bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sport-related concussion physician’s chart review – 2011–2016
Authors: D Carson James , A Kraft Sari , Kuwahara Nariko , Cheung Lovisa , Mansoora Qurat-ul-Ain , Safwan Aliya , Jegatheesan Vijitha , Mubarik Mariam , Kirloss Mena , Chiu Julie , Moineddin Rahim , Fremont Pierre 
Published: November 2017

ObjectiveTo determine what proportion of patients experience an exacerbation of their symptoms as a result of premature return to play (RTP) and return to learn (RTL) following a sport-related concussion (SRC).DesignRetrospective longitudinal chart review.SettingA sport medicine physician’s office in Ontario, Canada.Participants266 cases related to 251 students with an SRC.InterventionsA review of 266 electronic medical records (charts) of patients seen for SRC over a five-year period (2011–2016). Two blinded authors independently reviewed each chart and SCAT2 or SCAT3/Child SCAT3 symptom self report form. In situations where there was discrepancy between the two reviewers’ results, a third author reviewed the charts.Outcome measuresremature RTP and RTL were defined as chart records documenting the recurrence or worsening of symptoms that accompanied the patients’ RTP or RTL.Main Results403 cases were identified as concussion patients assessed. 266 were included as these cases were related to 251 students involved in a sport activity. Premature return to sport and to school were observed in 67 (25.19%) and 107 (40.23%) of the cases, respectively.ConclusionsIn our comparable study ending 5 years prior, premature return to sport and to school were observed in 43.5% and 44.7% of the cases, respectively. Despite changing our medical advice, based upon evolving expert recommendations on return to learn (RTL) after an SRC, premature RTL is still quite common. Efforts are needed to find the best method of implementing a coordinated plan for the post-concussion athlete who is returning to school.Competing interestsNone.
When is it time to start rehab? exploring the optimal timing to initiate active rehabilitation for concussion management in children and adolescents
Authors: Gagnon Isabelle , Dobney CAT (C) Danielle M. , MSc PT Lisa Grilli , Kocilowicz Helen , Beaulieu Christine , Straub Meghan , Friedman Debbie 
Published: November 2017

ObjectiveEstimate the influence of time to initiation of active rehabilitation on post-concussion symptom (PCS) severity in youth who are slow to recover from concussion.DesignRetrospective analysis of a prospective cohortSettingConcussion clinic of a tertiary care Paediatric Trauma Centre in Canada.Participants569 youth (14.3±2.3 years) with persistent PCS. Clinic patients’ information is entered prospectively in a clinical database and participants were selected for this study if they 1) participated in the active rehabilitation program, and 2) had available PCS assessments at the intake and follow-up visits.InterventionActive rehabilitation consisting of: aerobic exercise, coordination exercises and, education/motivation. The intervention was initiated with a Physical Therapist in the Concussion clinic continued as a daily home program. The independent variable was time to initiation of the active rehabilitation program measured in weeks (2, 3, 4, 5, 6+).Outcome measureSymptom severity measured by the PCS scale of the SCAT3 at follow-up visit, 2 weeks after initiation of intervention.Main results: Patients initiating active rehabilitation 2 weeks post-injury were significantly less symptomatic at follow-up (Mdn PCS score=5) compared to those starting five (Mdn=17) and six weeks or more (Mdn=17.5) (p=0.0002). Those starting at 3 (Mdn=9) and 4 (Mdn=10) weeks also had significantly less severe symptoms compared to those starting 6 weeks or later (p<0.05).ConclusionsThe findings suggest that children benefit more from active rehabilitation if it is initiated between two and four weeks post-injury, and have poorer outcomes if it is delayed beyond 6 weeks post-injury.Competing interestsNone.
Test-retest reliability of the kinarm end-point robot for assessment of sensory, motor and neurocognitive function in athletes
Authors: W Benson Brian , Cosh Madeline , S Mang Cameron , H Scott Stephen , Debert Chantel , Dukelow Sean 
Published: November 2017

