bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of the wii balance board to assess changes in postural balance across athletic season
Authors: Cullen Hilary M , Sun Yao , Christie Brian R , Paul Zehr E 
Published: November 2017

ObjectiveThe purpose of this study was to investigate potential utility of a customised Wii Balance Board (WBB) program to assess postural balance in an athletic population. Researchers hypothesised that WBB measures would be strongly correlated to the Balance Error Scoring System (BESS) used in concussion assessments.DesignCross-sectional time series. Static and dynamic balance was assessed using the WBB and BESS at three time points of an athletic season: 1) pre-season, 2) mid-season, and 3) post-season.SettingUniversity research laboratorySubjectsInterventionOutcome measures1) BESS, 2) WBB dynamic recovery time, and 3) WBB static Centre of Pressure (COP).ResultsWBB COP data were found to be strongly correlated with BESS scores across all time points [pre-season (r=0.689, p<0.05), mid-season (r=0.767, p<0.01), and post-season (r=0.780, p<0.01)]. There were significant differences in recovery time (p<0.005) and COPx variance for the single-leg BESS condition across all time points (p<0.005). No significant differences were observed in raw BESS scores across time points.ConclusionsStudy results support the use of a WBB as an objective tool in measuring variance in static and dynamic postural balance. This program has potential utility for clinicians when assessing balance deficits related to concussion. Planned work will examine the use of the WBB program in measuring variance in postural balance in individuals with sport-related concussion.Competing interestsNone.
An investigation of the role of a rapid sideline head injury assessment form (hiaf) in the clinical diagnosis of concussion in elite australian football
Authors: Clifton Patrick , Harcourt OAM Peter , Gastin Tom , Makdissi Michael 
Published: November 2017

ObjectiveTo investigate the role of a rapid sideline Head Injury Assessment Form (HIAF) in the clinical diagnosis of concussion in elite Australian football.DesignValidation studySetting/participantsThe study was conducted in all 207 matches of the professional competition during the 2015 season.InterventionsThe HIAF comprised 12 individual tests based on previously validated clinical features1and video signs2of concussion. Experienced team physicians were required to complete the HIAF for any incident potentially resulting in a concussion. The HIAF directs team physicians to either permanently remove the player (9 of 12 tests), or conduct a more detailed assessment (e.g. SCAT3, 3 of 12 tests). Where possible, the tests were conducted by both direct assessment and video review of the incident. At the end of the season, data on all clinically confirmed concussions was collected from team physicians.Main results135 HIAFs were submitted throughout the 2015 season resulting in 44 players permanently removed from play for concussion. 8 confirmed concussions were not identified during the match. When compared to information on clinically confirmed concussions, the HIAF captured concussive incidents with 89% sensitivity (95% CI: 75.44% – 96.21%) and 98% specificity (95% CI: 92.03% – 99.72%).ConclusionsThe HIAF was demonstrated to have a high level of sensitivity and specificity. It is a useful precursor to the SCAT3 for the sideline diagnosis of concussion, in most cases providing a faster and more prescriptive assessment. A modified version of the HIAF may be useful in lower levels of competition.
King-devick (kd) test as a rinkside tool for concussion assessment
Authors: Rhine DJ , Lamvohee T , Rhine BD 
Published: November 2017

