bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of computerised dynamic posturography for the assessment of the sensory integration after a head trauma
Authors: Karin Mani , Mario Bizzini , Cornelia Meier , Alfred Müller , Dominik Straumann , Nina Feddermann 
Published: November 2017

ObjectiveApart from headache dizziness, vertigo or visual problems are common symptoms after a head trauma. Making an adequate diagnose of the symptoms remains challenging and only a few laboratory tests exist. The computerised sensory organisation test (SOT) differentiates the sensory integration between somatosensory, vision, vestibular and visual preference and therefore helps to objectify symptoms.Designconsecutive case series.Settingrehabilitation centre.Participants29 consecutive post injury symptomatic and asymptomatic athletes with a diagnosed concussion (n=24) or combined injury (concussion plus commotio/contusio labyrinthi (n=5)).InterventionsAll athletes performed a post injury SOT on the computerised dynamic posturograph (Smart Equitest, 6 conditions). The sensory scores (somatosensory, vestibular and vision) were compared to the normative data (n=112).Outcome measuresThe main aim was to determine the sensory source of post-concussive symptoms by application of the sensory analysis after performance of the SOT.Main resultsHalf of the athletes (n=15) achieved a normal sensory score, the other half (n=14) were below average (−9.4%) in visual (n=2), vestibular system (n=5) or both (n=7). In these athletes an individual specific vestibulo-oculomotor therapy was recommended.ConclusionsThe computerised SOT is a useful tool to determine the specific sensory deficits in patients with or without symptoms after a head trauma.Competing interestsNone.
Advances in wearable impact sensors for monitoring and reducing brain injury risks due to cumulative head impact trauma in athletic and military environments
Authors: Ralston John , Thibado Jason , Woodard Jonathan 
Published: November 2017

ObjectiveAssess utility of wearable impact sensors to monitor and reduce cumulative brain injury risks in athletic and military environments.DesignAnalysis of results generated in multiple laboratory and on-field cohort studies.SettingYouth, college, and professional football, rugby, soccer, lacrosse, boxing; military training exercises.ParticipantsParticipants across multiple activities were monitored for head impacts using wearable sensors.InterventionParticipants suffering a concussion underwent neurocognitive testing and entered a supervised return-to-play protocol.Outcome measuresThe influence of sensor design and data processing on the accuracy and reproducibility of head impact data have been assessed. Differences in head impact incidence and severity have been compared between training regimes that did/did not implement behavioural modifications based on sensor data. Head impact data have been combined with finite element modelling and high resolution MRI/DSI imaging to study spatial distribution of tissue damage and changes in neural connectivity.Main resultsReduced size and weight skin-affixed sensors worn on the mastoid provide a stable and universally applicable solution for head impact monitoring. Behavioural modifications using these devices have reduced high risk head impacts by 30%−70%. Significant localised tissue damage and changes in neural connectivity are predicted and observed even in the absence of clinically diagnosed concussion symptoms.ConclusionsWearable impact sensors are enabling significant reductions in head injury risks and incidence in athletic and military environments. These devices show promise as neuro-trauma dosimeters that can assist in monitoring cumulative brain damage due to repetitive sub-concussive head impacts, and developing more comprehensive and personalised remove-from-play thresholds.Competing interestsX2 Biosystems designs and manufactures wearable impact sensors
Concussions in international ice hockey championships and olympic winter games between 2006 and 2015
Authors: Tuominen Markku , Hänninen Timo , Parkkari Jari , Stuart Michael J , Luoto Teemu M , Kannus Pekka , Aubry Mark 
Published: November 2017