ObjectiveTo determine the reliability of the KINARM robot in assessing sensorimotor and neurocognitive function in athletes.DesignTest-retest reliability.SettingSport Medicine Clinic.ParticipantsThirty-nine randomly selected athletes (mean age: 18±3 years) over 2011–2012 and 2014–2015 seasons.Outcome measuresSixty-three parameters from five robotic tasks (Visually Guided Reaching, Position Matching, Object Hit, Object Hit and Avoid, and Trail Making B) characterising sensorimotor and neurocognitive function. Each athlete was tested three times, with an average of 43±27 days between baseline (BL) and first retest (R1), and 306±32 days between R1 and second retest (R2). Reliability was assessed by intra-class correlation coefficients (ICCs) between BL and R1, and R1 and R2. Change in task performance between assessments was also evaluated with multivariate analysis of variance (MANOVA) and post-hoc comparisons within specific task parameters.Main resultsICCs ranged from −0.03 to 0.94 and −0.52 to 0.93 for BL to R1 and R1 to R2, respectively. ICCs were moderate to high (≥0.5) for 46 of 63 parameters (68%) from BL to R1, and 48 of 63 parameters (76%) from R1 to R2. MANOVAs and post-hoc comparisons indicated improvements in performance on 12/63 parameters (19%) between BL and R1, and changes in performance on 11/63 parameters (17%) between BL and R2. No significant changes were revealed in parameter performance between R1 and R2 sessions.ConclusionsOverall, results suggest moderate to good test-retest reliability for the majority of KINARM robot task parameters in measuring baseline sensorimotor and neurocognitive function in 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.Stephen H Scott Co-founder and CSO of BKIN Technologies that commercialises the KINARM robot.
Valid but invalid: suboptimal impact© baseline performance in university athletes
Authors: Walton Samuel , Broshek Donna , Freeman Jason , Cullum Munro C , Resch Jacob E 
Published: November 2017

ObjectiveTo investigate the frequency of valid yet suboptimal ImPACT© performance in college athletes.DesignDescriptive.SettingResearch Laboratory.ParticipantsDivision 1 University athletes (n=769) from 22 different sports.InterventionThe Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to participants per the institution’s concussion management protocol at baseline in groups <2. Participants who scored <16th percentile compared to ImPACT normative data on any neurocognitive index (potentially suggesting suboptimal effort) were re-administered ImPACT up to two additional times.Outcome measuresDescriptive analyses were used to examine validity indicators and individual Verbal and Visual Memory, Visual Motor Speed and Reaction Time ImPACT composite scores in initial and subsequent administrations.Main resultsBased on ImPACT’s validity criteria, 1% (9/769) of administrations were invalid and 14.6% (112/769) had one or more composite scores <16th percentile but were considered valid. After one re-administration 71.4% (80/112) achieved scores >16th percentile and an additional 18/32 scored >16th percentile after a third administration.ConclusionsApproximately 16% of ImPACT records were flagged as invalid or had one or more composite scores <16th percentile, potentially indicative of suboptimal performance. Upon readministration, 88% of those participants scored >16th percentile. Clinicians must be aware of suboptimal ImPACT performance as it limits the clinical utility of the baseline assessment. Further research is needed to address factors leading to “valid” but invalid baseline performance.Competing interestsNone.
A comparison of healthcare professional and school personnel perceptions and familiarity of academic adjustments for concussed adolescents
Authors: Welch Bacon Cailee E , Register-Mihalik Johna K , Kasamatsu Tricia M , Valovich McLeod Tamara C 
Published: November 2017

