bluuebunny/crossref_metadata_2025_split huggingface dataset:
A-04 Play After Concussion on Initial Symptom Burden and Length of Recovery
Authors: Allen D R , Guerin J , Bowman C , Gioia G A , Vaughan C G 
Published: June 2023

Abstract

Purpose
Removal from play after a concussion is a standard requirement across sports in order to reduce risk of re-injury. This study examines the effect of ongoing play on early symptom status and overall length of recovery.

Methods
191 adolescents aged 11-19 (mean age=15.3± 1.6, 57% male) presenting within 30 days of a concussion completed the Post-Concussion Symptom Inventory-2 (PCSI-2). Participants were recovered when their PCSI-2 Total Retrospective Adjusted Post-Injury Difference (RAPID) scores fell below the psychometrically established cut-off for minimal symptoms. ANOVAs compared initial symptom status and length of recovery (LOR) between those who continued play (CTP) and who were removed from play (RFP) after injury, by sex.

Results
No difference in initial symptom level was found between individuals who CTP versus those RFP (PCSI-2 RAPID mean 24.7 vs. 22.1, p=.41). A marginal difference was found in LOR between CTP versus RFP (31.7 vs. 27.2 days, p=.088). Marginally higher symptom levels were found for females vs. males (mean=26.4, 20.4, respectively, p=.055). Females took longer to recover than males (33.7 vs. 25.2 days, p=.001, η2=.05). There was no interaction between CTP by sex on symptom levels (p=.92) or on LOR (p=.10), after accounting for CTP and sex alone. However, females who CTP had longer LOR compared with females who were RFP (38.0 vs 29.3 days, p=.029).

Conclusions
Findings show marginal overall difference in symptom status but not LOR based on immediate removal from play. Females who CTP had longer recovery suggesting a possible sex-specific interaction effect of ongoing play after concussion.
A-05 Clinical Considerations for the Management of Post-Concussion Psychogenic Speech Impairments
Authors: Amalfe S A , Jennings S , McIndoe E , Durfee K , Dollar C , Womble M , Elbin R J 
Published: June 2023

Abstract

The purpose of this case study was to present clinical approaches for psychogenic speech impairments following concussion.

Methods
Retrospective chart review of a 17-year-old Black male (Patient 1) who sustained a sport-related concussion and a 46-year-old Hispanic female (Patient 2) who sustained a concussion following a motor vehicle accident and exhibited dysfluencies after injury. Both completed a clinical interview, symptom, neurocognitive, vestibular-ocular motor, and mood assessments at each clinical visit. Clinical impressions and management decisions were discussed with treating neuropsychologists.

Results
At intake, neither patient was attending school/work. Both endorsed significant state anxiety, mild depression, and processing speed impairment. Patient 1 reported dysfluency ~2 hours post-injury, characterized as rapid repetition of sounds followed by full words, which increased under stress. The clinical evaluation required extra time and included psychoeducation regarding atypical speech patterns and stress management. Patient 1 was encouraged to resume school, non-contact cheerleading, and counseling sessions. Speech dysfluencies resolved at 24 days post-injury without speech intervention. Patient 2 reported dysfluency at 32 days post-injury after witnessing an MVA which provoked isolated aphasia followed by a consistent psychogenic speech pattern. Dysfluency was triggered by light/noise sensitivity and some parts of the clinical evaluation were not tolerated following exposure. Vestibular therapy increased dysfluency and was replaced with speech therapy and numerous medication trials (SSRIs, beta-blockers, benzodiazepines) without success. The patient returned to work after 9 months and did not fully resolve speech abnormalities.

Conclusions
Speech abnormalities following concussion are variable and require the clinician to be flexible with the evaluation and treatment plan.
A-19 Sex Differences in Post-Concussion Symptom Reporting of Elementary School-Aged Children
Authors: Datoc A , Mathew A , Boucher S , Choi D , Ellis C , Abt J , Burkhart S 
Published: June 2023

Abstract

Purpose
Research on sex differences in the presentation of concussion has produced mixed findings and have primarily studied adolescents and adults. The purpose of this study was to explore sex differences in post-concussion symptom reporting and recovery time in elementary school-aged children.

Methods
Retrospective data were abstracted from the medical records of patients aged 5-10 who presented to a specialty concussion clinic between 2020-2023 (N=109, 67% male). Groups were divided based on sex (female=36, Mage=8.9; male=73, Mage=8.8). A MANCOVA was conducted to determine the relationship between sex and Post-Concussion Symptom Scale total scores at initial visit (PCSS-1), PCSS total scores at follow-up visit (PCSS-2), and recovery time. Covariates included were age and days since injury (DSI).

