bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concussed elite athletes have better tandem gait performance
Authors: Nabhan Dustin , Walden Taylor , Moreau William J 
Published: November 2017

ObjectiveDescribe tandem gait score performance in concussed elite athletes as compared to asymptomatic baselines.DesignWithin subjects, repeated measures.SettingUnited States Olympic Committee Sports Medicine ClinicsParticipantsSix hundred forty-one elite athletes (291 women and 350 men, mean age 24.9±5.2 years) representing 23 Olympic sports participated in this study.InterventionThe SCAT3 was administered during a preseason baseline and repeated as clinically indicated during initial evaluations and serially as part of a multimodal concussion management program.Outcome measuresSCAT3 performance measures of concussed elite athletes were compared to baseline SCAT3 performance.ResultsTandem gait performance was significantly better in concussed elite athletes than on athletes tested for healthy asymptomatic baselines (9.6 vs. 11.7, P<0.001), despite concussed athletes reporting significantly higher total number of symptoms (6.4 vs. 2.1, P<0.001) and symptom severity scores (13.1 vs. 3.4, P<0.001) during concussion recovery.ConclusionsThere is a paradoxical relationship between concussion status and tandem gait performance in elite athletes, with concussed athletes performing better on average than athletes evaluated for a baseline SCAT3 evaluation.Clinical RelevanceTandem gait performance is not impaired in athletes with symptoms of concussion. Intrinsic motivation to return to play may result in enhanced tandem gait performance in concussed athletes.Competing interestsNone.
Stratification of recovery from concussion using an objective multi-factorial approach to neurocognitive and motor performance assessment
Authors: Linder Susan M , Russman Andrew , Figler Rick , Cruickshank Jason , Grey Bob , Lally Maureen , Dey Tanujit , Alberts Jay L 
Published: November 2017

ObjectiveTo characterise neurologic impairment and recovery associated with concussion in youths and young adults using the Cleveland Clinic Concussion application (C3 app).DesignRetrospective observational studySettingConcussion clinic at an academic medical centreParticipants181 student-athletes aged 14–20 diagnosed with concussion by a Cleveland Clinic physician were included.InterventionC3 data were collected pre-season and at least once post-injury. At least one clinical examination by a physician was obtained to characterise clinical impairments. Individuals were stratified into two groups based on recovery time: typical <21 days (n=97) or protracted 21+ days (n=84).Outcome measuresThe following modules of the C3 app were administered across groups: 1) Graded symptom checklist (GSC); 2) Standardised Assessment of Concussion (SAC); 3) Trail Making Test; 4) Simple and Choice Reaction Time; 5) Processing Speed Test; 6) Biomechanical quantification of balance during the BESS.Main resultsAt baseline, both groups performed similarly on all modules. However, significant differences were evident at 21 days post-injury in the protracted recovery group with worse performance in: simple and choice reaction time (p<0.001), Trail Making Test B (p=0.01), Biomechanical quantification of BESS (p<0.05), and GSC (p=0.0001). No difference between the groups at 21 days was found in BESS error scores, SAC or processing speed.ConclusionsAn approach that utilises objective and quantitative measures to characterise multiple aspects of neurocognitive and motor function are more sensitive than traditional measures of concussion assessment. These new outcomes provide value in the stratification of patients and their potential time to recovery.Competing interestsJLA and SML have authored intellectual property associated with the mobile application presented in this study. The remaining authors declare no competing interest.None.
Changes in measures of cervical, vestibular, dynamic balance and tasks of divided attention following sport-related concussions in elite youth ice hockey players
Authors: Schneider Kathryn J , Palacios-Derflingher Luz , Meeuwisse Willem H , Emery Carolyn A 
Published: November 2017