ObjectiveTo compare healthcare professionals (HCPs) and school personnel (SP) perceptions of and familiarity with academic adjustments for adolescents following a concussion.DesignCross-sectional.SettingSelf-reported online survey.Subjects4,376 participants (1,095 males, 2,003 females, 1,278 missing sex; 2,209 HCPs, 2,156 SP; age=47.5 ± 14.8) from a convenience sample of 51,507 individuals (8.5% response rate) completed theBeliefs, Attitudes, and Knowledge of Paediatric Athletes with Concussions(BAKPAC) survey.Outcome measuresThe independent variable was role (2 levels: HCP, SP). The dependent variables were participants’ responses to the survey items. Mann WhitneyUtests (P<0.05) were used to determine group differences.ResultsBoth HCPs and SP agreed that concussions can affect school performance (3.7/4.0±0.9;P=0.08) and that concussed adolescents are eligible for consideration under the Americans with Disabilities Act (3.0/4.0±1.0;P=0.81). 57.3% of HCPs and 57.0% of SP reported that they have managed a concussed adolescent who experienced decreased school performance, while 61.0% of HCPs and 57.5% of SP noted concussed adolescents received academic adjustments. Familiarity with individualised education plans (IEPs;P≤.001) and 504-plans (P≤.001) differed among groups. SP were moderately to extremely familiar with IEPs (3.5/4.0±0.71) and 504-plans (3.3/4.0±0.91), while HCPs were only minimally to moderately familiar (IEP: 2.8/4.0±1.2; 504-plans: 2.6/4.0±1.4).ConclusionsHCPs and SP must collaborate to ensure proper concussion management for concussed adolescents. These results suggest the need for targeted education for HCPs and SP concerning academic adjustments to promote a safe return-to-learn.Competing interestsNone.
Early vestibular and visual dysfunction predicts prolonged symptomatology following paediatricpediatric concussion
Authors: Master Christina L , Grady Matthew F , Storey Eileen , Podolak Olivia , Lockyer Julia , Wiebe Douglas 
Published: November 2017

ObjectiveVestibular and visual dysfunction, including accommodation disorder, symptoms with vestibular ocular reflex (VOR) testing, or receded near point of convergence, are common following concussion and have been associated with prolonged concussion symptomatology. The objective of this study was to determine whether vestibular and visual information contributed significantly to a model predicting the likelihood of having persistent concussion symptoms at 28 days after injury.DesignRetrospective cohort studySettingSports medicine concussion program within a large regional paediatric healthcare network.Participants274 consecutive patients aged 3-18 years with the diagnosis of concussion seen in the concussion programIndependent VariablesStandard demographic and clinical data, as well as vestibular and visual examination findings at presentationOutcome measuresSymptom recovery from concussion, defined as a symptom score=0 on the Post Concussion Symptom Scale at 28 daysMain resultsStudy subjects were 3–18 years (median=14), presenting a median of 14 days from injury. Applying a stepwise regression approach using traditional demographic and clinical variables (age, gender, past medical history, symptoms and balance testing) as well as information from vestibular and visual testing, we found that VOR testing is a statistically significant component (p=0.02) of the final predictive model. Furthermore, in the subset of patients presenting within 14 days of injury, positive VOR testing (p=0.02) and vision problems (p=0.01) significantly contribute to predicting ongoing symptoms at 28 days.ConclusionsSymptoms with VOR testing and vision problems upon presentation within 14 days of injury contributed significantly to the prediction model for prolonged symptoms following concussion and warrant further study.Competing interestsNone.
Education in action: evaluating kids concussion infographics
Authors: Provvidenza Christine , Carmichael Jason , Reed Nick 
Published: November 2017

ObjectiveTo assess the impact of infographics on enhancing concussion knowledge and their effectiveness as a knowledge translation (KT) strategy.DesignProspective, post-survey design to assess a KT strategy.SettingCommunity and hospital based education events.ParticipantsIndividuals across various stakeholder groups were invited to provide feedback on six infographics. Data (N=106) was collected from youth (52%) and adults (48%), representing five stakeholder groups: athletes, students, teachers, healthcare trainees and healthcare professionals.InterventionSix infographics were created to provide salient information about concussion for a multi-stakeholder audience.Outcome measuresA survey was designed to gather information about the value and utility of the infographics as a KT strategy and to determine additional knowledge needs.Main resultsNinety percent of participants identified that the infographics met their knowledge needs, and 84% of participants indicated that the infographics gave them new knowledge related to sleep, myths and facts, and signs and symptoms. Participants indicated that they intend to use the infographics to build knowledge (91%), educate others (52%), and cope with concussion (26%). Feedback provided about the infographic format was positive, and suggestions for future topics were offered.ConclusionsInfographics are a potentially effective KT strategy that meets knowledge needs and appeals to many different audiences. Participants identified that they want to learn more about areas including concussion recovery and management. Data collection is ongoing and continues to inform the value of infographics as a KT strategy. This study is part of a broader education initiative to optimise paediatric concussion knowledge.Competing interestsNone.
The association between psychological distress and concussion history in college athletes
Authors: Combs Patricia R , Wasserman Erin B , Rodrigo Corey J , Guskiewicz Kevin G , Mihalik Jason P 
Published: November 2017