Results
Mean DSI at initial visit was 8.5±23.9 for females and 5.7±6.4 for males. There was a significant difference between males and females on the combined dependent variables (Wilks’ Λ=.87, F(3,103)=5.36, p=.002, partial η2=.14) after controlling for age and DSI. Females reported significantly more symptoms than males on PCSS-1 (Mfem=31.8±21.3, Mmale=22.4±19.3; p=.02) and PCSS-2 (Mfem=17.1±18.5, Mmale=6.0±10.2; p&lt;.001). Recovery days were not significantly different between sexes (Mfem=38.7±43.6, Mmale=31.0±43.9; p=.06).

Conclusions
Commensurate with studies that have evaluated sex differences in concussion in older cohorts, females reported greater symptom burden than their male peers. While not significantly different, females took one week longer to recover than males, suggesting that higher symptom reporting during initial and subsequent concussion visits is not necessarily indicative of longer recovery time. To provide tailored care, future research should examine sex differences in specific symptoms reported post-concussion across age cohorts.
A-24 Behavioral Regulation is Associated With De creased Post-Concussion State Anxiety and Depression
Authors: Durfee K J , Jennings S , Womble M N , Amalfe S , Dollar C M , Schatz P , Kontos A P , Collins M W , Elbin R J 
Published: June 2023

Abstract

Purpose
To examine the effects of self-reported behavioral regulation on post-concussion anxiety and depression in individuals with sport-related concussion (SRC)

Methods
A retrospective chart review of patients (ages 15–25yrs) seeking care for a SRC within 1-7 days following injury were included in this study. Participants completed a self-report, 4-point Likert scale (0-Never, 3-Most of the Time) questionnaire that assessed the previous week’s frequency of Sleep, Physical Activity (PA), Diet, Hydration, and Stress Management behavioral regulation domains. Scores were divided into HIGH (Most of the Time) and LOW (Some of the Time – Never) regulation groups for each domain. A series of independent samples t-tests and analyses of covariance (ANCOVA) were used to compare these groups on state anxiety (STAI) and depression (PHQ-9) scores.

Results
One hundred thirty-two participants (M=16.42, SD=1.95 yrs, 45% female) completed the study measures at 3.85 days post injury (SD=1.40). Participants in the HIGH behavioral regulation groups for Sleep (F(1,129)=4.67, p=.03), PA (F(1,128)=8.88, p=.003), and Stress (t(130)=1.89, p=.03) demonstrated significantly lower state anxiety scores than the LOW groups. Depression scores were significantly lower for the HIGH behavioral regulation in Sleep (F(1,129)=8.70, p=.004), Diet (F(1,125)=10.22, p=.002), and PA (F(1,128)=5.09, p=.03) domains than the LOW groups.

Conclusions
Behavioral regulation affects post-concussion state anxiety and depression. This low cost, non-pharmacological strategy should be the first step for the management of SRC.
A-27 Using The Concussion Clinical Profiles Screening Tool And Pre-injury Risk Factors To Identify Concussion Profiles
Authors: Gomes D , Burley C , Rabon W , Preszler J , Collins M , Kontos A 
Published: June 2023

Abstract

Purpose
To determine the ability of the Concussion Clinical Profiles Screening Tool (CP Screen) and pre-injury risk factors to accurately predict concussion profiles.

Methods
Sample included 297 patients (59.3% male, mean age=16.6 years), 73.7% sport-related injuries, previously diagnosed with concussion. Patients completed the CP Screen and medical histories. Receiver operating characteristics (ROC curves) provided area under the curves, and sensitivity and specificity values.

Results
The post-traumatic migraine (PTM) composite resulted in an AUC of .63 (95% CI=.55-.68); sensitivity was 0.19 and specificity was .86 at a 4.5 symptom cutoff score. The anxiety/mood composite resulted in an AUC of 0.84 (95% CI=.78-.88); sensitivity was .56 and specificity was .88 at a 4.5 symptom and risk-factor cutoff score. The vestibular composite resulted in an AUC of 0.71 (95% CI=.66-.78); sensitivity was .37 and specificity was .87 at a 4.5 symptom and risk-factor cutoff score. The ocular composite resulted in an AUC of .55 (95% CI=.52-0.66); sensitivity was .30 and specificity was .79 at a 4.5 symptom and risk factor cutoff score. The cognitive composite resulted in an AUC of .52 (95% CI=.40-.57); sensitivity was .35 and specificity was .63 at a 4.2 symptom cutoff score.

