bluuebunny/crossref_metadata_2025_split huggingface dataset:
A-16 Self-reported balance disturbance and performance-based balance measures in varsity level athletes with and without concussion history
Authors: Butterfield K M , Wilson A , Mochizuki G , Wojtowicz M 
Published: June 2023

Abstract

[Outstanding Trainee Award Winner]

Purpose
Assessment of postural balance in varsity athletes is essential to managing sport-related concussion. The current study characterizes the relationship between subjective and objective measures of balance in varsity athletes.

Methods
A total of 208 varsity athletes across 12 sports participated in pre-season testing from June 2019 to January 2020 (no history of concussion= 117; 1+ past concussion= 91). Measures included the Sport Concussion Assessment Tool (SCAT-5) and the AccuGait force plate. Relationships between objective and subjective balance measures were assessed using correlations, parametric, and non-parametric tests.

Results
Of the total sample, 9.6% (n=20) endorsed subjective balance issues and 5.3% (n=11) reported subjective dizziness. Those with a history of concussion, endorsed greater total number of symptoms at baseline (M=2.95, SD=4.03) than those without (M=1.90, SD=3.07; p=.04; Cohen’s d=.30). However, there were no differences on subjective or objective balance measures (i.e., total balance error on the MBESS or force plate measures; ps&gt;0.05) between athletes with and without a history of concussion. For those with no history of concussion, total balance errors from the Modified Balance Error Scoring system were significantly associated with force plate metrics in the eyes closed condition (ps&lt;0.05) but not the eyes open condition. These associations were not observed in athletes with history of concussion (ps&gt;0.05). Similarly, no associations were found between subjective balance issues and objective balance metrics.

Conclusions
Overall, findings suggest poor alignment between subjective and objective balance measures in varsity athletes, regardless of concussion history. Associations were observed across the objective balance measures in those with no history of injury, but not in athletes with a history of concussion.
A-20 Chronic Traumatic Encephalopathy Concerns Among Aging Amateur Football and Non-Football players: Preliminary Data from CLEAATS
Authors: Doggett H , Didehbani N , LoBue C , Cullum C M 
Published: June 2023

Abstract

Purpose
We evaluated self-reported concerns about developing 1) chronic traumatic encephalopathy (CTE) and 2) “permanent memory or thinking problems” due to head-injury exposure among former football and non-football college-level male athletes 50 or older.

Methods
188 male participants (Mean age=64.4 years, 90% White) completed a comprehensive online survey for the College Level Aging Athlete Study (CLEAATS). Using chi-squared tests, frequency of self-reported concerns between football players and non-football players for two different survey questions were evaluated: 1) concerns for developing CTE, and 2) concerns for developing “permanent memory or thinking problems” related to a history of concussions and/or head impacts. Level of concern was measured on a 5-point scale ranging from 1=Not at all to 5=extremely.

Results
Former football players (n=102) endorsed greater concerns about CTE (X2 [1, N=188]=45.86, p&lt;.001) than non-football players (n=86), with 20.5% (21/102) indicating they were “moderately” or “extremely” concerned, compared to 6.9% (6/86) of non-football players Similarly, former football players (n=102) endorsed greater concerns of developing permanent memory/thinking problems, with 32% (31/102) reporting moderate to extreme concerns, compared to 11.6% (10/86) of non-football players (X2 [1, N=188]=30.3, p&lt;.001).

Conclusions
Preliminary data found that 1/5th of former college football players over age 50 expressed significant concerns of developing CTE. One-third had significant concerns about their long-term cognition. This is despite the unknown prevalence and risk factors for cognitive problems, dementia, or CTE among contact-sports participants. We suggest continued caution when reporting on long-term outcomes in former athletes, given the elevated concerns in the context of currently mixed literature.
A-21 Do Guardian Caps Reduce Concussion Frequency, Symptom Severity, and Time-Loss After Concussion In Football Athletes?
Authors: Donahue C C , Rosenblum D R , Pugh K F , Resch J E 
Published: June 2023

Abstract

Purpose
The Guardian Cap (GC) was designed to mitigate biomechanical forces to football helmets. This pilot study was designed to examine if the use of GCs reduced concussion frequency, total symptom severity (TST), and days-until-symptom-resolution (DUSR) following a SC in collegiate football athletes. We hypothesized the GCs would not decrease SC frequency, TST, or DUSR.

Methods
Participants (N=14) in our cross-sectional study were Division I collegiate football athletes who were diagnosed with a SC (20.0±1.32 years old) who did (GC; n=3) or did not (NoGC; n=11) wear the GC. Only SCs that occurred to athletes required to wear the GC during practice were included in our analyses. As spring practice was cancelled during 2020 due to COVID-19, only fall practices were included in our analyses. The head coach remained consistent during the NoGC and GC study periods. Descriptive statistics were used to examine concussion frequency. Mann-Whitney U tests were used to compare TST and DUSR between groups. Also, [interquartile range] could not be calculated for the GC group due to the low number of SCs.

Results
On median, the number of SCs decreased from 4 to 1.5 per season from the NoGC to the GC period. On median DUSR decreased from 13.5[11] to 5[n/a] for the NoGC and GC groups, respectively (U=9.50,z=-.93,p=.35). TST also decreased from 16[27] to 6[n/a] in the NoGC and GC groups, respectively (U=5.0,z=-1.79,p=.07).