ObjectiveKing-Devick test as a rinkside tool for concussion diagnosis.DesignKD was administered to hockey players immediately after removal from the game with a suspected concussion. Results were compared to baseline. Concussion was suspected with slowing by >5.2 sec.1SettingHockey games.ParticipantsHockey players (male/female) – school-based hockey academy and a Canadian junior hockey teamInterventionsAthletic trainers were trained in the use of KD and obtained baseline KD times for players. AT’s administered the KD test to hockey players immediately after removal from the game with a suspected concussion.Main outcome measuresKD time post-injury was compared to the KD time baseline.ResultsDuring the 2015–16 season, KD testing was collected on players with suspected concussion (42 concussions identified out of 148 players). Of the 42 concussions, 13 had KD sideline testing done immediately post-injury; 8/13 demonstrated >5.2 sec slowing in their KD baseline scores. All were further evaluated with a comprehensive concussion assessment protocol that included symptom scoring-balance assessments-cognitive testing. Concussion was confirmed with this diagnostic approach in 8/8 players with KD times slowed by more than 5.2 sec.Abstarct 212 Table 1King-Devick Sideline Assessment for Concussion: Diagnostic Difference >5.2 sec from BaselineAGEGENDERSPORTBaselineSidelineΔKD14yrMaleHockey53.0861.088.0 sec14yrMaleHockey30.0942.8112.7215yrFemaleHockey42.553.511.015yrFemaleHockey37.054.023.017yrFemaleHockey46.554.057.5518yrMaleHockey36.8843.356.9719yrMaleHockey36.0161.024.9920yrMaleHockey39.0247.088.06ConclusionsAn ideal concussion sideline diagnostic tool should be inexpensive, portable, reproducible, fatigue-tolerant, resistant to test-retest learning and suitable for non-medical personnel.23The King-Devick test, that assesses saccadic eye movements, has these characteristics. It can be administered in less than 2-minutes. It has been reported that a post-injury slowing of KD times >5.2 seconds is diagnostic of concussion.4Sideline/rinkside KD testing with > 5.2 sec slowing compared to baseline results accurately identified concussion with 100% accuracy.
A workshop for educators on concussion led directly to the user-centredcentered design of a school board approved return to learn protocol
Authors: Carson James D , Garel Alisha , Rendely Alexandra , Moser Stefanie E , Rabinovitch Sarah T , Kraft Sari A , Fremont Pierre 
Published: November 2017

ObjectiveTo improve the educators’ knowledge and implementation of academic accommodations for optimal return to learn (RTL) after a sport-related concussion (SRC).DesignInitially designed as a pre- post- intervention study, this qualitative report describes an unexpected but most relevant outcome of an educational intervention regarding SRC management in a school-based setting.SettingA sport-focused Ontario (Canada) secondary school.Participants94 educational staff, including teachers, administrators and psychologists.InterventionA workshop where educators learned about SRC management and reflected on their own experiences with some of the 63 cases of SRC managed at theirschool over the preceding 3.5 years. Participants were asked to develop RTLprotocols adapted for their environment.Outcome measuresCapacity to develop RTL protocols to improve concussionmanagement in school-based settings.main resultsWorking in small groups, participants were able to independently construct RTL protocols. As an unexpected outcome of this session, the educators formed a committee, which formalised a user-centred (teacher accepted and student focused) eight-stage post-SRCRTL protocol. In 2015 their school board accepted this protocol for use at over 200 schools. The index school initiated a daily accommodations update RTL passport.ConclusionsWorking in small groups, participants were able to independently construct RTL protocols. As an unexpected outcome of this session, the educators formed a committee, which formalised a user-centred (teacher accepted and student focused) eight-stage post-SRCRTL protocol. In 2015 their school board accepted this protocol for use at over 200 schools. The index school initiated a daily accommodations update RTL passport.Competing interestsNone.
Annual trends in follow-up visits for paediatricpediatric concussion in emergency departments and doctors’ offices in ontario, canada between 2003–2013
Authors: Fridman Liraz , Scolnik Michal , Macpherson Alison , Rothman Linda , Guttmann Astrid , Grool Anne , Rodriguez Duque Daniel , Zemek Roger L 
Published: November 2017