ObjectiveTo evaluate acute changes in measures of cervical spine, vestibulo-ocular reflex (VOR) function, dynamic balance and tasks of divided attention in elite youth ice hockey players following a sport-related concussion.Study DesignProspective Case seriesSettingSport Medicine Centre, Calgary, Alberta, CanadaParticipantsFive hundred and fifty-nine (474 males) elite (AA and AAA) Bantam (13-14 years) and Midget (15-17 years) youth ice hockey players.Outcome measuresClinical measurements including cervical flexor endurance test (CFE), head perturbation test, head thrust test, dynamic visual acuity (DVA) (clinical and computerised), Functional Gait Assessment (FGA) and Walking While Talking (WWTT) test at baseline and acutely following concussion.Main resultsSixty-nine of 97 (71%) players completed both baseline and acute post concussion measures for their first concussion and were included in these analyses. Following concussion, neck pain, headache and dizziness increased in 42%, 58% and 40% of participants respectively. After Bonferroni corrections (α=0.00625), using Wilcoxon Signed-Rank Test, cervical spine measures were significantly worse following concussion compared to baseline [cervical flexor endurance test (z=−5.195, p<0.001) and head perturbation test (z=−4.631, p<0.001)]. Time to complete a complex task of divided attention (WWTT) relative to their normal walking speed was longer than baseline (z=−2.762, p=0.0057). There was no change in DVA or FGA following concussion.ConclusionsMeasures of cervical spine function and tasks of divided attention were worse following concussion. However, tests of VOR and dynamic balance were not significantly different than at baseline. Future research to evaluate the mechanism underlying these changes is warranted.Competing interestsNone.
Concussion in the emergency department; unconsciously incompetent?
Authors: Phillips Thom , Guy Katie , Martin Rhodri , Tomkinson Alicia , Phillips Dan , Sloane Nicole 
Published: November 2017

ObjectiveSports related concussion is an increasingly common occurrence. Outside professional sport it is typically managed within Emergency Departments. The objective was to assess the level of knowledge and understanding of UK emergency medicine doctors of concussion; it’s recognition, diagnosis and management.DesignCross-sectional observational study using self-report questionnaires.SettingQuestionnaires were distributed at regional EM conferences between October 2015 and January 2016. 15 secondary and 5 tertiary care centres were represented.Participants156 questionnaires were completed. Illegible answers, defaced or incorrectly completed questionnaires were discarded. 134 were included in the analysis. Training levels represented were: Consultant (10%), Specialist Registrar (12%), Staff Grade (5%), Core Trainee (34%), Foundation Trainee (20%), Emergency Nurse Practitioners (1.5%), Medical Students (16%).Interventions (or Assessment of Risk Factors)The questionnaire asked respondents to correctly identify signs and symptoms of concussion according to the Zurich consensus statement. It asked whether there were differences in the management of adult and paediatric concussion together with questions regarding RTP guidelines and use of potentially protective equipment.Main resultsConsultants obtained the highest signs and symptoms score (6.2). The least correct were Specialist Registrars (2.0). Diagnostic accuracy did not differ between secondary and tertiary centres (p=0.67). 80% of participants incorrectly identified headguards as being protective against concussion. 35.4% of respondents acknowledged a difference between adult and paediatric concussion.ConclusionsThis small yet representative sample highlights a lack of knowledge in concussion in health professionals working in EDs in the UK. Efforts to improve the knowledge and understanding of concussion are required given the increasing awareness of the impact and occurrence of sports concussion.Competing interestsNone.
Differences in symptom severity and gait balance deficit in concussed adolescents with and without concussion history
Authors: Chou Li-Shan , Peterson Quinn , Osternig Louis 
Published: November 2017

ObjectiveThere is conflicting evidence on whether a prior concussion is associated with a prolonged recovery course. This study was aimed to examine the effect of concussion history on recovery of symptoms and gait balance control in adolescents.DesignA prospective, repeated-measures design was employed. Subject were assessed within 72 hours of sustaining a concussion and at 2, 4, and 8 weeks post-injury.SettingsUniversity research laboratoryParticipantsHigh school student athletes with concussion injuryOutcome measuresSymptoms resulting from the injury were assessed using a 22 symptom inventory adapted from the Standardised Concussion Assessment Tool. Dual-task gait testing was employed to examine how divided attention affects balance control following concussion. Comparisons between subjects with and without concussion history were made for dependent variables of symptom scores and medial-lateral motion of the center-of-mass.Main ResultsA total of 31 concussed adolescents were tested, 9 of them had 1 or 2 diagnosed concussions more than 12 months prior to the current injury. Four subjects without concussion history and 4 subjects with concussion history were not permitted to resume normal physical activities within our 2-month study period. Subjects with concussion history displayed significantly elevated symptom scores during the first two weeks of recovery and displayed greater gait instability during the first month of recovery when compared to subjects without concussion history.ConclusionsThese preliminary findings indicate that previous concussion, more than one year prior to the current injury, could affect deficit severity and length of recovery.Competing interestsThe authors have no conflicts of interest to declare.
Effect of concussion history on sway velocity and bess scores in division i football players
Authors: Miyashita Theresa , Batchelder Benson 
Published: November 2017