Conclusions
The anxiety/mood and vestibular composites demonstrated strong predictive utility, while PTM, ocular, and cognitive fatigue composites did not. The combined CP Screen and health histories may be sufficient to predict concussion profiles within the domains of anxiety/mood and vestibular.
A-28 Systemic Failures Impacting Concussion Symptom Non Disclosure and “Toughing it out” Among Black Athletes
Authors: Goodwin G , Richards D , Williams J 
Published: June 2023

Abstract

Purpose
Despite socio-political and community efforts to shift the narrative among college and professional sports toward injury disclosure, “toughing it out” narratives continue to impact players and, more specifically, Black players. Symptom nondisclosure narratives disproportionately affect Black athletes' concussion symptom knowledge and willingness to disclose a concussion. The purpose of this study is a call for accountability, fellowship, and active caring of Black college and professional athlete’s in order to promote concussion symptom disclosure.

Data Selection
A literature review of peer-reviewed articles from 2018 to 2022 from PubMed and Google Scholar was conducted. Keywords include racial disparities, concussions, identity, and professional and college athletes. Informal analyses were used to identify and analyze themes across articles, including health disparities, concussions, and nondisclosures.

Data Synthesis
Black athletes are more likely to under-report concussion symptoms than their white counterparts. Power and privilege within the context of institutionalized racism inform disparities in concussion psychoeducation. Black athlete identity formation within white institutions further informs willingness to report symptoms. Consequently, concussion non-disclosure can put athletes at risk for repetitive head injury, persisting neurocognitive, and psychological deficits.

Conclusions
Recognizing the role of systemic racism in concussion symptom reporting is critical. Neuropsychologists are responsible for understanding intersectionality, institutional racism, and Black athlete identity. To this end, concussion symptom non-disclosure needs to be conceptualized as suppression of Black athletes' voices and wellbeing. A shift towards fellowship and active caring is needed to understand athlete identity among Black athletes and how these narratives influence symptom disclosure over time.
A-31 Normative Data For Cognitive, Physical, Affective, And Sleep-Arousal Symptom Subscales Of The SCAT-3 Symptom Evaluation
Authors: Ingram E O , Karr J E 
Published: June 2023

Abstract

Purpose
Develop baseline normative reference data for the Sport Concussion Assessment Tool-3 (SCAT-3) Symptom Evaluation and examine how sex and preexisting conditions relate to the symptom domains endorsed by collegiate athletes.

Methods
Participants (N=24,696 collegiate student-athletes; 62.6% Male, 61.5% White, 9.2% Hispanic or Latino) from the Concussion Assessment, Research, and Education Consortium completed the SCAT-3 at a preseason baseline. Using a four-factor model (i.e., cognitive, physical, affective, and sleep-arousal), normative percentiles were calculated for each symptom subscale and the total score, with stratifications by sex and number of preexisting conditions. Symptom score distributions were compared across stratifications using Mann-Whitney U tests.

Results
Generally, female athletes and those with more preexisting conditions endorsed significantly higher symptoms at baseline (e.g., 84th percentile affective score: males=1, females=3, p&lt;.001, r=.14; females with 1 condition=4, 3+ conditions=8, p&lt;.001, r=11; males with 1 condition=3, 3+ conditions=7, p&lt;.01, r=.06). This pattern held for all but the physical (i.e., no difference between individuals with 1 and 3+ conditions) and sleep-arousal (i.e., no difference between males with 1 and 3+ conditions) subscales.

Conclusions
Female sex and preexisting conditions were associated with higher symptom burden on most subscales. A female athlete with a symptom score of 10 may appear to have elevated post-concussion symptoms; however, if she has 3 preexisting conditions, this experience is average (i.e., 50th percentile) compared to others with 3+ conditions at baseline. She may benefit from intervention, but symptoms may not be attributable to a concussion. Normative reference data may help indicate symptom severity when baseline data are unavailable.
A-33 Examining Acute Symptoms after Sport-Related Concussion in Collegiate Athletes with Pre-Injury Migraines
Authors: Jo J , Maxwell B A , Berkner P D , Iverson G L , Zuckerman S L , Terry D P 
Published: June 2023

Abstract

Purpose
To examine whether a personal history of migraines is associated with worse acute symptom burden following sport-related concussion (SRC) in collegiate athletes.