ObjectiveTo describe the occurrence and trend of concussions during the international ice hockey tournaments.DesignRegister study.SettingThe International Ice Hockey Federation (IIHF) World Championships (WC) and Olympic Winter Games (OWG).ParticipantsA total of 3293 games were played in the 169 tournaments by 1212 teams (26130 players) comprising 142244 athletic game exposures.Outcome measuresOne hundred and sixty concussions were observed.Main resultsThe average injury rate (IR) for concussion was 1.1 per 1000 ice hockey player-games for all IIHF WC tournaments. The injury rate was highest in men’s WC A-pool tournaments and OWG (IR 1.6) and lowest in women’s WC and OWG (IR 0.9). However, the annual injury rate for concussion in men’s tournament has been lower than that in World Junior tournaments since 2012. When a concussion occurred with contact on a flexible board the IR was 0.2 per 1,000 player games while the number was 1.1 if the board and glass were traditional [RR for the latter: 6.4 (95% CI 1.50 – 27.61]. In men’s tournaments, the trend of concussions caused by illegal hits decreased over the study period. After the 2012 Zurich Consensus Guidelines none of the concussed players in men’s WC returned to play during the same day.ConclusionsThe risk of concussion was significantly lower if games were played on rinks with flexible board and glass. Between 2006 and 2015, the annual risk of concussion in men’s WC has been decreasing because of the decreasing number of concussions caused by illegal hits.Competing interestsNone
Innovative behaviourbehavior modification strategies to reduce concussion risk in high school american football athletes
Authors: Wasserman Erin B , Mihalik Jason P , Campbell Kody R , Combs Patricia , Fraser Melissa A , Grand Erin , Nocera Maryalice , Register-Mihalik Johna K , Guskiewicz Kevin M , Marshall Stephen W 
Published: November 2017

ObjectiveTo improve tackling and blocking techniques to reduce concussion in high school American football players, and to evaluate the program’s feasibility and acceptance.DesignClustered quasi-experimental study.SettingHigh schools.ParticipantsVarsity American high school football players on three teams (two intervention; one control).InterventionsAll players wore in-helmet head impact accelerometers. “High-risk” intervention team players were selected and attended clinician-coach-player mentoring sessions designed to change playing technique. Accelerometer data were used for “high-risk” selection and during mentoring sessions to reinforce the technique-driven intervention.Outcome measuresThe change in top-of-head impacts and impacts with peak linear acceleration>60 g was compared between intervention and control subjects using linear risk models. Coaches and players completed post-season exit surveys.Main resultsNinety-seven players (70 intervention; 27 control) participated. Thirteen (19%) intervention players were identified as “high risk” and received mentoring. The mentored players’ high magnitude impacts (percent>60 g) in practices dropped 1.9 percent from pre-intervention to post-intervention. There was no change in non-mentored players. In post-season surveys, mentored players “strongly agreed” (56%) or “agreed” (44%) that the study improved their playing behaviours. Among intervention team coaches, three (43%) thought the study was “very effective” in changing football player behaviours about safe play, and the remaining four (57%) thought it was “effective.”ConclusionsThere is growing concern head impact frequency and severity may result in neurological issues for some athletes later in life. If head impact frequency and severity can be reduced through behavioural intervention, this can have a great public health impact.Competing interestsThis study is funded by a grant from the National Centre for Injury Prevention and Control (Grant #R49CE002479).
Quantification of postural control deficits in patients with recent concussion: an inertial-sensor based approach
Authors: Doherty Cailbhe , Caulfield Brian , Ryan John , Komaba Yusuke , Inomata Akihiro , Zhao Liang 
Published: November 2017

ObjectiveTo quantify postural control ability in a group with concussion compared with a ‘healthy’ control group.DesignCase-control study.SettingUniversity Biomechanics Laboratory.ParticipantsFifteen concussion patients (4 females, 11 males) and a group of fifteen age- and sex- matched controls. Participants were excluded if they had any: lower extremity injury that may affect gait; history of cognitive deficiencies; history of ≥3 previous concussions; loss of consciousness following the concussion for >1 minute; a previously documented concussion in the previous yearIndependent variableGroup; Task (3 stance variants of the Balance Error Scoring System [BESS])Outcome measuresSway area as computed using a force-plate and sway volume as computed from an accelerometer placed on the sacrum during performance of the BESS.Main resultsConcussed patients exhibited increased sway area (1500 mm2[95% CI: 900 to 2000 mm2] vs 650 mm2[95% CI: 520 to 780 mm2] p=0.02) and sway volume (9.5 m3s–6[95%CI: 8 to 20 m3s–6] vs 2.80 m3s–6[95% CI: 1.8 to 3.6 m3s–6]) in the bilateral stance position of the BESS. The sway volume metric also had excellent accuracy in identifying task ‘errors’ (tandem stance: 95% CI: 80–96%, p<0.001; unilateral stance: 95% CI: 85–95%, p<0.001).ConclusionsIndividuals with concussion display increased postural sway during bilateral stance. The sway volume that was calculated from the accelerometer data not only differentiated a group with concussion from a healthy control group, but successfully identified when task errors had occurred. This may be of value in the development of a pitch-side assessment system for concussion.Competing interestsNone.
Age and sport are associated with higher odds of playing through a concussion and delayed removal from play
Authors: Zuckerman Scott L , Kuhn Andrew W , Yengo-Kahn Aaron M , Kerr Zachary Y , Totten Doug J , Solomon Gary S , Sills Allen K 
Published: November 2017