ObjectiveThe purpose of our study was to investigate if concussion history has an effect on sway velocity and BESS scores in Division I football players.DesignCohort StudySettingDivision I UniversityParticipants75 Division I football players (age=19.76 ± 1.1, height=72.41” ± 2.19”, weight=222.55 lbs ± 38.17 lbs)Outcome measuresCorrelation statistics determined the association between concussion history, sway velocity, and BESS errors. Sway velocity was determined by performing the BESS test on a force plate, and BESS errors were determined by one experienced evaluator. Players performed the six trials of the BESS test: three stances on two surfaces.Main resultsThere were no statistical associations between concussion history and sway velocity or BESS errors. There were significant and positive correlations between sway velocity and BESS errors, indicating as sway velocity increased so did the number of errors, on the following trials: single leg firm surface (rs=0.62,p<0.001), tandem stance firm surface (rs=0.72,p?< 0.001), single leg foam surface (rs=0.25,p=0.029), tandem stance foam surface (rs=0.70,p<0.001), and composite scores (rs=0.68,p<0.001).ConclusionsConcussion history does not appear to have an impact on sway velocity measures or BESS scores. However, there was a significant and positive correlation between sway velocity and BESS errors during four of the trials and the composite scores, supporting the validity of the BESS test.Competing interestsNone.
Exposure to injury in mixed-martial-arts is associated with evidence of concussion injury
Authors: Neville Christopher , Johnson Paul , Baracks Joshua , Rieger Brian 
Published: November 2017

ObjectiveThe purpose of this study was to determine if exposure to injury during mixed-martial-arts (MMA) fights is associated with concussion injury. It was hypothesised that number of hits-to-the-head (HTH) would be associated with concussion assessment findings.DesignCase-seriesSettingAmateur MMA fighters agreed to complete the testing at training facilities and fight venues.ParticipantsA convenience sample 33 MMA fighters completed pre and post-fight assessments (32 males, 1 female)Interventions (or Assessment of Risk Factors)The independent variable was group assignment. The low-exposure (LE) group (n=17) had a mean of 5.8±5.9 HTH while the high-exposure (HE) group (n=16) had a mean of 34.0±9.8 HTH.Outcome measuresThe dependent variables were compared using an ANOVA model. They included: average speed to complete the Tails B cognitive test, balance measured with an inertial measurement unit, S100B protein concentration in blood serum, and self-reported symptoms.Main resultsThe change in S100B concentration from pre to post-fight was significantly greater (p=0.01) in the HE group (0.22±0.14 ug/L) compared to the LE group (0.10±0.11 ug/L). Dual-task balance cost was significantly greater (p=0.02) in the HE group (0.04±0.05 m/s2/Hz) compared to the LE (0.01±0.01 m/s2/Hz) group. No difference in Trails B speed or self-reported symptoms was observed.ConclusionsThe increase in S100B concentration in the peripheral blood and changes in balance performance suggest concussion injuries are common during MMA fights but injuries are associated with exposure to head impacts. Cognitive tests and symptom report may not be as sensitive to injury.Competing interestsDr. Neville: Ongoing research sponsorship and equity interest in Motion Intelligence Inc. who provided the hardware for some of the concussion screening used in this study.Dr. Johnson: None.Mr. Baracks: None.Dr. Rieger: Ongoing research sponsorship and equity interest in Motion Intelligence Inc. who provided the hardware for some of the concussion screening used in this study.
Multi-disciplinary management of paediatricpediatric sports-related concussion: early experience of the pan am concussion program
Authors: Russell Kelly , Ritchie Lesley , McDonald Patrick J , Cordingley Dean , Reimer Karen , Girardin Richard , Vis Sara , Selci Erin , MacDonald Peter , Leiter Jeffrey , Ellis Michael 
Published: November 2017

