bluuebunny/crossref_metadata_2025_split huggingface dataset:
A-18 Indicators of Behavioral Symptom Management Strategy Adherence in Collegiate Athletes with Concussions
Authors: Clise E , Poskus J , LoGalbo A 
Published: June 2023

Abstract

Purpose
This study explores indicators of post-concussive behavioral symptom management strategy adherence in collegiate athletes.

Methods
Behavioral Symptom Management Strategy Recommendations were provided to 34 collegiate athletes (23 males, 11 females, ages: 18-22) at post-injury. At follow-up, athletes rated strategy adherence in overall frequency (never, rarely, sometimes, often, almost always). Athletes were administered the Sport Concussion Assessment Tool-5th Edition (SCAT-5) at post-injury and follow-up. Participant data was grouped by adherence frequency: Low (never-rarely, N=7), Moderate (sometimes, N=5), and High (often-almost always, N=22). Increases in SCAT-5 Total Symptom Score (TSS) and Symptom Severity Score (SSS) were calculated by subtracting baseline scores from post-injury scores. Score change outliers and instances in which baseline scores were higher than post-injury scores were removed.

Results
An overall significant mean difference in TSS and SSS changes from baseline to post-injury among adherence frequencies was found, F(2,31)=4.45, p=.02, F(2,31)=4.40, p=.021. Post-hoc tests (Tukey) demonstrated that increases in TSS from baseline to post-injury were significantly higher in athletes with High (M=8.73, SD=5.28, p=.03) and Moderate (M=10.40, SD=5.22, p=.039) adherence frequency compared to those with Low (M=3.00, SD=2.94). Similar effects were demonstrated for increases in SSS for High (M=21.77, SD=18.04, p=.043) and Moderate (M=29.80, SD=19.31, p=.029) compared to Low (M=3.71, SD=3.59). A significant correlation was found between adherence frequency and number of previous concussions, r=.39, p=.025.

Conclusions
Results suggest that greater increases in SCAT-5 TSS and SSS from baseline to post-injury and number of previous concussions are associated with a higher frequency of adherence to post-concussive behavioral symptom strategy recommendations in collegiate athletes.
A-22 Beyond Sports and Concussions: The Link between Shifting and Higher-Order Executive Functioning in Young Women
Authors: Doucette M M , Garcia-Barrera M A 
Published: June 2023

Abstract

Purpose
Our aim was to investigate the role of lifestyle factors, physical activity, sport, and concussion history, as well as Miyake and colleague’s (2000) three lower-order factors of executive function (shifting, updating, and inhibition) on higher-order decision making and self-reported executive functioning in young women.

Methods
180 Canadian female university students (ages 18–25) completed 9 computerized executive function tasks assessing shifting, updating, and inhibition, as well as decision making (Iowa Gambling Task). Participants also completed the Executive Function Index (subjective executive functioning) and reported their age, concussion history, weekly physical activity, and level of sports participation. Linear regression analysis was used to assess the effects of the predictor variables on the Executive Function Index scores and Iowa Gambling Task scores.

Results
Only shifting significantly predicted both subjective executive functioning scores (b=2.65, p&lt;.05) and Iowa Gambling Task performance (b=269.02, p&lt;.01). Weekly physical activity was significantly associated with subjective executive functioning (b=.10, p&lt;.01), but not Iowa Gambling Task performance. Age, concussion history, sport participation, inhibition, and updating were not significant for either regression.

Conclusions
These findings suggest that shifting may be a critical component of both higher-order decision making and subjective executive functioning, while physical activity may be important for subjective executive functioning. The lack of predictive value for lifestyle factors such as concussion history and sports participation suggests that there are other factors influencing executive functioning performance in healthy young women. Future studies should explore other factors, such as hormonal variability, that may be impact subjective executive functioning and decision making in young women.
A-29 To report or not to report: A review of adolescent decision-making theories following sports-related concussion
Authors: Goodwin G J , Evangelista N D , Ozturk E D , Merrit V C 
Published: June 2023

Abstract

Purpose
Sports-related concussion (SRC) is a prevalent concern among adolescent athletes. If SRC is suspected, athletes are usually removed from play for assessment and symptom monitoring. Return-to-play decisions heavily rely on athlete self-report of SRC and associated symptoms. Social pressures and attitudes related to symptom reporting influence an athlete’s decision of whether to disclose symptoms; not reporting increases risk for subsequent injury and delayed recovery. Therefore, it is important to understand the adolescent decision-making process following SRC. In this review, prevailing theories that explain symptom reporting and decision-making following SRC will be evaluated from a clinical lens.

