bluuebunny/crossref_metadata_2025_split huggingface dataset:
A-04 One Size Fits None: Neurobiologic-Specific Modifications For The Assessment, Diagnosis, and Treatment of Sport-Related Concussion
Authors: Beebe K E , Reynolds E 
Published: June 2020

Abstract

Objective
The primary objective of this review paper is to introduce the underlying neurobiology of concussion symptoms, including relevant neuroanatomy, and to discuss these findings relative to the traditional homogenous model and a newer clinical profile model for sport-related concussion (SRC) assessment, conceptualization, and treatment.

Method
Empirical studies, meta-analyses, and consensus statements relevant to the assessment, conceptualization, and treatment of SRC were identified via systematic, but informal, procedures. This literature review focused on papers discussing the neuroanatomy and neurobiology of concussion symptoms and sequelae, as well as the exploration of new clinical treatment models for SRC.

Results
Exploration of the literature further supports the use of a clinical profiles-based SRC assessment and treatment protocol. Comparisons of traditional and new protocols show that a traditional assessment, conceptualization, and treatment model of SRC as a homogenous injury inadequately captures the individual injury experience and recovery trajectory.

Conclusions
This review confirms existing literature that the clinical profiles-based model best addresses the heterogeneous nature of sport-related concussion using a neurobiological and neuroanatomical approach to understanding SRC. Utilizing this model, clinicians can provide an individualized assessment, conceptualization, and treatment plan for SRC, leading to an improved clinical experience for athletes and better clinical outcomes.
A-09 Time to Unrestricted Participation Following Sport-Related Concussion in High School Athletes
Authors: Covassin T , Bretzin A , Beidler E , Wallace J 
Published: June 2020

Abstract

Objective
To measure time-to-unrestricted participation in high school athletes following a sport-related concussion (SRC) diagnosis.

Method
This was a descriptive epidemiological study using the Michigan High School Athletic Association (MHSAA) online Head Injury Reporting System (HIRS). This study included 10,411 (65.9%) male and 5,412 (34.1%) female SRC cases that occurred in 20 sports with greater than 30 SRC cases during the 2015–2016 to 2018–2019 academic years. The HIRS includes dates for SRC injury events and medical clearance for unrestricted return-to-participation for each case; dates were used to calculate recovery time. Kaplan-Meier time-to-event analysis identified crude proportions of athletes that had not obtained medical clearance in weekly increments (e.g., 7 days, 14 days, 21 days, 28 days, 35 days) across sports.

Results
The median time-to-unrestricted participation was 11 days. Overall, 71.8% of SRC cases took longer than 7 days to return, 29.6% of SRC cases took longer than 14 days, 13.1% of cases took longer than 21 days to return, and 6.5% took longer than 28 days to return to their respective sports. Results by sport show that over 25% of gymnasts took longer than 28 days to return-to-unrestricted participation, followed by competitive cheerleaders (15.5%), wrestlers (12.1%), and male divers (12.0%).

Conclusions
Almost one in three high school athletes with SRC took longer than 14 days to return-to-unrestricted participation. These results serve as proportional time estimates for return-to-unrestricted participation across a sample of 20 high school sports; and provide rationale to further evaluate recovery patterns in individual sport groups.
A-12 Differential Effects of Symptom Clusters at Baseline on Cognitive Performance
Authors: Datoc A , Issac L , Bennett R , Lashley L 
Published: June 2020

Abstract

Objective
The purpose of this study was to observe the effects of self-reported affective, sleep, and vestibular-somatic symptomatology on cognitive performance at baseline as measured by ImPACT.

Method
Participants were selected from a de-identified archival database of high school athletes aged 13–18. Symptom clusters included affective (N = 435, 61.7% female, Mage = 15.46), sleep (N = 435, 53.8% female, Mage = 15.49), and vestibular-somatic (N = 435, 52.2% male, Mage = 15.31). Three One-Way ANOVAs compared baseline composite scores between athletes who reported varying levels of symptomatology within each symptom cluster. Athletes were divided into groups based on their reported symptoms: None (n = 145), Mild (n = 145), and Moderate/Severe (n = 145). Significance was found at p = 0.01.

