basis of concussion history (p<0.001), but not in cognitive or emotional clusters.

Conclusions

Developmentally, younger athletes may be less insightful in identifying their cognitive or emotional symptoms. Younger athletes who sustain multiple concussions may experience residual symptoms, which may be precursors to future concussion-related difficulties. These results raise poignant implications for: 1) symptom reporting in younger athletes, thus affecting research and clinical assessment, and 2) the possible impact of early concussion residuals on future functioning of college and professional athletes.

Competing interests

Dr. Schatz serves on the ImPACT Scientific Advisory Board.
Irritability and aggression in persistent youth concussions
Authors: Han Dong (Dan) Y , Combs Hannah L , Koehl Lisa , Camargo Fernanda C , Mattacola Carl G
Published: November 2017

Objective

To assess whether irritability and aggression are viable indicators of persistent post-concussive symptoms in adolescents.

Design

Group differences between those diagnosed with concussions were analysed using ANOVAs (p< 0.05).

Setting

Outpatient clinic.

Participants

46 concussed adolescents age 12–17 with persisting concussion symptoms were assessed. Athletes were split into two groups: those endorsing irritability/aggression (AGG, n=24) and a control group of those denying irritability/aggression (CON, n=22). Those with baseline psychiatric history and/or special education were excluded.

Assessment of risk factors

Post-concussive symptom variable relationships were assessed.

Outcome measures

group differences were analysed using ANOVAs.

Results

Adolescents endorsing irritability/aggression reported more fatigue (p=0.002), disordered sleep (p=0.001), anxiety(p=0.028), depression (p=0.003), and mood lability (p<0.001) during clinical assessment. Adolescents reporting more irritability also had elevated scores on related psychometric scales, including the Beck Youth Inventory-II Anxiety [t(41)=−2.916,p= 0.006], Depression [t(41)=−3.551,p= 0.001], and Anger Scales [t(41)=−2.958,p=0.005].

Conclusions

Results indicate that adolescents with self-reported irritability and aggression post-concussion were more likely to display more affective symptoms than those who did not endorse irritability and aggression following concussions. They were also more likely to complain of fatigue and disordered sleep. These findings suggest that change in level of irritability/aggression could potentially serve as an identifiable indicator for parents and coaches to recognise when an adolescent is not recovering well post-concussion.

Competing interests

None.
Knowledge, attitudes and practices in paediatricpediatric concussion: informing research, education and clinical care
Authors: Provvidenza Christine , Greenspoon Dayna , Fait Phil , Reed Nick
Published: November 2017

Objective

To assess knowledge, attitudes, and practices surrounding research, education and clinical care in paediatric concussion at One Voice: the 1st International Symposium on Paediatric Concussion.

Design

Quantitative, cross sectional, one-group survey design.

Setting

One Voice: the 1st International Symposium on Paediatric Concussion.

Participants

Sixty-two international paediatric concussion leaders representing a multi-stakeholder group.

Intervention

None.

Outcome measures

A survey was designed to assess self-reported knowledge, attitudes, and practices surrounding paediatric concussion research, education, and clinical care.

Main results

Participants identified knowledge gaps as an issue across different groups including athletes and coaches. Attitude towards concussion in the sport culture was recognised as a barrier to common issues such as under reporting and playing while symptomatic. Stakeholders also identified that healthcare professionals do not have adequate training to diagnose and manage paediatric concussion, and highlighted the need for additional knowledge and streamlined education to enhance clinical practices.

Conclusions

Knowledge, attitude and practice gaps in paediatric concussion exist across various stakeholder groups, leading to inconsistencies in concussion care and a lack of concussion recognition and reporting. Survey results align with outcomes identified in the literature. One Voice stakeholders underscored the value of education in enhancing knowledge, and its role in shifting attitude and optimising practices in paediatric concussion: identification, management and prevention. These outcomes will inform research, education and clinical initiatives to best meet the needs of the paediatric concussion community.

Competing interests

None.