ObjectiveSummarise clinical characteristics, outcomes, and healthcare resources and personnel needs of paediatric sports-related concussion (SRC) patients who were evaluated and managed at a multi-disciplinary paediatric concussion program.DesignRetrospective cohort studySettingPaediatric, multi-disciplinary concussion clinicParticipants423 paediatric SRC patients: 14.3 years (SD: 2.3), 59.6% males, 43.0% hockey-related, and 75.8% acute SRCInterventions (or assessment of risk factors)Initial assessment and diagnosis by a neurosurgeon with the multi-disciplinary team completing Return-to-Play decision-making. On-site neurosurgeon, neuropsychologist, vestibulo-ocular therapist, and exercise physiologist and referrals to neurology and psychiatryOutcome measuresSRC diagnosis and recovery were defined by the 2013 Zurich Consensus Guidelines. Post-Concussion Syndrome was diagnosed using ICD-10 criteria of at least 3 symptoms at 30 days or more. Outcomes included demographic and injury data, healthcare resources and personnel utilised, and recoveryMain resultsOverall, 294 (69.5%) of SRC patients met the clinical criteria for recovery, 75 (17.7%) were lost to follow-up, 53 (12.5%) remained in treatment, and 1 died (0.2%). In acute patients, median time to initial consultation was 7 days (IQR: 5, 12). Median days to recovery among acute SRC patients with complete follow-up was 23 days (IQR: 15, 36) and 44.1% of acute SRC patients were diagnosed with PCS. 25.3% of SRC patients underwent at least one diagnostic imaging test and 32.6% received referral to another member of our multi-disciplinary clinical team.ConclusionsYouth received comprehensive care with access to appropriate diagnostic resources and multi-disciplinary collaboration of experts with national and provincially-recognised training in TBICompeting interestsNone.
Pilot study of knowledge and management of concussion in emergency department doctors in singapore
Authors: Probert Joanne , Sirisena Dinesh , Walter Joy 
Published: November 2017

Objective1. To gain an understanding of Singapore Emergency Physicians (EPs) knowledge and practice habits when assessing concussions in the Emergency Department (ED).2. To determine what knowledge exists regarding current international concussion management and return-to-play guidelinesDesignA 21 item anonymous internet survey was developed and disseminated to EPs in Singapore. A limited time period for completion was given. Because of anonymity, non-responders could not be specifically targeted. Participation was voluntary and no incentives were offered.Results26 responses which included 9 Associate Consultants or above, 4 Registrars, 14 junior doctors. 63% were Singapore trained.88.9% were aware of the concussion diagnosis but only 50% could document the salient points required to diagnose concussion.The highest percentage (33.3%) reported seeing cases of concussion monthly, 18.5% fortnightly, 29.6% weekly and 14.8% daily. 33.3% of EPs were aware of Internationally Recognised guidelines but only 11% use them.70.4% refer concussions for follow up (47.4% to Neurosurgery and 21.1% to Sports Medicine). Only 14.8% of EPs have had specific training in sports concussion management.Conclusions1. It is likely that concussion is under diagnosed; many EPs only report seeing cases monthly and are unaware of the salient features to diagnose concussion.2. International guidelines regarding return-to-play and standardised assessment have not reached the majority of EPs.3. A small proportion of concussion cases are referred to Sports Clinics for follow up.4. Further training in sports concussion management in Singapore EDs is needed.5. Further studies in this area are required.Competing interestsJoanne Probert – Trainer for World Rugby.
Preseason performance on cervical, vestibular and divided attention measures in youth ice hockey players
Authors: Schneider Kathryn J , Palacios-Derflingher Luz , Codd Chevonne , Shi Qian , Meeuwisse Willem H , Emery Carolyn A 
Published: November 2017