BackgroundOver the past ten years, ED and physician office visits for paediatric concussion have more than quadrupled. Current concussion management guidelines recommend follow-upand clearance by a physician prior to resumption of contact activities. However, compliance with recommended follow-up is not well documented in the literature.ObjectiveTo examine trends in follow-up visits in accordance with current recommended guidelines for children with concussion.DesignRetrospective population-based study.SettingChildren and youth presenting to emergency departments (EDs) and doctors’ offices with concussion over a 10-year time period (2003–2013) in Ontario, Canada.Outcome measuresWe examined the percentage of children and youth who were seen for follow-up visit post-concussion. Trends in the percent of children with a follow-up visit following an index visit to either a doctor’s office or an ED were reported.Main resultsThe proportion of children and youth assessed for concussion follow-up (N=45,150) has increased significantly (p<0.0001). In 2003, only 1010 of 7170 (14.2%) patients with an index visit for concussion had follow-up assessment; in 2009, 2733 of 10,134 (27.0%) had a follow-up visit, and by 2013, 11,806 of 21,681 (54.5%) received follow-up care.ConclusionsDespite increasing trends in the proportion of children being examined for concussion follow-up over a 10-year period, nearly half of all children with an index visit for concussion still do not receive follow-up assessment. This suggests that ongoing efforts to improve compliance with recommended guidelines will be important.Competing interestsNone.
Predictors of recommended academic adjustments among concussed student-athletes presenting to the primary care setting
Authors: Wasserman Erin , Herzog Mackenzie , Register-Mihalik Johna , De Maio Valerie , Fonseca Janna , Phillips Kristen , Bloom O. Josh 
Published: November 2017

ObjectiveThe purpose was to describe academic ajdustments recommended by primary care physicians to paediatric concussion patients and to identify predictors of recommended adjustments.DesignProspective cohort.SettingPrimary care sports medicine clinic.SubjectsParticipants were 8–18 years old, injured during organised or recreational sports, and presented to the clinic within 3 days of concussion.InterventionSymptom scores, average visual near-point convergence, and ImPACT composite scores were evaluated as predictors of accommodations using logistic regression.Outcome measuresAcademic adjustment information was obtained from a standardised, provider completed form. Patients with no recommendation form were excluded (N=31). Academic accommodations were grouped into: 1) cognitive (e.g. limited or no testing, extra time for schoolwork) and 2) visual-vestibular (e.g. auditory participation only, limited visual stimulants).Results163 patients met the inclusion criteria; 88 (54%) were male. The mean age was 14.3±2.2 years. Most patients received academic adjustment recommendations (N=140; 86%). 21 (13%) received cognitive recommendations, 13 (8%) visual-vestibular, and 105 (64%) both. The most common recommendations were: “Take rest breaks during the day as needed” (N=108, 66%), “Patient is to limit visual stimulants and screen time” (N=102, 63%), and “Allow extra time to complete tasks” (N=97, 60%). Patients with higher symptom scores (OR=1.03 per 1-point increase; 95% CI: 1.00–1.05; p=0.03) and lower processing speed scores (OR=1.07 per 1-point decrease; 95% CI: 1.01–1.13; p=0.02) were more likely to receive visual-vestibular accommodations. There were no significant predictors of cognitive adjustments.ConclusionsMost student-athletes received academic adjustment recommendations. Symptom and neurocognitive measures may aid clinicians in decision-making about academic adjustments.Competing interestsStudy funded in part by a research grant from the National Operating Committee on Standards for Athletic Equipment.Ms. Fonseca is employed at the study setting.Ms. Phillips is employed at the study setting.Dr. Bloom is employed at the study setting.
Simulations of recently observed shear shock wave physics amplify local brain accelerations by a factor of 40 in head drop experiments – future implications for concussion
Authors: Campbell Kody R , Mihalik Jason P , Tripathi Bharat B , Espindola David , Pinton Gianmarco F 
Published: November 2017

ObjectiveShear waves that travel in the brain are highly nonlinear and can develop into shock waves. This newly observed phenomenon could have implications for concussion. Our objective was to determine the effect of the brain’s nonlinear shear wave propagation behaviour on laboratory acquired head impact kinematics through numerical simulations.DesignHead impact kinematics, obtained from controlled laboratory drops to cadaveric human heads, provided inputs to a one dimensional simulation of a cubically nonlinear shear wave equation solved with a piecewise parabolic method. Of the 292 drops, 125 caused significant motion about one axis. We assumed this would provide optimal conditions to create shears waves. The nonlinear and attenuation properties for the simulation were experimentally measured in fresh porcine brains with high frame-rate ultrasound.SettingLabratory.SubjectsNone.InterventionIndependent variable – Nonlinear and attenuating properties of the brain.Outcome measuresPeak Linear Tangential Acceleration (PLTA) measured at the skull was compared to the max PLTA acquired from the simulation for each of the 125 trials.ResultsThere were 17 cases where nonlinearity overcame attenuation and resulted in the PLTA amplifying as high as 40 times the initial PLTA at the skull.ConclusionsOur models of previously unobserved shear shock wave physics strongly suggest that nonlinearity is a first order parameter in brain kinematics and may have a fundamental influence on brain injury. Expanding these nonlinear simulations to three dimensions could better link head impact kinematics collected in the field with concussion risk and other head injuries.Competing interestsHead drop data were obtained in collaboration with Drs. Cameron “Dale” Bass and Jason F. Luck (Duke University, USA) and Dr. David B. Camarillo (Stanford University, USA)None.
The impact of concussion on brain adaptation: the use of prism glasses as a novel diagnostic tool
Authors: Little Elaine C , Emery Carolyn A , Schneider Kathryn , Dukelow Sean P 
Published: November 2017