ObjectiveTo elucidate situational factors and individual characteristics related to playing through a sport-related concussion (SRC) and delayed removal from play.DesignRetrospective cross-sectional analysis.SettingA single comprehensive sports-concussion centre.Participants250 middle school, high school, and collegiate athletes who sustained an SRC and presented to a regional concussion center between 2011 and 2015.InterventionStandardised in-depth phone interviews.Outcome measuresGender, race, age, competition level, sport, concussion history, practice/game, and collision awareness, among other variables, were incorporated into a multivariate regression model to determine if any of these variable could significantly predict the likelihood of playing through a sport-related concussion versus immediate removal from play.Main resultsAge (p=0.047) and sport (p=0.006) were both significantly associated with playing through a concussion. For every additional year of age, the odds of playing through an SRC decreased by 1.32 [95% CI: 1.00–1.72]. Football players were much more likely to attempt to “play through” a concussion when compared to baseball/softball, basketball, cheerleading, lacrosse, rugby and volleyball athletes (OR 5.41 [95% CI: 1.62–18.2] to 71.4 [95% CI: 4.93–1,000] times the odds of playing through an SRC for various sports, with all differences reaching statistical significance).ConclusionsYounger age and certain sports (football) were significantly associated with delayed removal from play after a SRC in middle school, high school, and collegiate athletes. Given these results, sports medicine practitioners may be better able to identify situational and individual characteristics of athletes who may be more likely play through a SRC.Competing interestsGS Solomon receives consulting fees from the Tennessee Titans (NFL), the Nashville Predators (NHL), and the athletic departments of several universities, all fees paid to institution. In addition he is a member of the ImPACT Scientific Advisory Board, and receives reimbursement for expenses to board meetings. AK Sills is a consulting physician to the Nashville Predators (uncompensated) and also serves as an unaffiliated neurotrauma consultant for the NFL. SL Zuckerman, AW Kuhn, AM Yengo-Kahn, ZY Kerr, DJ Totten, report no conflicts of interest.
Blue card: referees’ perspectives of a rugby union concussion recognition and management programme
Authors: Sullivan John , Collins Kyal , Grey Andrew , Handcock Phil 
Published: November 2017

ObjectiveThe Northland (New Zealand) Rugby Union developed an innovative concussion recognition and management programme (Blue Card) as part of its player welfare responsibilities for club (community) players. The referee is empowered to issue a Blue Card (BC) to any player they suspect of being concussed, thus removing them from the game. The purpose of this descriptive study was to investigate the referees’ perspectives on having this added responsibility, and whether this detracted from their enjoyment of refereeing.DesignCross-sectional survey.SettingNorthland Rugby Union headquartersParticipantsTwenty-one amateur male referees who officiated in club-level rugby matches covered by the Northland Rugby Union Blue (NRUBC) programme during the 2014 season volunteered to participate.Outcome measuresCustom-designed survey instrument using both open and closed questions.Main resultsThe referees had between 2 and 35 (mean=12.1) seasons of refereeing experience with 81% (17/21) claiming a good or average knowledge of concussion. The majority (20/21) reported that they had sufficient training for their expanded role. Two thirds (14/21) of the respondents did not think that the additional responsibility impacted on their refereeing satisfaction. Over the season nine (9) BCs were issued by 7 of the participating referees, with 5 indicating that they were “very confident” in their decision.ConclusionsThe referees indicated that they were well prepared to handle the added responsibility as on-field concussion gatekeepers, and this role did not detract from their enjoyment of refereeing the game. Additional insight into how the NRUBC programme is received by players, teammates and their families, needs investigation.Competing interestsS.J Sullivan, A Gray and P Handcock: None.K Collins was involved in the development of the Northland Blue Card Programme but was not involved in the data analysis.None.
Concussion diagnosis: the king-devick test in the canadian football league
Authors: J Naidu Dhiren , Mrazik Martin 
Published: November 2017