ObjectiveTo determine preseason values on cervical, vestibular and divided attention measures in youth ice hockey players aged 10-14 yearsDesignCross-Sectional studySettingSport Injury Prevention Research Centre, Alberta, CanadaParticipantsYouth Ice Hockey players (n=934, age 10-14 years).Outcome measuresNumeric pain rating scores for neck pain, headache, dizziness; Cervical flexor endurance test (CFE), cervical flexion rotation test (CFRT), cervical spine strength, head perturbation test, functional gait assessment (FGA), walking while talking test (WWTT), head thrust test and dynamic visual acuity (DVA).Main resultsSymptoms of neck pain, headaches and dizziness were reported by 17%, 18% and 10% of participants respectively. The median time of CFE was 27.0 seconds (IQR: 19.9, 40.7). CFRT was positive in 52 (6.2%) participants. Median anterolateral cervical spine strength was 8.0 lbs (IQR: 6.1, 10.3) right and 7.8 lbs (IQR: 6.0, 10.1) left. 13% of participants were unable to maintain a stationary head position when an external force was applied. 48% of participants performed less than perfect on the FGA. Time to complete a complex task while walking increased 40 foot walking time by a median of 6.4 seconds (IQR: 4.0, 10.3). Head thrust test was positive in 33 (3.7%) participants. Clinical DVA score was a median of 0.2 logMar (IQR: 0.1, 0.3).ConclusionsSymptoms are common at baseline and outcomes on many commonly used clinical tests may be different for healthy 10-14 year olds compared to the adult literature. These findings form an important reference point for the interpretation of post-injury testing.Competing interestsNone.
The feasibility of romberg quotient in assessment of balance after sport concussion
Authors: Vartiainen Matti , Holm Anu , Koskinen Sanna , Hokkanen Laura 
Published: November 2017

ObjectiveTo evaluate the feasibility of a computerised balance test and a calculated Romberg Quotient in acute recognition of concussionDesignProspective pilot study.SettingFinnish national ice hockey league.ParticipantsFour teams participated in the study (n=113, male). Nine athletes who sustained a head/neck-related injury and control group of seven non-concussed volunteer players were followed.Study procedureAll participants underwent the baseline assessment before season. The study period was one hockey season 2009- 2010. All game related concussions during this time were recorded. Post-concussion assessment was administered within 36 hours after injury.Outcome measuresBalance was measured using a portable computerised platform. Romberg test stances were used on hard surface and soft foam. The participants stood still for 30 seconds with a closed stance. A relative balance change, Romberg Quotient (RQ), was assessed by calculating the ratio between eyes open, and eyes closed parameters. RQ was computed for sway length, area and velocity in each conditionMain resultsConcussed and control group did not differ in balance measures at baseline. At post-injury, soft foam measures showed a difference between groups in sway length (U=5.0, p=0.005) and velocity (U=5.0, p=0.005). Among the concussed, RQ mean in sway velocity was 2.02 (1.7–2.3, 95% confidence limits) at baseline and 2.14 (1.9–2.4) post-injuryConclusionsAlternating between different visual and/or somatosensory conditions in balance testing brings out the effect of concussions. RQ is easy to calculate regardless of the measurement systems or scales and can be used as valid tool in sport concussion measurementCompeting interestsNone.
The sport concussion baseline assessment: an investigation of sex and sport differences
Authors: Resch Jacob E , Walton Samuel , Freeman Jason , Broshek Donna 
Published: November 2017

ObjectiveTo assess for sex and sport baseline differences for the Immediate Postconcussion and Cognitive Test (ImPACT) and Sensory Organisation Test (SOT) in collegiate athletes.DesignCross-sectional.SettingResearch laboratory.ParticipantsParticipants consisted of 315 male (n=189) and female (n=126) division I collegiate athletes with an average of 19.5 + 1.34 and 19.3 + 1.31 years, respectively.InterventionParticipants completed ImPACT and the SOT baseline assessments as part of their university concussion management protocol.Outcome measuresAnalyses of variance were used to assess for sex and sport differences for ImPACT’s Visual and Verbal Memory, Visual Motor Speed, and Reaction Time and the SOT’s composite scores. Post-hoc analyses were performed with Tukey’s test. All analyses were performed with α=.05.Main resultsIn terms of sex, females scored significantly higher than males on ImPACT’s Verbal Memory (F (1,314)=4.85, p=0.03) and Visual Motor Speed (F (1,314)=4.51, p=0.03) composite scores. Within male sports, a significant difference was observed for the SOT composite score (F (6,181)=3.22, p=0.01). Within female sports, a significant difference was observed between sports for ImPACT’s Reaction Time composite score (F (6,125)=4.16, p=0.01).ConclusionsOverall, sex as well as sport differences were observed for baseline ImPACT and SOT performance for one or more composite scores. Our results support the use of baseline assessments to account for performance differences between sex and sport.Competing interestsNone.