ObjectiveTo evaluate brain adaptation following concussion. Do youth with a history of previous or acute concussion require more ball throws to land on or near a target, when wearing prism glasses (bend light to the left by 15&ring;), than youth with none?DesignCross-sectional study.SettingSport Injury Prevention Research Centre, Alberta, Canada.ParticipantsIce hockey players: 21 with acute concussion [(17 males), mean age 13.8 (95% CI: 13.4, 14.2), median number of days since concussion 4 (range 2–11)], 40 reporting previous concussion(s) [(33 males), mean age 13.4 (95% CI: 13.1, 13.7), median number of days since last concussion 620 (range 90–1560)], and 40 with no concussion history [(36 males), mean age 12.9 (95% CI: 12.5, 13.2)].Independent variableLifetime concussion history (yes/no) or acute concussion (<10 days).Dependent variableNumber of throws for brain adaptation.Main resultsA significant concussion effect was identified across groups [F(2,98)=26.17, p<0.001]. Post-hoc analyses showed a difference in the number of throws in players with no concussion history versus players reporting previous concussions [−4.700 (95% CI: −8.44, −0.96)] and acute concussions [−13.440 (95% CI: −17.89, −8.99)], as well as between previous history versus acute concussion groups [−8.740 (95% CI: −13.19, −4.29)].ConclusionsConcussion history and acute concussion appears to negatively impact brain plasticity in youth. They do not adapt as well as individuals with no concussion history. Our results support the use of a prism adaptation paradigm for identifying/quantifying short and long-term neurologic impairments in youth following concussion.Competing interestsNone.
Using neurophysiological measures to assess concussion. a case control study in one player
Authors: Cohen Adrian , Doug King , Alan Pearce J 
Published: November 2017

Objectivecase study presents data using multimodal assessment using impact sensors, oculomotor function and transcranial magnetic stimulation (TMS) to quantify neurophysiological changes in the acute period following concussion.DesignCase control study.ParticipantsOver one season, we evaluated a male rugby union player (age: 29 years; prior concussions: 1; last concussed >120 months) for head impacts using impact sensors (X2 Biosystems, USA) and oculomotor function (King-Devick test).1TMS (MagVenture, Denmark) protocols utilised previously published methods for concussion studies2,3with data compared to our normative database of age-group controls (33 males; mean age: 28.6±3.9 years).InterventionAny impact that resulted in a concussion, confirmed by the team doctor, required post-match testing utilising the King-Devick test and follow up testing for TMS at 5 d and 12 d.Outcome measuresTime and errors completing the King-Devick test. TMS measures included latency (TMS stimulus to evoked potential onset ), evoked potential amplitude, and intracortical inhibition (TMS onset to return of uninterrupted electromyography activity).Main resultsAn impact of 60.7 g/17, 114.1 rads/s2revelead a decreased King-Devick performance of 3.8 s. At 30 d King Devick remained below pre concussion baseline. Compared to controls, TMS revealed increased intracortical inhibition duration of 20.6 ms at 5 d post concussion, and returning to baseline/control levels by 12 d.ConclusionsThis novel case study demonstrates the value of using multimodal measurements in the assessment of concussion and return to play decisions.Competing interestsNone.AJP is supported, in part, by a research grant by the Australian Football League.
Characteristics of paediatricpediatric concussion patients utilisingutilizing emergency department services prior to initial concussion clinic evaluation
Authors: Maio Valerie De , Register-Mihalik Johna , Herzog Mackenzie , Fonseca Janna , Phillips Kristen , Josh Bloom O 
Published: November 2017

