bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exercise induced recurrence of concussion symptoms after symptom free status
Authors: O’Brien Michael J , Pepin Michael J , Howell David , Meehan William P 
Published: November 2017

ObjectiveDetermine the proportion of athletes who have a recurrence of concussion symptoms with exercise after being symptom free at rest.DesignProspective cohort studyProspective cohort studySettingSport Concussion clinicParticipantsPatients diagnosed with a concussion and returned to the clinic after resuming exercise.InterventionAssessment of risk factorsOutcome measuresOur main outcome variable was recurrence of symptoms with exercise after being symptom free at rest while recovering from a sport-related concussion. Co-factors included age, gender, loss of consciousness with injury, prior concussions (diagnosed and undiagnosed), post-concussion symptom scale (PCSS) score, time until clinical presentation, and duration of symptoms.Main ResultsOf the 217 patients included, 25 (12%) experienced a return of symptoms. Losing consciousness at the time of injury (aOR=0.079, 95%CI=0.003–0.563) and a longer time period between injury and clinic presentation (aOR=0.936, 95%CI=0.877–0.984) were associated with a decreased risk of symptoms recurring with exercise, while those athletes that had sustained previous undiagnosed concussions (aOR=5.036, 95%CI=1.634–16.83), and had suffered a longer duration of symptoms at rest (aOR=1.006, 95%CI=1.002–1.010) were at increased risk of symptoms recurrence with exercise.ConclusionsRelatively few athletes who are symptom free at rest after a concussion will have a recurrence of symptoms when they start exercising. The risk of symptoms recurring with exercise may be higher among those athletes who have sustained previous undiagnosed concussion and had a longer period of symptoms at re.Competing interestsNone.Dr. Meehan receives royalties from ABC-Clio publishing for the book, Kids, Sports, and Concussion: A guide for coaches and parents, from Springer International for the book, Head and Neck Injuries in Young Athletes, and from Wolters Kluwer for working as an author for UpToDate. He is under contract with ABC-Clio publishing for a future book entitled, Concussions. His research is funded, in part, by the Football Players Health Study at Harvard, which is funded by the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. Dr. O’Brien receives royalties from Wolters Kluwer for working as an author for UpToDate and from Springer International publishing for the book, Head and Neck Injuries in Young Athletes. Dr. Howell and Mr. Pepin have nothing to disclose.
Measuring cognitive-motor integration to detect prolonged performance declines post-concussion
Authors: Sergio Lauren E , Dalecki Marc , Hurtubise Johanna , Brown Jeffrey , Gorbet Diana , Hughes Cindy , Macpherson Alison 
Published: November 2017

ObjectiveThere is a higher risk of re-injury for athletes with concussion history when returning to play, despite being asymptomatic and cleared for activity. One possible explanation is that current return to play assessments test thinking and moving separately, but sport activities often require their concurrent processing (cognitive-motor integration, CMI). The aim of this research is to characterize CMI performance across a range of ages and skill levels following concussion. We hypothesize that there will be CMI impairment, even when cognition and motor action measured separately are deemed recovered, and that impairment level is affected by age and skill level.Methods133 participants with concussion history (mix of youth, adolescent, university, and elite athletes) and 130 no-concussion controls (age/sex/skill matched) performed two eye-hand coordination tasks. Participants displaced a cursor from a central to peripheral targets by either sliding their finger on a vertically-oriented touchscreen or with decoupled eye-hand coordination (targets/cursor viewed on vertical screen but finger slid on second horizontal touchscreen with 180° cursor feedback rotation).ResultsChildren, young adult, and elite athletes with concussion history all had CMI performance deficits in movement planning, timing and execution, despite being asymptomatic and returned to play. Younger and less skilled athletes were more impaired relative to older/elite performers.ConclusionsCognitive-motor integration tasks are successful in detecting performance post-concussion relative to established assessment tools that test these domains separately. We propose that testing CMI performance, a skill crucial in sport, is important to comprehensively assess function post-concussion and to prevent re-injury.Competing interestsNone.
Neurocognitive and somatic recovery curves following concussion in female interscholastic soccer players
Authors: Forbes Cameron , Glutting Joseph J , Kaminski Thomas W 
Published: November 2017