Results
No significant relationship between self-reported affective or sleep symptomatology and cognitive performance was observed. A significant relationship was shown between self-reported vestibular-somatic symptomatology regarding the Visual-Motor composite [F (2,432) = 5.925, p = .003]. Bonferroni pairwise comparisons revealed athletes with no reported vestibular-somatic symptoms performed significantly better on Visual-Motor tasks than those with Mild and Moderate/Severe symptoms.

Conclusions
These results may assist in the understanding of the influence of symptoms reported by athletes’ post-concussion. While those with varying levels of vestibular-somatic symptomatology were found to have significantly different performance on Visual-Motor tasks, this cluster of symptoms was not found to impact other domains of cognitive functioning. The influence of symptoms on cognitive performance likely varies between individual athletes, which can have implications on return-to-play decisions. This highlights the critical need for an individualized approach to be utilized when evaluating athletes post-concussion considering the current literature to date.
A-20 Do Children With LD and/or ADHD Differ at Baseline on a Pediatric Measure Used to Assess Concussion?
Authors: Friedman S , Moser R S , Schatz P 
Published: June 2020

Abstract

Objective
To examine differences at baseline between children with ADHD and/or LD vs. children with neither ADHD/LD on 1) neurocognitive scores and 2) child- and parent-reported concussion symptoms.

Method
Retrospective data was obtained for 1856 children ages 5–11 who were assessed at baseline using ImPACT Pediatric. Groups were determined based on parent-reported diagnosis of their child at baseline (ADHD and/or LD vs. neither ADHD/LD), and groups were compared on the four factor scores: Sequential Memory, Word Memory, Visual Memory, and Rapid Processing and on child- and parent-reported concussion symptoms using a series of ANOVAs.

Results
ANOVAs revealed that children with ADHD and/or LD performed significantly worse than children without ADHD/LD on Sequential Memory (F(1,1845) = 69.86, p &lt; .001)) and Word Memory (F(1,1853) = 10.36, p = .001)). In contrast, children with ADHD and/or LD performed significantly better on the neurocognitive measures of Visual Memory [(F(1,1845) = 4.94, p = .026)] and Rapid Processing [(F(1,1853) = 20.35, p &lt; .001). Symptom reporting was significantly greater in the ADHD and/or LD group for both child (F(1,1853) = 30.21, p &lt; .001) and parent (F(1,1853) = 34.64, p &lt; .001) reported symptoms.

Conclusions
The current study demonstrated differences at baseline in children on neurocognitive performance and concussion symptom reporting based on diagnostic group. Analysis of symptom reporting suggested that children with pre-existing diagnoses of ADHD and/or LD and their parents may report concussion-like symptoms at baseline, prior to ever experiencing a concussion. This finding has clinical implications for interpretation of post-concussion symptoms without a baseline comparison in children with pre-existing diagnoses such as ADHD and/or LD.
A-21 Relationship of the Vestibular-Ocular Reflex and Computerized Neurocognitive Testing Composite Scores
Authors: Hattrup N , Pardini J 
Published: June 2020

Abstract

Objective
The purpose of this study was to understand if the vestibular-ocular reflex is related to scores from a computerized neurocognitive exam.

Method
Data was obtained via IRB-approved retrospective chart review. 109 youth athletes (median age 13; 73.3% male) participated in a pre-season baseline assessment consisting of the gaze stabilization test (GST; a measure of vestibular-ocular reflex function) and the ImPACT computerized neurocognitive test (CNT). ImPACT composite scores and GST velocities in the leftward and rightward directions were evaluated. A spearman correlation was utilized to determine the relationship between variables (GST and CNT).

Results
No significant relationship existed between rightward and leftward velocities and any ImPACT composite (highest value; r = 0.20, p &gt; 0.05 for Right GST and Impulse Control).

