bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

ObjectiveTo evaluate differences in biomechanics between young adult participants with and without a history of concussion during a jump cut manoeuvre.DesignCase controlSettingLaboratorySubjects7 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).InterventionParticipants 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 measuresPeak knee flexion, abduction, and axial rotationResultsConcussed 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].ConclusionsThere 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 interestsThis 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

ObjectiveTo 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).DesignDouble-blind, prospective case series.SettingFour athletic seasons (2011–2015).Participants1,214 elite athletes (904 males, 310 females, mean age: 18 and 20 years, respectively).Outcome measuresFifty-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 results95 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).ConclusionsResults of this large prospective study suggest the KINARM robot is a valid, objective tool for quantifying sensorimotor and neurocognitive impairment in concussed athletes.Competing interestsBrian 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

ObjectiveIdentifying risk factors is important in adolescent sports concussions. This study aimed to explore the relationship between affective symptoms and physical symptoms in youth concussions.DesignAthletes 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.SettingOutpatient clinic.Participants37 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 factorsPost-concussive symptom variable relationships were assessed.Outcome measuresgroup differences were analysed using ANOVAs.ResultsNo 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.ConclusionsResults 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 interestsNone.
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

ObjectiveOntario 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.DesignDescriptive.SettingOntario public school boards (n=72).Participants and main resultsIn 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 measuresAs 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.ConclusionsSignificant 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 interestsNone.
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

ObjectiveThere 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.DesignCase series.SettingThree primary concussion clinics in the USA.ParticipantsThree subjects who sustained a concussion, ages 16 to 31 years, one male and two females.Outcome measuresBNA 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 resultsIn 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.ConclusionsBNA analysis could provide a biomarker to augment current approaches to assessing and managing patients with concussion.Competing interestsAR 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

ObjectiveGiven 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.DesignPre-test only.ParticipantsA 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).InterventionThe 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 groupMain resultsOtherwise 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.ConclusionsDevelopmentally, 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 interestsDr. 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

ObjectiveTo assess whether irritability and aggression are viable indicators of persistent post-concussive symptoms in adolescents.DesignGroup differences between those diagnosed with concussions were analysed using ANOVAs (p< 0.05).SettingOutpatient clinic.Participants46 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 factorsPost-concussive symptom variable relationships were assessed.Outcome measuresgroup differences were analysed using ANOVAs.ResultsAdolescents 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].ConclusionsResults 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 interestsNone.
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

ObjectiveTo assess knowledge, attitudes, and practices surrounding research, education and clinical care in paediatric concussion at One Voice: the 1st International Symposium on Paediatric Concussion.DesignQuantitative, cross sectional, one-group survey design.SettingOne Voice: the 1st International Symposium on Paediatric Concussion.ParticipantsSixty-two international paediatric concussion leaders representing a multi-stakeholder group.InterventionNone.Outcome measuresA survey was designed to assess self-reported knowledge, attitudes, and practices surrounding paediatric concussion research, education, and clinical care.Main resultsParticipants 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.ConclusionsKnowledge, 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 interestsNone.
One voice: the 1st international symposium on paediatricpediatric concussion
Authors: Provvidenza Christine , Greenspoon Dayna , McFarland Stephanie , Hickling Andrea , Fait Phil , Reed Nick 
Published: November 2017

ObjectiveOne Voice: the 1st International Symposium on Paediatric Concussionis a knowledge sharing event dedicated to translating research generated by the paediatric concussion community. The objective of this study was to evaluate the effectiveness of pre-symposium webinars and collaborative workshops as part of the symposium.DesignQuantitative, cross sectional, one-group survey designSettingPaediatric rehabilitation hospital.ParticipantsSixty international paediatric concussion leaders representing various stakeholder groups.InterventionKnowledge sharing webinars and action plan development through facilitated workshopsOutcome measuresSurveys were designed to assess: the effectiveness of the webinars as a knowledge sharing strategy; and the experiences of the stakeholders participating in action planning workshops.ResultsParticipants found the webinars to be effective in highlighting international research (93%) and education initiatives (91%). There was agreement that the symposium provided participants with the opportunity to engage (97%) and network (96%) with others, as well as co-create an action plan (95%) with three strategic directions: 1) connecting kids to care; 2) moving facts forward; and 3) driving big change.ConclusionsOne Voice was developed to support the paediatric concussion community to best help children with concussion do the things they want, need and love to do. One Voice enabled the development of a collaborative international action plan in paediatric concussion. Findings will inform the development and delivery of future symposia and action planning events specific to paediatric concussion to meet the needs of this population. Moving the strategic directions forward will help guide the future of paediatric concussion care globally.Competing interestsNone.
Perception and practice of prescribed rest following concussion in primary and secondary schools
Authors: Taylor Alex M , Blackwell Laura S , Robinson Anna F , Proctor Mark R 
Published: November 2017