ObjectiveTo measure the acute effects of SRC on cognition and symptoms over a 7-day time course in interscholastic female soccer players.DesignProspective.SettingSoccer fields.Participants36 interscholastic female soccer players were equally divided into concussed [CON] (age 16.3±1.4 yr.) and non-concussed [NOCON] (age 16.1±1.3 yr.) groups.InterventionA 17-item SRC-symptom checklist was completed resulting in a total symptom score (SX). Neurocognitive performance [ANAM] throughput scores [higher scores better] (SRT1, SRT2, MSP, MTH, CPT1, CPT2, ST6) was also measured. The CON and NOCON were evaluated on five occasions: baseline, day 1 [D1], day 3 [D3], day 5 [D5], and day 7 [D7].Outcome measuresData from the 8 outcome variables were analysed using the multivariate approach to a repeated measures ANOVAMain resultsSignificant (p<0.05) deficits in throughput scores in the CON, including SRT1 (222.0 vs 200.3 – D7) and SRT2 (224.4 vs. 209.3 – D7), MSP (42.9 vs 38.8 – D7), and ST6 (83.8 vs. 75.1 – D5) as well as SX (9.1 vs. 12.8 – D5) existed across the 7 day recovery period. Differences between baseline and D1 existed for CPT and MTH scores but they surpassed the baseline on D3.ConclusionsCON subjects exhibited robust symptoms and neurocognitive deficits in the days immediately following SRC. Similar to American football, our recovery curves represent an initial decline with gradual improvements in the days succeeding post-injury and reinforce the need for clinicians to be cautious in the 7-day period post-concussion and depend on cognitive rest to aid recovery.Competing interestsNone.
Return to academic activities after concussion in sport
Authors: Guérin Fanny 
Published: November 2017

ObjectiveIdentify the impact of postconcussion symptoms, cognitive change and psychologicalreactions on academic activities.DesignRetrospective study on clinical evaluation and intervention; a prospective follow-up ofoutcome.SettingIn a sport neuropsychogical clinic in Montreal, Quebec.InterventionThe number and intensity of symptoms, the cognitivechanges (memory, attention), the psychological factors (anxiety, depression), and the delay after theconcussion are the independant variables.Outcome measuresThe capacity of following school part or full time is the dependant variable.Main resultsThe noise and light sensitivity, the lack of cognitive endurance during learning, theattentional deficits and the performance anxiety in reaction to the difficulty to recover and to follownormally school activities compromise the academic functionning and force the students to quit school.ConclusionsAccording to the results, a decision tool is created to help the evaluation and therecommandations of physician and neuropsychologist to individualise a return protocol to school.Competing interestsThe clinicial work of the author will be examined.
The association between moderate and vigorous physical activity and time to medical clearance to return to play following sport-related concussion in youth ice-hockey players
Authors: Lishchynsky Justin , Palacios-Derflinger Luz , Toomey Clodagh , Emery Carolyn , Yeates Keith , Meeuwisse Willem , Schneider Kathryn 
Published: November 2017

ObjectiveThe objective of this study was to determine if youth ice-hockey players who perform more moderate and vigorous physical activity (MVPA) during recovery take longer to achieve medical clearance to return to play (RTP).DesignCohort study.SettingSport Medicine Centre, Alberta, Canada.ParticipantsThirty youth ice-hockey players [25 males, 5 females, median age 14 years (range 12–17)] presenting to a sport medicine clinic within 4 days (range 2–20 days) of sustaining a sport-related concussion diagnosed by a sport medicine physician.ExposureParticipants MVPA during the first three days following their initial appointment was measured using a waist worn Actigraph accelerometer. MVPA was dichotomized into high (≥45 minutes) and low (<45 minutes) activity based on the median daily MVPA.OutcomeThe primary outcome was time (days) to medical clearance to RTP.ResultsAll thirty participants performed at least some MVPA over the first three days, despite physician instruction to initially rest following the concussion. Players performing low levels of MVPA reached medical clearance in a median of 15 days (range: 10–30 days). Players performing high levels of MVPA reached medical clearance in a median of 19 days (range: 12–55 days). The low level MVPA group reached medical clearance significantly sooner than the high activity group (log-rank chi2=5.27, p=0.02).ConclusionsMore time in MVPA during the first three days after initial assessment is significantly associated with greater time to medical clearance to RTP. Future research is needed to better understand the optimal amount and timing of MVPA for concussion recovery.Competing interestsNone.
Do measures of cervical, vestibulo-ocular function, balance and divided attention change over a year in youth ice hockey players?
Authors: Schneider Kathryn J , Palacios-Derflingher Luz , Shi Qian , Meeuwisse Willem H , Emery Carolyn A 
Published: November 2017