Data Selection
Literature was reviewed using Google Scholar, PubMed, and SCOPUS. Search terms included “concussion” AND “sport” AND “symptom reporting” OR “reporting” OR “self-report”. Other terms included “decision-making”, “disclosure”, “adolescent”, “high school”, and “college”. Articles from 2004-2023 were included.

Data Synthesis
Three prevailing theories have been proposed to explain symptom underreporting among adolescent athletes: the Theory of Reasoned Action and Planned Behavior, the Bandura Social Cognitive Theory, and the Disclosure Decision-Making Model. These theories will be critiqued and the lack of research on neurodevelopmental components of decision-making will be highlighted.

Conclusions
The decision-making process following SRC is complex, multi-factorial, and state-dependent. While these theories provide critical insights into symptom reporting following SRC, they do not consider important neurodevelopmental factors such as the imbalance between cognitive control and reward processing in adolescence. When educating parents and coaches about symptom reporting following SRC, it will be important for clinicians to consider socioemotional, cultural, environmental, and neurodevelopmental factors.
A-38 A Comparison Of Concussion History And Propensity For Risk-Taking In College-Aged Individuals
Authors: Loftin M C , Zynda A J , Pollard-McGrandy A M , Tracey A J , Covassin T 
Published: June 2023

Abstract

Purpose
The purpose of this study was to investigate differences in propensity for risk-taking between college-aged individuals with and without a history of concussion.

Methods
A cross-sectional study of individuals ages 18-30 years was conducted. Participants were administered a brief survey that included demographics, medical history, and the General Risk Propensity Scale (GRiPS). The GRiPS is an 8-item, self-report measure that assesses an individual’s general propensity to take risks (e.g., “I would take a risk even if it meant I might get hurt”). A score of 20 or higher indicates high propensity for risk taking while a score lower than 20 indicates low propensity for risk-taking. An independent samples t-test compared the mean scores of the GRiPS between individuals with and without a concussion history. Statistical significance was set at p&lt;0.05.

Results
One hundred eighty-one participants (92 female; μ age=20.65 years; SD=2.56 years) were included in this study. Ninety-six (53.0%) participants had no concussion history, while 85 (47.0%) had a history of concussion. No significant differences in GRiPS mean scores was noted between groups (no concussion history: μ=23.97, SD=5.96; concussion history: μ=23.68, SD=6.72, p=.73).

Conclusions
These results suggest that an individual’s propensity for risk-taking is not influenced by concussion history, which conflicts with previous research. Future research may consider developing a survey to assess specific risk-taking behaviors that may be associated with a concussion (e.g., “I do not report symptoms of a concussion”) or if a propensity for risk-taking is higher in individuals currently with a concussion or a specific number of previous concussions.
A-40 Effort in ADHD/LD may be viewed on a continuum in baseline cognitive testing
Authors: Maietta J , Higgins K L , Bouchard H C , Liang J M , Schultz D H 
Published: June 2023

Abstract

Purpose
Baseline testing is commonplace for athletes at all levels. Poor effort complicates interpretation of baseline data. Previous research suggests that athletes with attention-deficit/hyperactivity disorder and/or learning disorder (ADHD/LD) perform worse on cognitive testing and are flagged invalid more often. It is unclear if this is due effort issues or cognitive difficulties from neurodevelopmental diagnoses. This study investigated the effect of self-reported ADHD/LD on performance validity testing (PVT).

Methods
231 NCAA athletes completed baseline ImPACT and one of two stand-alone PVTs (Medical Symptom Validity Test or Rey Dot Counting Test). Athletes (n=44; 19%) self-reported ADHD and/or LD. Effort was operationalized as a dichotomy (pass/fail 1+ indicator) and as a continuum (0, 1, 2, or 3+ failed indicators). Chi-square assessed the relationship between ADHD/LD and effort. Linear models assessed the relationship between ADHD/LD and clinical outcomes.