Conclusions
There was no relationship between a measure of the vestibular-ocular reflex and CNT. Thus, the tests measure two distinct abilities that can be affected by sport-related concussion. Results indicate the importance of understanding pre- and post-injury function for both cognitive and vision function to guide clinical decision making.
A-24 Influence of Biopsychosocial Factors on First-Appointment Presentation After Sport Related Concussion (SRC)
Authors: Jennings S , Blaney N , Elbin R J , Womble M N , Collins M W , Kontos A P 
Published: June 2020

Abstract

Objective
To examine the influence of biopsychosocial factors on clinical outcomes and recovery time following SRC

Method
59 athletes with SRC (51% male) aged 14.42, SD= 1.65 years from two concussion specialty clinics between May 2019 and January 2020. Patients completed the Behavioral Regulation Assessment for Concussion (BRAC) inventory measuring sleep, diet, hydration, physical activity and stress; on a 4-point Likert scale, ImPACT, and PCSS. Analyses included one-way ANOVAs with Tukey’s post-hoc test and chi-square analyses.

Results
Verbal memory scores were higher F(3,55)= 2.85, p&lt;.05 in participants reporting 8-10hrs of sleep “most of the time” (M= 85.12, SD = 10.58) vs. “some of the time “ (M= 75.65, SD= 11.91). Verbal memory differed when engaged in stress regulation F(4,54)= 2.65, p&lt;.05; “MOT” (M=81.38, SD= 10.95); “SOT” (M=82.33, SD= 12.64) and “never” (M= 84.05, SD= 13.07). PCSS sleep factor scores increased when individuals obtained 8-10hrs of sleep “MOT” (M=.30, SD=.423) “SOT” (M= 1.40, SD= 1.54) and “seldom/rarely” (M= 1.95, SD= 1.58). PCSS somatic scores were associated with decreased sleep X2(1, N=57) = 37.68; p= .001, and hydration X2(1, N=57) = 60.70 p&lt; .001. Sleep and recovery time X2(1, N=55) = 120.82 p= .028.

Conclusions
Findings suggest that biopsychosocial factors including sleep, stress, and hydration are associated with symptoms, cognitive function, and recovery time following SRC and should be monitored by clinicians.
A-28 Updated Baselines Show Improvement, Even When Athletes Sustain A Concussion Between Assessments
Authors: O'Connor S , Dean T , Schatz P 
Published: June 2020

Abstract

Objective
To explore change across repeated baseline assessments using raw scores and percentile scores, for athletes sustaining and not sustaining a concussion between baselines.

Method
Athletes (12–23 years) completed two valid, baseline neurocognitive test sessions using ImPACT. Participants were divided into independent groups based on having sustained a concussion between annual baselines (CONCUSSION; N = 269) or no concussion (NO CONCUSSION; N = 270) between baselines. Raw change scores were calculated between the first and follow-up baseline for both groups by subtracting the first baseline score from the updated baseline score on the four ImPACT composite scores. Age- and gender-based percentile scores were then applied for all participants, and percentile change scores were calculated in the same manner. Raw change scores and percentile change scores between groups were compared using 4 ANOVAs with a Bonferroni-corrected p-value of (p &lt; .0125).

Results
Using raw scores ANOVAs revealed that athletes in the CONCUSSION group showed significantly greater improvement on follow-up testing than athletes in the NO CONCUSSION group on Verbal Memory (p &lt; .001) and Visual Motor Speed (p = .001), but not on Visual Memory (p = .41) and Reaction Time (p = .04). Using percentile ranks, ANOVAs revealed significantly greater improvement in CONCUSSION group on Verbal Memory (p &lt; .001), but not on Visual Memory (p = .34), Visual Motor Speed (p = .03), or Reaction Time (p = .014).

Conclusions
Athletes sustaining a concussion between annual baseline assessments show increases on Verbal Memory and Visual Motor Speed follow-up testing when using raw composite scores, but only on Verbal Memory when using age- and gender-based percentile ranks.
A-31 Association Between Cognitive Activity and Recovery Outcomes in College Students Following Concussion
Authors: Petit K M , Zynda A J , Anderson M , Tomczyk C P , Covassin T 
Published: June 2020

Abstract

Objective
To evaluate the relationship between self-reported cognitive activity and recovery outcomes (symptom reporting, recovery time) in college students following concussion.

Method
Cognitive activity was defined as self-reported minutes spent in class and studying during the first 5 days following concussion. Self-reported symptoms were reported at day 5 post-injury using the Post-Concussion Symptom Scale (PCSS). The PCSS evaluates 22 symptoms on a 7-point Likert Scale from 0 (none) to 6 (severe). Recovery time was defined as total days from injury to unrestricted medical clearance. Separate Spearman’s rank correlations assessed the relationship between total cognitive activity (minutes in class and studying) and recovery outcomes (symptom total (22), symptom severity (132), and recovery time). Alpha level set a priori at 0.05.