ObjectiveTo examine how baseline measures of psychological distress, including depression, anxiety, and somatization, in college athletes are affected by concussion history.DesignCross-sectional study.SettingA National Collegiate Athletic Association Division I university.SubjectsDivision I college athletes (age=20.6±1.4 years) with a self-reported history of 1 or more concussions (n=128; 52 (41%) females; 76 (59%) males) and with no self-reported concussion history (n=286; 100 (35%) females; 186 (65%) males). An additional 67 student-athletes were excluded due to incomplete demographic information.InterventionAthletes self-reported concussion history on a questionnaire completed during pre-season baseline testing.Outcome measuresAll participants completed the Brief Symptom Inventory18 (BSI-18) during the same pre-season baseline assessment.ResultsThere were no significant differences in total BSI-18 scores (P=0.47) between participants with a concussion history (median BSI-18 score=0, IQR=0–2) and those with no concussion history (median BSI-18 score=0, IQR=0–3). Additionally, there were no significant differences found between groups for any BSI-18 subset score (Depression:P=0.99; Anxiety:P=0.53, Somatization:P=0.07).ConclusionsA history of 1 or more concussions does not influence baseline psychological distress measures in college athletes. While associations between concussion history and increased risk of clinical depression in retired professional athletes have been reported, our data do not support this association at the college level. Our results may underscore the need to develop more sensitive questionnaires to assess psychological distress among otherwise young healthy emerging adults. Future research should explore more diverse samples, and explore the utility of psychological distress measures during post-injury recovery.Competing interestsNone.
Predicting protracted recovery in professional rugby union: what can the symptoms, signs and modifiers of concussion tell us?
Authors: Matthew Cross , Stokes Keith , Kemp Simon , Smith Andy , Trewartha Grant 
Published: November 2017

ObjectiveTo investigate the association between the signs, symptoms and modifiers of concussion and protracted recovery in professional Rugby Union players.DesignProspective cohort.SettingThe English Premiership (the highest level of competition in England).Participants810 professional Rugby Union players over two seasons (2012/13 and 2013/14). 150 players reported 181 concussions for which 100 provided data for this analysis (80 concussions had insufficient follow up and 1 player left the study).Independent variablesSymptoms were grouped into 4 domains (head, cognitive, sleep and neuropsychological) previously demonstrated to have adequate internal consistency (Pardini et al., Brit J Sports Med: 38, 661–662, 2004). Symptom burden and standardised assessment of concussion (SAC) scores alongside signs and modifiers (amnesia, loss of consciousness, previous concussion history and balance error score) were also reported.Dependent VariableTime (days) to return to play (RTP). Protracted recovery was defined as >14 days.Main resultsEighteen percent of players did not RTP within 14 days. Higher symptom burden (OR 1.17, 95% CI 1.01–1.31) and higher balance error scores (OR 1.33, 95% CI 1.06–1.66) were associated with protracted recovery. A higher number of self-reported ‘head cluster’ symptoms were associated with a shorter (<14 days) recovery time (OR 0.90, 95% CI: 0.82–0.98).ConclusionsClinicians should pay particular attention to higher symptom burden and balance error scores as part of a multimodal assessment to aid early identification of protracted recovery. The association between balance and protracted recovery suggests that targeted rehabilitation programs to improve the vestibular system warrant further investigation.Competing interestsDr. Matthew Cross – Employed by the Rugby Football Union who part funded the PhD (stipend and fees) that this study was part ofDr. Keith Stokes – Receives research funding from the Rugby Football UnionDr. Simon Kemp – Employed by the Rugby Football UnionDr. Andy Smith – Employed by Premiership Rugby who part funded the PhD (stipend and fees) that this study was part ofDr. Grant Trewartha – Receives research funding from the Rugby Football Union
The association betweencatechol o-methyltransferase (comt) rs4680 polymorphism, harm avoidance scores, and concussion history in rugby union players
Authors: Fie Sarah MC , Abrahams Shameemah , Patricios Jon , Suter Jason , Posthumus Michael , September Alison V 
Published: November 2017