ObjectiveThe purpose of our study was to characterise return-to-learn practices following concussion in primary and secondary schools, particularly with regard to prescribed cognitive rest.DesignCross-sectional survey.SettingMassachusetts.ParticipantsNine hundred member of the Massachusetts School Nurse Research Network (MASNRN) employed full or part-time at a public, private, or charter school serving pre-school through the 12th grade.Outcome measuresPrescribed rest (actual) versus perceived benefit of rest.Main resultsA majority of respondents expressed the opinion that more prolonged cognitive rest benefits recovery, with 53.6% endorsing 4–10 days as beneficial compared to 44.3% endorsing 3 days or less. Only 2.1% felt no benefit to cognitive rest following concussion. The average number of medically advised rest (actual) was equal for older and younger students (4.5 days). School nurses perceived less benefit to prolonged cognitive rest (>4 days) for high school students relative to students in elementary school [2 (4, n=97)=11.05, p<0.05], but provided academic accommodations to high school students for comparatively longer periods of time (10–14 days vs. 6–10 days) [F(2,89)=4.74, p=0.011].ConclusionsCounter to the practice of administering accommodations for fewer days in younger students, school nurses perceived greater benefit to shorter periods of cognitive rest (3 days or less) for older children (high school age) relative to elementary school and middle school children. In all settings, schools rest is overprescribed in light of recent finding indicating that prolonged rest (beyond two to three days) may delay recovery.Competing interestsNone.
Tracking developmental trajectories on neurocognitive testing in young athletes ages 5–12
Authors: Schatz Philip , Ferris Charles 
Published: November 2017

ObjectiveDespite increased attention to sports-related concussion, there is a lack of research on younger athletes. The purpose of this study was to establish developmental trajectories on neurocognitive testing in younger athletes ages 5 to 12.DesignPre-Test Only Design.SettingMulti-site study from numerous locations in the Eastern USA and Canada.ParticipantsA total of 788 youth athletes, 73% male, assigned to groups on the basis of age: Ages 5–6 (N=128), Ages 7–8 (N=282), Ages 9–10 (N=284), Ages 11–12 (N=94).InterventionAn iPad-based Paediatric version of the ImPACT test was administered individually to participants in a quiet office setting.Outcome measuresAccuracy scores were documented on: Word List Learning (Immediate, Delayed, Recognition); and accuracy and timing scores on Design Rotation, Choice Reaction Time, Visual Sequencing and Visual Memory.Main resultsOne-way ANOVAs with Bonferroni correction for multiple comparisons, and Scheffé post-hoc comparisons were conducted between age groups on the dependent measures. All measures showed statistically significant changes (p< 0.001) across the developmental age groups, with better performance in older participants and lower performance in younger participants.ConclusionsYouth athletes between the ages of 5 and 12 are underrepresented with respect to age-appropriate assessment measures, and these results document the need for developmentally- and age-appropriate measures and normative data, in order to capture neurocognitive change across developmental stages.Competing interestsDr. Schatz serves on the ImPACT Scientific Advisory Board.None.
Vestibular and vision deficits following concussion in children under 12
Authors: Master Christina L , Curry Allison E , Kessler Ronni , Pfeiffer Melissa R , Grady Matthew F , Robinson Roni , Arbogast Kristy B 
Published: November 2017

ObjectiveVestibular and oculomotor visual (VOM) deficits are emerging as key characteristics of youth concussion. However, since most studies of paediatric concussion focus on adolescents, little is known about the extent to which younger children experience this deficit. To address this gap, we used an electronic health record (EHR) system across a large paediatric healthcare network to quantify the presence of VOM deficits following concussion in patients under age 12.DesignDescriptive epidemiology.SettingData were collected from all primary (n=31) and relevant specialty care (n=4) network settings.ParticipantsWe identified all patients aged 5–11 years who had ≥1 clinical visit for concussion at a network primary or specialty care site from 7/1/2014 through 6/30/2015. We included the 82% of these patients for whom a concussion electronic clinical decision support tool within the EHR was used during their initial visit.Outcome measuresThe proportion who demonstrated each VOM deficit – balance, saccades, gaze stability, and convergence – was calculated among all who were assessed for that deficit.Main results871 patients were included (median [IQR]: 10 [8, 11] years). On physical examination, 58% had at least one VOM deficit. 44% had balance abnormalities, 39% had saccadic dysfunction, 28% had deficits in gaze stability, and 10% convergence insufficiency.ConclusionsIn this sample, vestibular oculomotor visual deficits following concussion in young children were common. Improved recognition of the deficits will lead to timely diagnosis and appropriate management, including school accommodations for oculomotor visual challenges and vestibular therapy for motion sensitivity issues.Competing interestsNone.KB, Arbogast serves as a consultant to the National Football League Players Association on head injury topics.