Results
Twenty-one participants (14 female, 7 male, 19.5 ± 1.3 years) averaged a total of 653[IQR = 348] minutes of cognitive activity during the first 5 days after concussion (334[IQR = 149] minutes in class, 273[IQR = 313] minutes studying). Five days after injury, participants self-reported 3[IQR = 8] total symptoms yielding a severity of 4[IQR = 12]. Participants took 15 [IQR = 8] days to reach unrestricted medical clearance. No associations were found between total cognitive load and any post-concussion recovery outcomes (symptom total: Rs = −.299, p = .19; symptom severity: Rs = −.230, p = .32; recovery time: Rs = −.041, p = .86).

Conclusions
Preliminary analyses suggest that concussed college students can be encouraged to gradually return to normal levels of cognitive activity, as it may not be associated with future symptom reporting or recovery time. Future research is needed to assess specific cognitive activities immediately influence on post-concussion symptom reporting.
A-37 Neuropsychological Functioning In Cognitively Normal And Impaired Aging NFL Retirees
Authors: Schaffet J , Didehbani N , LoBue C , Hart J , Cullum C M 
Published: June 2020

Abstract

Objective
Identify differences in neuropsychological (NP) functioning between older (≥ 50) National Football League (NFL) retirees and age-matched controls, and examine whether differences correlate to head-injury exposure.

Method
NFL retirees were diagnosed with normal cognition (n = 20), mild cognitive impairment (n = 19), or dementia (n = 5) using Jak and Bondi (2009) criteria and clinical consensus. Retirees were age-matched to either healthy controls (n = 18) or clinical controls with MCI (n = 21) or dementia (n = 5). MANCOVAs and partial correlations covarying for age and education compared retiree’s NP performances to controls, and examined whether differences in NP measures were correlated with number of concussions, or games and years played in the NFL.

Results
Cognitively normal (CN) retirees displayed lower processing speed, naming, and verbal memory (p’s &lt; .05) than CN controls. Impaired retirees displayed worse processing speed and naming than impaired controls, but better verbal memory (p’s &lt; .05). Only lower verbal memory performance in CN retirees significantly correlated with number of games (r = −.60) and years played (r = −.54).

Conclusions
Aging CN and impaired retirees performed worse on single measures of processing speed and naming, but their performances did not correlate to head-injury exposure. Verbal memory performance varied between CN (worse than controls) and impaired retirees (better than controls). Overall, results suggest some aging NFL players may be at risk for reduced verbal memory, but this relationship could diminish following onset of MCI. No clear dose-response relationship was observed between head-injury exposure and NP functioning. Future studies should examine longitudinal trajectories of NP performances in larger samples to elucidate these findings.
A-38 A Different Approach for Examining Gender Differences on Computerized Neurocognitive Testing: Percentile Ranks Versus Composite Scores
Authors: Schatz P , Slicer K , Elbin R J 
Published: June 2020

Abstract

Objective
ImPACT is a popular tool used to assess neurocognitive function after concussion. Age- and gender-based percentile ranks are provided as part of the ImPACT clinical report, but only raw composite scores are provided for research. Percentile ranks may provide an alternate look at gender differences on neurocognitive testing. We sought to compare the use of percentile ranks versus composite scores when comparing neurocognitive performance between male and females.

Method
Pre-season baseline data from 3,238 collegiate athletes were exported from a larger multi-site database, 1,714 male (53%) and 1,524 female (47%), ages 18–22 (Mean = 19.3, SD = 1.2). ImPACT composite scores were extracted (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time) and Percentile Ranks were calculated using age- and gender-based reference tables in the ImPACT 2017–2012 Technical Manual. One-way analyses of variance (ANOVA) were conducted with gender as the IV and the four composite scores and their associated percentile ranks as the DVs. Bonferroni correction for 8 comparisons set the alpha level to p &lt; .006.