ObjectiveTo investigate the relationship between personality traits andCatechol O-methyltransferase (COMT)rs4680 genotypewith concussion history in rugby players.DesignCase-control study.SettingHigh school, amateur, and professional rugby teams in South Africa.ParticipantsParticipants were excluded if they reported a previous brain-related medical condition or a non rugby-related concussion, or were not of European ancestry. Three hundred and one participants were included in the study. Based on self-reported concussion history (30 suspected concussion cases were excluded), participants were grouped into the control (non-concussed, n=140) or case group (one or more diagnosed concussions, n=131).Assessment of risk factorsParticipants completed a concussion history questionnaire, Cloninger’s Tridimensional Personality Questionnaire (TPQ) and all DNA samples were genotyped forCOMTrs4680. Logistic regression, co-varying for age, was used to determine differences in genotype frequencies. A one-way analysis of variance was used to compare TPQ dimension (novelty seeking, harm avoidance, and reward dependence) scores.Outcome measuresCOMTrs4680 genotype frequencies and TPQ scores.Main resultsTheCOMTrs4680 VV genotype was overrepresented in the controlgroup when all participants were combined (p=0.030, OR: 1.89, 95% CI: 1.05 – 3.45; control: 31%, cases: 18%) and whenonly school participants were analysed (p=0.009, OR: 3.23, 95% CI: 1.27 – 8.33; control:37%, cases:15%). Furthermore, the schoolcontrol group had higher harm avoidance scores compared to cases (p=0.004), andthe VV genotype was associated with increased harm avoidance subscale 1 scores (p=0.023).ConclusionsThis study provides preliminary indication that personality traits, and associated genetic variants, can influence concussion in rugby.Competing interestsNone.
White matter integrity and its relationship to cognitive-motor integration in females with post-concussion syndrome
Authors: Hurtubise Johanna , Gorbet Diana , Hughes Cindy , Macpherson Alison , Sergio Lauren 
Published: November 2017

ObjectiveCognitive-motor integration (CMI) is required in sport when performing movements where a rule is used to align the required motor output and the guiding visual information. Previous research has shown CMI declines in young athletes with a concussion history, deemed recovered at the time of evaluation. The purpose of this study was to characterise differences in symptoms, CMI, and white matter integrity (fractional anisotropy, FA) in those with post-concussion syndrome (PCS) and healthy controls. We hypothesised that those with PCS would have decreased FA and CMI performance, with increased symptom scores.ParticipantsTwelve females were included; 6 with PCS for 6 months or more, and 6 age-matched healthy controls with no concussion history.MethodsParticipants were administered the SCAT3, four visuomotor CMI tasks, and diffusion weighted images were acquired. Participants displaced a cursor from a central target to peripheral targets by sliding their finger on a horizontally placed tablet either directly to the viewed target or with decoupled eye-hand coordination (targets viewed on a vertical monitor, 180° feedback rotation, or both).ResultsWe observed worse symptom scores and impaired performance in CMI tasks, as well as decreased mean FA in bilateral corticospinal tracts beneath the premotor and primary motor cortices and in the white matter underlying the right superior parietal lobule, in those with PCS compared to healthy controls.ConclusionsCMI decline may be related to decreased FA within the frontal-parietal-subcortical network. Measuring CMI, a skill crucial to athletes, provides an effective behavioural means for detection of brain alterations associated with concussion.Competing interestsNone.