Results
Athletes with ADHD/LD reported more symptoms, less sleep, and performed worse on ImPACT’s Visual-Motor Speed composite (p&lt;.05). When effort was dichotomized (pass/fail), athletes with ADHD/LD were more likely to “fail” PVTs (χ2=4.83; p&lt;.05). When assessed on a continuum, athletes with ADHD/LD were more likely to fail 2+ indicators (45.5% versus 27.3%) but were not more likely to fail only 1 indicator than neurotypical athletes (18.2% versus 16.6%; χ2=6.55; p&lt;.05).

Conclusions
Results suggest that ADHD/LD may increase the number of effort indicators failed; however, failure rates for one indicator may be similar to healthy controls. It is still unclear whether this performance is due to poor effort or diagnostic considerations. Future research is needed.
A-44 Piloting the Feasibility and Tolerability of a Post-Concussion Intervention
Authors: Morigney J , Squires R , Seagly K 
Published: June 2023

Abstract

Purpose
As yet, there is no gold standard treatment approach for persistent symptom experience following concussion, including sports-related concussion. As most methodologically sound studies indicate brain recovery following concussion is brief, it follows that other factors can maintain persistent symptom experience after the brain has healed. The literature indicates factors can include psychological status, avoidance of activity and emotion, poor sleep, and feeling isolated. As such, treatment should focus on these factors.

Methods
This pilot study examined the feasibility and tolerability of a virtual group intervention combining evidence-based concussion education with CBT- and ACT-based interventions to address the above factors. The goal of treatment was to redirect patients back to participation in values-based activities, with provision of coping strategies, thus decreasing focus on and experience of symptoms. Seventy-six patients who were at least three months post-injury and reporting continued post-concussion symptoms were clinically referred and sequentially enrolled in a virtual six-session concussion recovery group. The Concussion Symptom Checklist (CSC) was administered pre- and post-treatment to assess symptoms. Anonymous qualitative feedback about the group was also collected.

Results
Most patients remained enrolled in the group, missing no more than one session. Statistically significant decreases in both symptom severity and frequency were found from pre- to post-treatment. Qualitative patient feedback was predominantly positive.

Conclusions
The virtual concussion recovery group intervention was feasible, well-tolerated, and well-liked. Though no generalizations can be made from limited preliminary outcome data, there is indication that the severity and frequency of symptom experience, as measured by the CSC, decreased with this treatment.
A-45 Criteria for Determining Clinical Recovery from Concussion: A Survey of Sports Concussion Specialists
Authors: Moser R S , Choi D , Uhrig C , Broglio S , Mayer B , Boltz A , Master C , Schatz P 
Published: June 2023

Abstract

Purpose
To poll sports concussion specialists regarding most frequently used criteria for determination of concussion recovery.

Methods
Seventy-four participants responded to a survey including 17 items regarding clinical recovery from concussion in youth and adults. Overall, 69 reported treating patients with sports concussion, meeting criteria for inclusion (92.8% white, 53.6% male). Participants included neuropsychologists (n=35), certified athletic trainers (n=30), physicians (n=3), and one physical therapist who rated (1=Not Important; 5=Essential) clinical criteria for concussion recovery decisions.

Results
For youth, the majority of participants provided the highest “Essential” modal rating for all six criteria: Normal visual/ocular motor testing; non-contact physical exertion without symptoms; completion of graded return-to-play protocol; full day of school without symptoms; no concerns in physician exam; no fear/avoidance/anxiety in return to sport. For adults, highest model ratings included seven items: participation in non-contact exertion without symptoms; passed formal physical exertional testing; completion of graded return to play protocol; completion of full day of work/school without symptoms; physician exam with no concerns; no report of fear/avoidance/anxiety regarding return to sport; athlete reports feeling 100% back to normal. In adults, 79% indicated one week of no symptoms was sufficient to help indicate recovery and 75% indicated so for youth. For youth and adults, 56% of respondents endorsed use of neurocognitive testing as Essential/Very Important.