Methods
Data were collected through a prospective concussion surveillance system in 11 NCAA Division III college athletic programs between September 2014 and January 2023. Mann-Whitney U tests compared total Post Concussion Symptom Scale (PCSS) score and individual symptom scores (taken within 3 days of injury) between collegiate athletes with and without pre-injury migraines. Chi-squared tests were used to compare proportions of athletes endorsing individual symptoms (i.e., item score ≥1) between the two groups. Multivariable regression analyzed potential predictors of PCSS scores.

Results
Of 1,190 athletes with an SRC, 93 (7.8%) had a pre-injury history of migraines. No significant difference in total PCSS scores were found between athletes with and without pre-injury migraines (22.0±16.4 vs. 20.5±15.8; U=48719, p=.47). Athletes with pre-injury migraines reported greater “sensitivity to light” (1.59±1.59 vs. 1.23±1.41; p=.04) and “feeing more emotional” (0.91±1.27 vs. 0.70±1.30; p=.008). Athletes with migraine histories were more likely to endorse “feeing more emotional” (45.2% vs. 29.5%; p=.002). No differences were found across all other symptoms. In a multivariable model, history of migraine was not a significant predictor of acute PCSS scores, but those with a history of depression (β=0.12, p&lt;.001) and longer days to symptom evaluation since injury (β=0.08, p=.005) had higher PCSS scores.

Conclusions
Collegiate athletes with a pre-existing history of migraines did not have higher acute symptom burden following SRC. Future studies should investigate whether migraine history is associated with recovery time.
A-35 Difficulty Speaking, Stuttering, and Missing Words Post-Concussion: Findings from Two Independent Studies
Authors: Kennedy C J , Garcia-Barrera M A 
Published: June 2023

Abstract

Purpose
The current investigation examined the potential consequences of concussion on speech-language abilities by analyzing quantitative and qualitative data from two independent studies.

Methods
Study 1: 185 rugby, soccer, football, rowing, and hockey athletes (M=17.42 years, SD=3.80; 44% female) completed the Rosenbaum Concussion Attitude and Knowledge Survey (RoCKAS). Study 2: 19 varsity soccer, rugby, volleyball, and basketball athletes (M=21.74 years, SD=2.13; 37% female) with history of at least one concussion completed individual one-hour semi-structured interviews, and thematic analysis was used to identify patterns across athletes’ experiences of concussion.

Results
Study 1: Quantitative analysis of athletes’ endorsements of distractor and legitimate post-concussive symptoms on the RoCKAS yielded a relatively low rate of endorsement across all distractor symptoms (1–29%, M=11%), with the exception of ‘difficulty speaking’, which was endorsed by majority (70%) of the sample. Study 2: Thematic analysis of interview content identified long-term difficulties with speech articulation (i.e., stuttering and word-finding) as a post-concussive symptom for 42% of the sample.

Conclusions
While speech abilities are largely thought to remain intact following concussion, quantitative and qualitative findings from these two independent studies suggest that speech difficulties may be an overlooked outcome of concussion. Several neuropsychological (e.g., attention, memory, executive function, or processing speed) and neuropathophysiological (e.g., diffuse axonal damage to cortico-subcortical pathways) processes may be underlying this relationship. Exploratory studies and longitudinal data are needed to elucidate the potential consequences of concussion on speech-language abilities.
A-41 The Use of Virtual Reality for the Diagnosis of Pediatric Sports-Related Concussion: A Feasibility Study
Authors: Mathew A , Datoc A , Boucher S , Choi D , Ellis C , Abt J , Worts P 
Published: June 2023

Abstract

Purpose
Virtual Reality (VR) based concussion software has shown potential in diagnosing sports-related concussion (SRC). The purpose of this study was to explore potential symptom provocation when using a VR based diagnostic concussion software among SRC patients.

Methods
Pediatric SRC patients aged 12-18 and within 72 hours from injury to initial visit were recruited. While wearing the VR device, patients were instructed to fixate gaze on various targets to track eye movements in a gamified manner. The Post-Concussive Symptom Scale (PCSS) and Virtual Reality Sickness Questionnaire (VRSQ) were administered on a scale of 0 (none) to 3 (severe).

Results
A total of 21 patients were eligible (Age=14.9±1.7; Female 57.1%; White 61.9%). Patients noted minimal to no symptoms in terms of discomfort (.48±.60), fatigue (.48±.68), headache (1.48±.60), eye strain (.90±.77), inattention (.38±.59), blurred vision (.29±.64), and dizziness (.71±.56) while completing the VR task.