ObjectiveTo evaluate characteristics of paediatric concussion patients utilising the emergency department (ED) prior to initial concussion clinic evaluation.DesignProspective cohort.SettingClinics of an American urban/suburban family practice (12/2014–04/2015).SubjectsConsented concussion patients 8–18 years presenting to clinic within 3 days of injury (n=195; age=14.3, SD=2.1 years; female=42.3%).InterventionParticipants completed a systematic evaluation at initial clinic visit and survey at 4-6 weeks (73.8% follow-up). Criterion variables included demographics, prior head injury, time of injury (TOI) factors, total symptom severity, Immediate Postconcussion Assessment and Cognitive Test (ImPACT) composites, one-month persistent symptoms, one-month Paediatric Quality of Life (PedsQL).Outcome measuresED visit before clinic evaluation (yes/no) served as the dependent variable.ResultsED visits were reported for 12.8% (n=25) of participants. Amnesia (36.0% vs. 10.1%; p<0.001), loss of consciousness (LOC) (20.8% vs. 6.7%; p=0.021), confusion (40.0% vs. 20.0%; p<0.0255), difficulty remembering (52.0% vs. 26.5%; p<0.0091), paresthesias (16.0% vs. 4.7%; p<0.0282), and CT imaging (60.0% vs. 0.6%; p<0.0001) were greater for the ED group. Initial symptom severity and ImPACT composite scores, and one-month outcomes of persistent symptoms and PedsQL, were no different for the ED group.ConclusionsPaediatric patients presenting to concussion clinic with 72 hours of injury who first visited an ED, have more dramatic symptoms at the TOI, yet do not appear to have any worse initial symptom severity, ImPACT scores, or one-month persistent symptoms or PedsQL than those who presented first to clinic. Future study should evaluate these relationships in larger samples.Competing interestsThe current study is funded in part by the National Operating Committee on Standards for Athletic Equipment.Ms. Fonseca is employed at the study setting.Ms. Phillips is employed at the study setting.Dr. Bloom is employed at the study setting.
Role of sport-related concussion on academic achievement among youth athletes
Authors: Russell Kelly , Selci Erin , Rozbacher Adrian , Ellis Michael 
Published: November 2017

ObjectiveDetermine change in report card grades in youth after sustaining an acute sport-related concussion.DesignProspective case-series.SettingPaediatric, multi-disciplinary concussion.Participants48 youth athletes (mean age 14.3; SD: 0.9; male: 57.6%) who sustained a sport-related concussion during the school year. Overall, 3 youth were lost to follow-up and 12 youth submitted only one report card.Interventions (or assessment of risk factors)Subsequently developing Post-Concussion Syndrome (PCS: symptomatic after 30 days), initial concussion severity (Post Concussion Symptom Scale), self-reported concussion history, sex, age, and academic accommodations during recovery.Outcome measuresThe report card immediately before the concussion and the report card immediately after medical clearance were collected. Pre-concussion and post-concussion overall and core grade-point average was calculated from report cards. Core grade-point average (GPA) included math, sciences, social studies, English, and foreign languages.Main resultsOverall GPA was 82.9% (SD 8.5%) pre-concussion and 82.7% (SD 8.0%) after concussion recovery (difference: −0.2%, 95% CI: −1.6%, 1.1%). Core GPA was 80.0% (SD 10.1%) pre-concussion and 79.4% (SD 10.4%) after concussion recovery (difference: −0.6%, 95% CI: −2.8%, 1.6%). There were no significant differences in overall or core GPA when stratified by sex, age, initial concussion severity, previous concussion history, receiving adequate school accommodations during recovery, or subsequently developing PCS.ConclusionsThere were no statistically or clinically significant changes in overall or core GPA during concussion recovery. Further research is needed to determine if there are more subtle changes in academic performance during the recovery process.Competing interestsNone.