ObjectiveTo determine if preseason measures of cervical, vestibulo-ocular function, balance and divided attention change over one year in 10-12 year old ice hockey players.DesignProspective cohort studySettingSport Injury Prevention Research Centre, Alberta, CanadaParticipantsYouth Ice Hockey players (10-12 years old) who completed cervical, vestibular and divided attention tasks at a preseason assessment during two seasons of play.Outcome measuresNumeric pain rating scores (neck pain, headache, dizziness), cervical flexor endurance test (CFE), cervical flexion rotation test (CFRT), anterolateral cervical spine strength, head perturbation test, functional gait assessment (FGA), walking while talking test, head thrust test and dynamic visual acuity (DVA).Main resultsA total of 193 uninjured youth ice hockey players [95% males; median age 11 (range 10-12) in the first season] completed preseason testing measures in two consecutive seasons (2013-2015). After Bonferroni corrections (α=0.0042), using Wilcoxon Signed-Rank Test, anterolateral neck strength increased (right: z=−5.96, p<0.0001; left: z=−6.52, p<0.0001), head perturbation test improved (z=4.40, p<0.0001), walking while dividing attention improved (z=6.41, p<0.0001) and there were more positive head thrust tests (chi2=13.64, p=0.0034) in the second year. There was no evidence of a difference in symptom reports, CFE, CFRT, DVA and FGA between the two testing sessions.ConclusionsSymptom reports did not differ between two years of play. However, tests of clinical function were different between two seasons of play in youth ice hockey players. These data suggest that developmental and/or maturational changes should be taking into consideration when interpreting these tests in youth.Competing interestsNone.
Does concussion history and post-injury sleep quantity influence neurocognitive scores following concussion in collegiate athletes?
Authors: Hoffman NL , Weber ML , Schmidt JD 
Published: November 2017

ObjectiveTo determine if concussion history and post-concussion sleep quantity changes influence neurocognitive performance following concussion in collegiate athletes. It was hypothesised that athletes with a concussion history or shorter sleep duration following concussion would have poorer neurocognitive performance compared to athletes without a concussion history or greater sleep durationDesignProspective cohort.SettingClinical Research Laboratory.ParticipantsTwenty-eight collegiate athletes (21 males and 7 females: age=20.2 ± 1.7 years, height=182.2 ± 11.9 cm, mass=90.3 ± 24.2 kg) without history of: headaches or migraines, substances/alcohol abuse, and/or psychiatric conditions.InterventionParticipants completed a preseason baseline and post-injury (PI) evaluation (1 day PI) using Immediate Post-Concussion Assessment and Cognitive TestingOutcome measuresSleep change was calculated by subtracting post-injury sleep duration from baseline sleep duration. Athletes were categorised into either shorter sleep (<-1 hour change) or longer/same sleep (≥−1 hour change) groups. Independent samples t-tests were conducted to compare neurocognitive composite scores (verbal memory, visual memory, visual motor speed, reaction time, impulse control) between concussion history and sleep quantity change groups (α=0.05)Main resultsAthletes with a concussion history had a faster reaction time (RT) (history:0.57±0.06 sec, no history:0.63±0.10 sec; p=0.048), but were more impulsive (history:8.55±5.87 errors, no history:4.18±3.89 errors; p=0.045) compared to those without a history of concussions. Neurocognitive performance did not differ between sleep quantity change groups.ConclusionsAthletes with a concussion history may be quicker to respond to neurocognitive tasks, but commit greater number of errors. Post-concussion sleep quantity changes do not influence neurocognitive performance one day post-injury. Future research should consider effects of concussion history on RT and impulse assessments.Competing interestsNone.
Evaluation of physical examination elements in the diagnosis and prognosis of sports related concussion in adolescent athletes
Authors: Willer Barry , Baker John , Hinds Andrea , Miecznikowski Jeff , Czuczman Natalie , Lesh Kevin , Leddy John 
Published: November 2017