Results
ANOVAs revealed a significant effect of gender on ImPACT Verbal Memory [F(1,3236) = 16.32, p &lt; .001], Visual Memory [F(1,3236) = 66.06, p &lt; .001], Visual Motor Speed [F(1,3236) = 15.61,p &lt; .001] but not Reaction Time [F(1,3236) = 2.59, p = .11]. When using percentile ranks, ANOVAs revealed a significant effect of gender on only Visual Motor Speed [F(1,3236) = 31.07, p &lt; .001], but not Verbal Memory [F(1,3236) = 2.43, p = .12], Visual Memory [F(1,3236) = 0.48, p = .49], or Reaction Time [F(1,3236) = 0.61, p = .44].

Conclusions
Use of ImPACT Composite Scores in concussion research may exaggerate or inappropriately promote gender differences on computerized neurocognitive testing. Given that age- and gender-based normative data are available, use of percentile ranks is recommended.
A-39 Vestibular And Ocular Motor Symptoms And Impairment Associated With Post-Concussion Anxiety
Authors: Shaffer M , Holland C L , Eagle S R , Collins M W , Kontos A P 
Published: June 2020

Abstract

Objective
The purpose of this study was to examine the relationship between vestibular and ocular motor symptoms, impairment and anxiety following sport-related concussion (SRC). Immediate post-injury assessments are predictive of symptoms and are prognostic for prolonged recovery. Although concussion is associated with increased likelihood of developing mental health issues, the relationship between post-concussion vestibular symptoms, impairment and anxiety is unknown.

Method
This study represented a sub-analysis of a randomized control-trial (RCT), conducted on a sample of 50 participants (40% male), aged 13–18 ([M] = 15.38, [SD] = 2.05) years within 7–21 days of a SRC between October 2018 and January 2020. Participants completed the Vestibular/Ocular Motor Screening (VOMS) and General Anxiety Disorder 7 (GAD-7) at initial visit, and 2 and 4 week follow-ups. Patients were categorized using GAD-7 scores as having mild, moderate or severe anxiety.

Results
Numerous positive correlations ranging from .28 to .52 among VOMS and GAD-7 scores were supported. The severe (99.6, 26.6) anxiety group scored highest on total VOMS followed by the moderate (76.5, 30.1), and mild (63.1, 45.9) anxiety groups (p = .006). Results of logistic regression indicated that total VOMS score was a significant predictor of GAD-7 generalized anxiety score (R = .389, r2 = .151 p = .001).

Conclusions
Higher scores on VOMS were associated with higher post-injury anxiety. Participants with higher VOMS scores following SRC may be at increased risk for developing anxiety symptoms. The current findings can help clinicians target concussion treatment to each specific patient based on their VOMS and GAD-7 scores in combination, rather than in isolation.
A-41 Exploring the Influence of Referral Source on State Anxiety Levels of Concussed Patients
Authors: Stephenson K , Womble M N , Elbin R J 
Published: June 2020

Abstract

Objective
To explore the influence of referral source on state anxiety in concussed athletes.

Method
One hundred thirty athletes (mean age = 16.46, SD = 1.93 yrs; 42% female) seeking care for a concussion at a specialty clinic within 30 days of injury (M = 8.83, SD = 6.12 days) were enrolled in the study. Demographic (e.g., age, sex, and history of anxiety) and referral source (e.g., emergency department/urgent care, primary care/pediatrician, and athletic trainer) information were collected, and the State-Trait Anxiety Inventory (STAI) was administered to all participants. A one-way analysis of variance (ANOVA) was conducted to compare STAI scores between referral groups, and a logistic regression (LR) was used to assess the relationship between referral sources and patients with and without clinical levels of state anxiety (STAI &gt; 40). Statistical significance for all analyses was (p &lt; .05).

Results
Approximately 25% (32/130) of patients reported a history of anxiety, and 46% (60/130) scored above clinical cutoffs for clinical anxiety. The referral groups did not differ on STAI scores (F(3, 130) = 1.12, p = .34), and the LR was not significant, (χ2(2, N = 130) = 3.75, p = 0.15).

Conclusions
History of anxiety was highly correlated with state anxiety at the first clinical visit; however, patients referred from different medical sources did not differ on clinical levels of anxiety at the first clinical visit following concussion.