Conclusions
This study revealed similarity in concussion recovery decisions for adults and youth with minor differences. These results provide first steps toward documenting a template of current clinical practice for defining concussion recovery.
A-50 A Review of the Dangers of Misdiagnosing Concussions as Depression
Authors: Re S 
Published: June 2023

Abstract

Purpose
Underrepresentation of concussion diagnoses is of increasing concern for the health and wellbeing of young athletes. Similarly, there is increased attention on the mental health of student athletes. Less addressed, however, is potential for misdiagnosis between these concerns. This literature review explains the underpinnings of the potential misinterpretation of concussion symptoms under the guise of depression.

Methods
Peer reviewed studies published within the last 25 years were included in this review. Specific statistics referring to current high school and collegiate athletes included peer reviewed articles from 2020-2023.

Results
Depression and concussions are correlated, further, experiencing TBI and concussion puts an individual at increased risk for developing depression. Additionally, many symptoms of concussion overlap with diagnostic criteria for depression such as: fatigue, suicidal ideation, anhedonia, sleep difficulties, and low mood. The risk of misdiagnosis of depression in concussed athletes is apparent. However, no known study has demonstrated the rate of this misdiagnosis. Treatment for concussion recovery and depression management is fundamentally different, which calls for accurate differentiation between the occurrence of depressive symptoms and head trauma induced symptoms.

Conclusions
Future research regarding affordable and accessible methods to differentiate depression from concussion will help reduce the chances of misdiagnosis. Understanding the considerable overlap in symptomatology and importance of recognizing both concussion when it occurs as well as depression is essential for individuals working with student athletes. Improved education for high school and college coaches and athletes, along with clinicians and physicians is a key component in this change.
A-53 Co-Occurring Depression and Anxiety Increases Prospective Risk for Concussion
Authors: Riegler K E , Bradson M L , Sakamoto M S , Arnett P A 
Published: June 2023

Abstract

Purpose
There is limited research examining whether mental health concerns increase risk for future concussion, despite these difficulties being highly prevalent in college-age populations and student-athletes. This study investigates whether affective disturbance at baseline increases the risk for prospective concussion. We predict that athletes with co-occurring depression/ anxiety will incur the greatest risk for injury.

Methods
886 collegiate athletes completed baseline neuropsychological testing and were prospectively followed as part of a sports concussion management program. Athletes were separated into 4 groups (HCs, Depression Alone, Anxiety Alone, Co-Occurring Depression/Anxiety) based on self-reported anxiety and depression at baseline. Of the 886 athletes, 96 sustained future concussion. Logistic regression was conducted with prospective concussion (yes/no) as the outcome, and affective group as the predictor. Sex and sport were examined as covariates.

Results
After controlling for sport, athletes in the Co-Occurring Depression/Anxiety group were more than twice as likely to sustain prospective concussion compared to HCs, p=.03, OR=2.18, 95% CI [1.10,4.33]. Though not statistically significant, athletes in the Co-Occurring Depression/Anxiety showed a 59% and 56% increased risk for prospective concussion compared to the Depression Alone and Anxiety Alone groups, respectively. Athletes in the Depression Alone and Anxiety Alone groups both showed a 31% increased risk for prospective concussion compared to HCs.

Conclusions
Athletes with co-occurring depression/anxiety at baseline show a notably increased risk for sustaining future concussion, even after controlling for sport. These findings highlight the importance of screening for depression and anxiety at baseline to provide treatment for these athletes, improve well-being, and reduce concussion risk.
A-57 Resilience and School/Social/Home Life Disruption During Recovery in Concussed Adolescents
Authors: Shurtz L , Bunt S C , Chowdhury S K , Didehbani N , Stokes M , Miller S M , Bell K R , Cullum C M 
Published: June 2023

Abstract

Purpose
Resilience is an important factor in concussion recovery. Investigation of the relationship between resilience and level of perceived life disruption may prove beneficial in further understanding concussion recovery in adolescents.