ObjectiveTo conduct a sensitivity analysis of the King-Devick (K-D) test in professional football.DesignProspective cohort.SettingProfessional football.Participants:269 professional football players from the Canadian Football League (CFL). There were 24 concussions to analyse.InterventionThe K-D test was added to the existing CFL concussion protocol (medical and SCAT3). All participants completed K-D assessments at baseline, at the time of injury/concussion (TOI), and at medical clearance prior to return to play (RTP). 20 controls were re-tested post-baseline.Outcome measuresK-D scores were analysed to construct a sensitivity analysis.Main resultsTOI K-D results were significantly higher (mean=50.21, range: 35.4–107.4) than baseline K-D results (mean=44.3, range 28.4–66.4; p<0.01). TOI K-D results yielded 94% sensitivity and 80% specificity for diagnosing concussions. Four groups emerged from the TOI data. In Group 1, 4/4 were asymptomatic within 24 hours and scores were better (lower) than baseline; Group 2 were asymptomatic within 72 hours and 8/9 had abnormal (poorer) scores; Group 3 were asymptomatic within 11 days and 5/5 had abnormal scores. Group 4 were symptomatic by season’s end and 4/4 had abnormal scores. 18/18 players who RTP had better K-D scores than baseline prior to RTP.ConclusionsThe K-D test proved to be useful for concussion diagnosis. Interestingly, the players in Group 1 had normal TOI K-D scores and were asymptomatic in <24 hours. More research is needed and the CFL will continue this next season.Competing interestsNone.
Receded near point of convergence and gait are associated after concussion
Authors: Howell David R , O’Brien Michael J , Raghuram Aparna , Shah Ankoor S , Meehan William P 
Published: November 2017

ObjectiveTo examine post-concussion gait among patients with and without receded near point of convergence (NPC) and uninjured controls.DesignProspective observational study.SettingRegional sport-concussion clinic.ParticipantsThirty-one patients presented 10.1 [95% CI=8.1, 12.1] days post-concussion (57% female, age=16.5 [15.4, 17.7]); 38 controls were tested (55% female, age=15.5 [13.6, 17.4]). Participants completed symptom, NPC, and single/dual-task gait assessments. Exclusion criteria were a current lower extremity injury or diagnosed learning disability.InterventionThe effect of group (receded NPC, normal NPC, control) and task (single/dual) were evaluated via ANOVA. NPC and gait correlations were calculated.Outcome measuresNPC was the patient-reported diplopia point while a fixation target moved toward the nose. Receded NPC was >5 cm from the tip of the nose. Three inertial sensors quantified gait; variables included average gait speed, cadence, and stride length.ResultsNineteen concussion patients presented with receded NPC, 12 did not. Symptom severity was not significantly different between groups (27.1 [18.6, 35.6] vs. 26.3 [17.1, 35.5]). Those with receded NPC exhibited slower average gait speed (1.02 [0.93, 1.11] m/s vs. 1.19 [1.14, 1.24] m/s, p<0.001) and shorter stride lengths (1.11 [1.05, 1.18] m vs. 1.27 [1.23, 1.31] m, p=0.001) than controls. Near NPC and single-task gait speed were moderately correlated (ρ=−0.54, p= 0.002).ConclusionsAdolescents with receded NPC post-concussion exhibited significant gait-related alterations compared to healthy controls; those with normal NPC did not. Vergence and gross motor system dysfunction may be interrelated following concussion and may provide useful information to post-concussion evaluations.Competing interestsDr. Meehan receives royalties from ABC-Clio publishing for the sale of his book, Kids, Sports, and Concussion: A guide for coaches and parents, and royalties from Wolters Kluwer for working as an author for UpToDate. He is under contract with ABC-Clio publishing for a future book entitled, Concussions, and with Springer International publishing for a future book entitled, Head and Neck Injuries in Young Athletes. His research is funded, in part, by a grant from 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. He is under contract with Springer International publishing for a book entitled, Head and Neck Injuries in Young Athletes. Drs. Howell, Shah, and Raghuram have no conflicts of interest to report.
Recognition and knowledge of on-field management of concussion amongst english professional, semi-professional and amateur rugby union referees
Authors: Gallagher Tom , Mias Ed , Kipps Courtney 
Published: November 2017