Conclusions
Compared to other studies using VRSQ among healthy subjects, our sample of acutely injured children with SRC reported minimally provoked symptoms that were below empirically established limits. Specifically, both components of the VRSQ (ocular component MOcu=3.24, SD=1.89; disorientation component MDis=2.59, SD=2.27) ranked below the average limit compared to other studies using VRSQ (MOcu=6.7; MDis=5.8). Future research should gather validity and reliability data to establish the clinical environment in which to diagnose pediatric SRC.
A-48 Comparative Analysis of Adolescents With a Sport-Related Concussion Versus Non-Sport-Related Concussion During Initial Visit
Authors: Patel S , Trbovich A , Burley C , Mehmel B , Kegel N , Kontos A , Collins M 
Published: June 2023

Abstract

[Outstanding Trainee Award Winner]

Purpose
To investigate differences in pre-injury risk factors and clinical outcomes in adolescents with a Sport-Related Concussion (SRC) versus non-Sport-Related Concussion (non-SRC).

Methods
Participants (n=136, aged 10-18) presented to a specialty concussion clinic 2-30 (M=9.25) days post-injury. They completed a clinical interview with a trained clinician and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profile Screening (CP Screen), Vestibular/Ocular-Motor Screening (VOMS), Screen for Child Related Anxiety Disorders - Child Version (SCARED-C), and the Generalized Anxiety Disorder Assessment (GAD-7). Data analyses utilized independent sample t-tests, chi-square tests, and descriptive statistics to compare clinical outcomes of both groups during initial visit. Alpha was set to p&lt;.05 for all analyses.

Results
Adolescents with non-SRC took longer to seek specialty concussion care, were majority female, and were older than the SRC group. Non-SRC participants also reported a higher rate of migraine, depression, and anxiety history (i.e., SCARED-C Panic Disorder, SCARED-C Generalized Anxiety Disorder, and SCARED-C Anxiety Disorder). Additionally, non-SRC participants reported more symptoms on the PCSS Total score, and on most VOMS items, including Smooth Pursuits, Horizontal and Vertical Saccades, Horizontal and Vertical Vestibular-Ocular Reflex, Visual Motion Sensitivity, as well as VOMS Total. Non-SRC group also reported higher post-injury anxiety scores (i.e., GAD-7). All findings were below the p-value of .05.

Conclusions
The study findings suggest that mechanism of injury and individual risk factors play a significant role in determining the clinical presentation of a concussion in an SRC and non-SRC adolescent population.
A-51 EYE-SYNC Saccade Outcomes and Health/Demographic Factors in CFL Athletes
Authors: Ree-Fedun Q , Wagner R , Mrazik M 
Published: June 2023

Abstract

Purpose
Examine the relationship between demographic and health factors, and oculomotor functioning during baseline testing in professional Canadian Football League (CFL) athletes.

Methods
428 male athletes participated in baseline concussion testing. Athletes ranged in age from 21 to 40 years (M=26.44, SD=2.87) and reported a history of 0, 1, or 2+ sport-related concussions (SRCs). All athlete participants completed the Head Check questions of demographics and medical history, and the EYE-SYNC saccade test to explore how the presence of a history of concussions, Attention-Deficit/Hyperactivity Disorder (ADHD), Learning Disability (LD), age, and post-exertion influenced baseline measures of oculomotor functioning using the EYE-SYNC saccade outcomes of accuracy and precision.

Results
Correlations revealed no significant relationships between combined vertical and horizontal saccade outcomes and the demographic/health variables (p&gt;05). Independent t-tests indicated no significant differences in mean saccade performance between athletes with and without ADHD and/or LD (p&gt;.05). A three-way multiple analysis of variance, run with age group and four saccade outcomes (LeftAccuracyXY, LeftPrecisionXY, RightAccuracyXY, RightPrecisionXY), showed no main effect of age group on the combined saccade outcomes F(8, 844)=.91, p=.50. Finally, a one-way repeated measures analysis of variance also revealed no significant differences from pre- to post-exertion assessments, F(4, 56)=.41, p=.80.

Conclusions
The oculomotor functioning of CFL athletes at baseline does not appear to be influenced by a history of concussion, ADHD, LD, age, or physical exertion. This information may help professionals with their clinical decision-making regarding SRC diagnosis.