Methods
Participants aged 12-18 who sustained a concussion (n=779) were evaluated within 30 days of injury at a North Texas Concussion Registry (ConTex) clinic. Participants completed the Brief Resilience Scale (BRS) at initial visit and were grouped as low, average, or high resilience. At 3-month follow-up, data were collected on perceived disruption in school/work, social life, and home responsibilities. ANCOVA with age as a covariate was used to determine differences between resilience groups.

Results
Significant differences in perceived disruption were found between participants with low versus high resilience: school/work [F(2, 775)=3.02, p=.049], social life [F(2, 775)=4.77, p=.009], and home responsibilities [F(2, 775)=5.18, p=.006] with the low resilience group endorsing higher levels of disruption and the high resilience group endorsing lower levels of disruption. There were no significant differences between the average resilience group and other groups in these areas, though these participants were descriptively intermediate. Age was found to be a covariate in disruption of school/work (p=.012) and social life (p=.019), but not in home responsibilities (p=.30).

Conclusions
Adolescents with lower resilience may perceive greater disruption in school/work, social life, and home responsibilities during concussion recovery, and age may modify aspects of this relationship. Adolescents with lower resilience may benefit from additional attention following concussion.
A-58 ImPACT remote administration? Can athletes take it at home?
Authors: Slicer K , Stafford C , Bennett R 
Published: June 2023

Abstract

Purpose
The current study aimed to evaluate environmental effects of neurocognitive baseline performance and overall symptom reports among student-athletes who took the ImPACT baseline assessment in a clinical setting or their home environment.

Methods
Participants were selected from an archival de-identified database. The sample consisted of 1,893 (37.3% male and 62.7% female) student-athletes with a mean age of 19.71 years. All student-athletes were administered ImPACT as a neurocognitive baseline screener prior to the beginning of their respective sport. Student-athletes were further divided into two groups: 1. At-home (n=405), and 2. In-clinic (n=405). Multiple independent samples t-tests were utilized to compare mean composite scores between the two groups.

Results
The independent samples t-test yielded a significant difference between groups on the ImPACT reaction time composite score, t(1891)=3.81, p&lt;.001, and total symptom score, t(1891)=1.74, p=.024. Student-athletes who completed ImPACT at home demonstrated a significantly higher (slower) reaction time while also reporting significantly fewer symptoms.

Conclusions
When COVID-19 shut down our once-perceived “normal” societal function, university athletics were forced to change how they conducted concussion baseline screening for their student-athletes. The findings of the present study suggest the need for careful consideration regarding the environment of such neurocognitive baseline assessments as some factors including reaction time and total symptom report may be influenced by the test setting. Future studies should further explore possible confounding variables related to concussion assessment, such as test environment, that may be a unique precipitating factor of the COVID-19 pandemic.
A-68 The Relationship Between Brain Injury And Substance Use Patterns In University Students
Authors: Wilson A , Cherry J , Gicas K , Wojtowicz M 
Published: June 2023

Abstract

Purpose
Our prior research has suggested that athletes with history of traumatic brain injuries (TBIs) are at greater risk of single and polysubstance use. The present study further explored the factors associated with this relationship in a large undergraduate population.

Methods
894 university students (44% athletes) completed self-reported TBI history (blows to the head or whiplash causing loss of consciousness or memory, or feeling dazed), substance use (Alcohol and Cannabis Use Disorders Identification Tests (AUDIT; CUDIT)) and psychological measures. Relationships between these factors were examined using linear regression models.

Results
200 (22.4%) students reported a history of one or more TBIs (45.63% sport-related). TBI history predicted current cannabis and alcohol use, with those with a history of multiple TBIs reporting more problematic use of each substance (ps&lt;.01) as well as greater polysubstance use (p&lt;.001). Past history of depression predicted more problematic cannabis use (p=.007), while past history of anxiety and depression predicted more problematic alcohol use. When examining multiple factors associated with use, history of TBIs (p=.008) and higher current depression symptoms (p=.006) predicted more problematic cannabis use, whereas for alcohol users, history of TBI and female sex was related to more problematic use (p=.041).

Conclusions
History of TBI predicts higher levels of substance use and polysubstance use and increased number of TBIs and mental health problems may be related to greater risk of hazardous substance use. Consideration of TBI history is essential for identifying players at risk for engaging in problematic behaviours such as hazardous substance use.