Objectiveto investigate the knowledge and practice of Rugby Union referees regarding the recognition and management of concussion in English professional and semi-professional rugby.Designemail survey questionnaire.SettingEnglish Rugby Union Premiership, Championship and National Leagues.ParticipantsAll 180 actively practicing referees in England in the Premiership, Championship and National Leagues.Outcome measuresActual and perceived knowledge of concussion, and subjective confidence in diagnosing concussion.Main results22 referees with an average age 34.77 years (Range 26-49 SD 6.13) and returned surveys. The referees’ level of officiating ranged from Premiership (Level 1) to regional games (Level 8) with the highest proportion of referees officiating at Level 1 (31.80%). A high percentage of referees recognised functional disturbances including loss of balance (90%), slurred speech (73%), dizziness (95%) and blurred vision (100%) as signs of concussion. 59.09% rated their knowledge of concussion as average and 18.18%% good or excellent. Overall, 72% of referees felt they could subjectively diagnose concussion, the professional referees were more confident in diagnosing a concussion versus the amateur referees.ConclusionsReferees generally have a good knowledge of concussion and its management although 54.54% have had no previous education. The majority wanted to learn more on the subject (90.90%) but the methods which they are currently using to learn are varied and not standardised. Practical group sessions (59.09%) and online resources (45.45%) were recognised as the most popular method of learning. Further education regarding recognition and on-field management of concussion is recommended for rugby union referees. Future studies should focus on participant information retention after using such resources as HeadCase.Competing interestsNone.
Acute rest does not predict symptom recovery in collegiate student athletes
Authors: Buckley Thomas A , Munkasy Barry A , Clouse Brandy P , Evans Kelsey M 
Published: November 2017

ObjectiveTo assess the effect of acute cognitive and physical activity level and sleep on concussion recovery.DesignProspective.Setting:College sports medicine.Participants:Forty-one college student athletes (51.2% Female; Age: 19.6 + 1.2 years) diagnosed with sports-related concussions.InterventionsThe independent variables were the participant’s self-reported physical and cognitive activity levels (1–5 based on Majerske) and the number of hours slept the first two days post-concussion.Outcome measuresThe dependent variables were the number of days until the participant 1) self-report asymptomatic and 2) had full return-to-participation which required achieving baseline values on balance, cognitive, neuropsychological testing and completing a progressive return to activity protocol. The independent variables (activity levels and sleep) were used as predictors of recovery with a linear regression.Main resultsThe participants were asymptomatic 4.7 + 2.8 (95% CI: 3.8–5.5) days and returned-to-participation 13.0 + 4.2 (95% CI: 11.8–14.3) days post-concussion. Participants reported a mean 7.8 + 1.9 hours of sleep per night and low physical (1.4 + 0.7) and cognitive (2.7 + 1.4) activity levels. There were no significant correlations and the overall model did not predict days until asymptomatic (F=1.224, P=0.315) or return-to-participation time (F=0.036, P=0.991). None of the independent variables were significant predictors.ConclusionsThe activity levels and reported sleep in the first two days post-concussion did not predict recovery time. This finding is consistent with emerging literature suggesting acutely restricting activity may not improve concussion recovery time. Future studies should utilise sleep logs and objectively measure activity levels.Competing interestsNone.