ObjectiveTo evaluate a brief physical examination (PE) for diagnosis and prognosis of sport-related concussion (SRC) in adolescents.DesignProspective.SettingUniversityConcussion clinics.Subjects53 adolescents with SRC (mean age 15.4; 70% male) and 30 uninjured controls (mean age 15.8; 73% male).InterventionsParticipants received a brief PE (11 PE elements in three systems: cervical, oculomotor and vestibular). Concussed adolescents were assessed acutely (mean 4.5 days post-injury) and at follow up (mean 18.5 days).Outcome measuresDependent variables 1: Concussion versus uninjured and 2: Standard versus slow recovery (>3 weeks). Recovery was defined as asymptomatic and exercise tolerant.ResultsTable 1 shows the significant PE variables that distinguished concussed from uninjured (via Fisher’s exact test; significance p<0.05).Abstract 136 Table 1PE elements (Visit 1) with 95% CI for Odds ratio and p-valueElementCIpNeck tenderness(1.92, Inf)0.00321Smooth Pursuits(5.70, 786.21)<0.00001Convergence(1.10, 9.44)0.03475Abnormal saccades(3.34, 466.65)0.00009VOR(2.46, Inf)0.00144VOR Dizzy(3.67, Inf)0.00015Tandem gait(1.98, 291.60)0.00191Table 2 shows the significant PE variables distinguishing standard recovery from slow recovery at visit 2 (via Fisher’s exact test; significance p<0.05).Abstract 136 Table 2PE variables (Visit 2) with 95% CI for Odds ratio and p-valueNeck spasm(1.13, Inf)0.04148Smooth pursuits(2.26, 127.15)0.00298Convergence(2.08, 53.74)0.00319Tandem gait(2.91, 773.79)0.00105ConclusionsEasily administered physical exam reveals clinical findings that are important and sensitive for diagnosing acute concussion. Prognosis was less precise due to the heterogeneity of aetiology of slow recovery.Competing interestsNo competing interests for any authors.
Investigation of knowledge and attitude about concussion diagnosis and management among family medicine residents
Authors: Mann Aneet , Mann Aneet , Tator Charles H , Carson James D 
Published: November 2017

ObjectiveTo assess knowledge, attitude and learning needs about concussion among family medicine residentsDesignA web-based prospective surveySettingToronto, Canada.ParticipantsFamily medicine residents at the University of Toronto.InterventionA link to the survey was disseminated via e-mail by the Department of Family and Community Medicine post-graduate office at the University of Toronto. Data collection occurred over 5 weeks from January to March 2015 with reminder emails sent out to all 348 family medicine residents at 2 weeks and 4 weeks of the study period.Outcome measuresSurvey answers to assess knowledge and attitude about concussion.Main resultsThe residents who responded (n=73/348, response rate 21%) scored an average of 5.2 correct answers out of 9 (57.8%) questions regarding the diagnosis and management of concussion. Seventy-one percent of residents who responded did not recognise chronic traumatic encephalopathy and only 63% recognised second impact syndrome as consequences of repetitive concussions. Moreover, 32% of residents did not think that “every concussed individual should see a physician” as part of management.ConclusionsWe found significant gaps in knowledge surrounding concussion diagnosis and management among family medicine residents. This lack of knowledge should be addressed at both the undergraduate medical education and residency training levels to improve concussion-related care and patient outcomes.Competing interestsNone.
Psychophysiological stress in athletes across concussion recovery milestones
Authors: Mainwaring Lynda , Senthinathan Arrani , Hutchison Michael , Thomas Scott , Richards Doug , Churchill Nathan 
Published: November 2017

BackgroundPsychophysiological stress markers across concussion recovery milestones have not been examined in an integrated study.ObjectiveTo examine physiological (heart rate variability [HRV] and salivary cortisol) and psychological (mood, perceived stress, symptoms, and sleep quality) factors of stress in concussed athletes across clinical recovery milestones.DesignA prospective case control repeated measures study was conducted over three clinical recovery milestones: Symptomatic (acute), Asymptomatic, and 1-week Post Return-to-Play (RTP).SettingSingle university athlete program monitored by the university’s sport medicine clinic, Ontario, Canada.ParticipantsMale and female varsity athletes (n=26; M=16, F=10) with medically diagnosed concussion and their matched controls (n=26; M=16, F=10).Outcome measuresPhysiological: HRV and salivary cortisol; psychological: mood, perceived stress, sleep quality and symptoms.Main resultsUnivariate analyses identified a group by sex interaction for specific HRV measures (RR intervals p=0.0084, Low frequency Power p=0.0084, Mean Heart Rate p=.0049, and Low/High Frequency Ratio p=0.0084). Multivariate analyses of HRV identified main effects for sex and group, and a significant interaction with reduced HF HRV for female concussed athletes through to 1-week post RTP (FDR=.05). HRV suppression was related to mood disturbance in males (FDR.05). Psychological measures were significantly worse for concussed athletes relative to controls at the Symptomatic Phase, but significantly better at 1-week post RTP (paired Wilcoxon at FDR=.05).Funding disclosureThis study was supported by a grant from the Canadian Institute of Health Research (CIHR) −2012-ABI-CAT1-971 to L. Mainwaring.ConclusionsFor both males and females, mood disturbance, symptoms, and sleep quality perturbations were resolved by 1-week post RTP whereas autonomic nervous system disruption persisted beyond RTP in females. Psychophysiological non-invasive markers show promise for concussion monitoring.Competing interestsNone.
The world rugby pitch side concussion assessment (psca) phase 2 study: a prospective cohort study investigating the diagnosis of concussion in elite adult rugby union
Authors: DECQ Philippe , Gault Nathalie , Fuller Gordon , Kemp Simon PT 
Published: November 2017

ObjectiveRugby Union, in common with other elite sports, has developed systems to identify, evaluate and treat players sustaining sports related concussions. This study examines the clinical progress of players following head impact events and investigates which components of the clinical assessment influence a final diagnosis of concussion.DesignProspective cohort study using logistic regression modelling to determine the predictive value of components of clinical assessments in influencing a final diagnosis of concussion.SettingPhase 2 of the World Rugby PSCA study between September 2013 and May 2014ParticipantsConsecutive players sustaining head impact events with the potential for concussion during ten national and international elite adult Rugby Union competitionsInterventionParticipants underwent 3 standardised clinical assessments: Initial pitch-side screening; early 3 hours post-match SCAT 3 assessment; and late diagnostic assessment after 2 nights with symptom evaluation and a neuro-cognitive assessment tool.Outcome measuresDiagnosis of concussion determined at the last clinical assessment.Main resultsDuring the 8 months study period 229 players participated in the PSCA process. 130 (56.7%) players were diagnosed with concussion. The 3 hours post-match number of reported symptoms and Standardised Assessment of Concussion (SAC), and the presence of symptoms at 2 nights post injury were independently associated with a final diagnosis of concussion (p<0.05). Other clinical assessments provided no additional prognostic information.ConclusionsThe number of symptoms reported and SAC post-match were factors independently associated with a final diagnosis of concussion. Balance tests and severity of post-match symptoms did not appear to provide any additional information in the diagnosis of concussion.Competing interestsNone.
Comparison of spiral versus block curriculum styles in preparing medical students to diagnose and manage concussions
Authors: Wright Alexander D , Fraser Sarah K , Smirl Jonathan D , Donkelaar Paul van 
Published: November 2017

ObjectiveExamine differences between the recently implemented integrated spiral (year 1) and conventional block (years 2-4) MD curriculum at University of British Columbia (UBC) with respect to knowledge of concussion diagnosis and management.DesignCross-sectional surveySettingUBC undergraduate MD programParticipantsAn online survey was distributed to all 1152 students currently enrolled in UBC medical school. To date, 123 surveys have been returned (10.7% response rate) with 58 first year students (integrated spiral curriculum) and 65 students in years 2-4 (conventional block curriculum). Females made up 60% of responses.InterventionsOnline survey, hosted by FluidSurveys (Fluidware, Ottawa, ON), distributed through email.Outcome measuresQuestions focused on demographic data, knowledge of concussion definitions, and management considerations.Main resultsMajority of responses revealed both curriculums have promoted a strong understanding of concussion definition and related symptoms (84% correct response rate). Only 8.1% of participants believed that functional imaging (MRI or CT) is a mandatory assessment tool for concussions. Differences between the conventional and integrated curriculums included: understanding concussions can occur without direct impact to the head (91.4% integrated vs. 69.2% conventional: χ2(1)=43.325, p<0.001) and identifying long-term consequences of repetitive concussive injuries (dementia: 91.4% integrated vs. 66.2% conventional; death or severe disability with second impact syndrome: 77.6% integrated vs. 55.4% conventional).ConclusionsThe findings from this study reveal a number of positive signs regarding the evolution of medical education in terms of concussion diagnosis and management. The integrated curriculum is taking further steps in advancing concussion knowledge in medical education.Competing interestsNone.