Conclusions
GCs may potentially reduce concussion frequency, TST, and DUSR, however, future research with a larger sample size is needed to confirm and extend our findings.
A-23 Bouncing Back: The Resilience of Executive Functioning Post-Concussion
Authors: Dupriez-Mitchell B , VanderZwaag B , Kennedy C J , Doucette M , Garcia-Barrera M A 
Published: June 2023

Abstract

Purpose
This study aimed to examine the relationship between concussion history and executive function in a sample of Canadian university students.

Methods
247 participants completed an online survey and a web-based assessment battery consisting of nine computerized executive function tasks. Participants self-identified as ‘non-athletes’ (14.75%) or ‘athletes’ (85.25%) and reported having no history of concussion (n=183) or a history of one (n=37), two (n=15), or three or more (n=13) concussions. Bivariate correlations were used to examine the association between concussion history and executive function. The Kruskal-Wallis test was used to assess the effects of concussion history on objective (updating, shifting, and inhibition) and subjective (Total Executive Function Index, [EFI]) executive function.

Results
Concussion history was not significantly correlated with subjective executive functioning (i.e., EFI, r=-.054, p&gt;.05), or computerized executive functioning, including shifting (r=-.014, p &gt; .05), inhibition (r=-.000, p &gt; .05), and updating (r=-.02, p&gt;.05 ) performance. The Kruskal-Wallis test indicated that there was no significant effect of concussion history on EFI scores (χ2(45)=45.7, p=.36), nor shifting (χ2(202)=204.3, p=.44), inhibition (χ2(207)=207, p=.49), or updating (χ2(178)=180, p=.53) scores.

Conclusions
Our findings suggest that concussion history does not significantly impact executive functioning among university students with varying levels of athletic expertise. Protective factors (e.g., higher education and physical exercise engagement) may mitigate the detrimental effects of concussion on executive function.
A-25 Barriers to Protracted Sport Participation in Youth: What Should be the Focus?
Authors: Flowers J , Talamahe'a T , Eve H , Baldini D , Steinbaugh A , Hirst R 
Published: June 2023

Abstract

Purpose
Sports participation is recommended by the mental health field. However, the picture of sports in the U.S. has shifted from school-based to private clubs and continued participation may be difficult for lower income families. The present study examined the influence of socioeconomic status (SES) on total years playing sports, while exploring the influence of full scale IQ (FSIQ), as little research has assessed for intellectual ability as a barrier to youth participation.

Methods
The present study analyzed Wechsler Abbreviated Scale of Intelligence, 2nd Edition (WASI-II) FSIQ and SES, operationalized as maternal education level, data in a sample of youth athletes (n=69, 79.7% male), aged 8-18 years (mean=11.94). Participants competitively participated in soccer, basketball, baseball and/or American football. Multivariate linear regression investigated the influence of SES and FSIQ on total years playing sports.

Results
SES and FSIQ have a significant association with total years played (p&lt;.001) and explain 23% of the variance, with a small combined effect size (r2 =.23). Individually, higher SES significantly predicted greater total years played (p=.005), while FSIQ did not (p=.15).

Conclusions
Higher SES predicted greater total years of sports participation among youth athletes, whereas FSIQ did not. This highlights a necessary focus for low-cost and accessible sporting programs. Due to the significant association with total years played, future research should examine the joint contributions of FSIQ and SES to sports participation.
A-26 Area Deprivation Index and Clinical Outcome Following Concussion in Adolescents
Authors: Gaudet C E , Cook N E , Kissinger-Knox A , Liu B , Stephenson K , Berkner P , Iverson G L 
Published: June 2023

Abstract

Purpose
The purpose of this study was to assess whether socioeconomic status is associated with clinical recovery time following concussion in adolescents.

Methods
Participants included adolescent student athletes (N=130; age M=16.6, SD=1.2; 60.8% boys, 39.2% girls) who attended one of nine selected high schools in Maine, USA. Schools were identified as either higher or lower SES based on the Area of Deprivation Index (ADI), and indicator of neighborhood disadvantage, associated with their address and the percent of students receiving free and reduced lunches. Athletic trainers entered injury and recovery dates into an online surveillance application between September 2014 and January 2020. Chi-square analyses and Kaplan-Meier survival analyses were used to compare the groups on two clinical outcomes: time to return to school and sports.

Results
Results of chi-square tests did not reveal between group differences in time to return to school at 21 or 28 days; however, groups differed in the percentage of adolescents who had returned to sports by 21 days (lower SES, 62.5%, higher SES 82.0%, χ2=4.96, p=.03, OR=2.73, 95% CI, 1.11-6.74) and 28 days (lower SES, 78.6%, higher SES 94.0%, χ2=5.18, p=.02, OR=4.27, 95% CI, 1.13-16.16) following concussion.

Conclusions
The adolescents attending lower SES schools took longer to reach medical clearance for return to sports. Further research is needed to better characterize factors underlying group differences in time to return to sports and examine a broader array of SES indicators. These results may reflect disparities in health care resources between schools serving higher versus lower SES areas.
A-30 The Association between Pre-injury Symptoms and Self-Efficacy in Youth with Concussion
Authors: Guerin J , Allen D , Bowman C , Vaughan C , Gioia G 
Published: June 2023

Abstract

Purpose
Youth’s self-efficacy for managing their recovery is associated with post-concussion symptom severity. The association between pre-injury symptoms and self-efficacy is not known.

Methods
Participants were 947 youth ages 9-18 (mean age=14.28, 52% female) with concussion (mean days since injury=19.11) and their caregivers. Participants and caregivers reported on pre-injury symptom domains (physical, cognitive, fatigue, and emotional) using the age-specific Post Concussion Symptom Inventory-2 (PCSI-2; 8-12 years, 13-18 years, caregiver versions). Self-efficacy for managing concussion recovery was measured using the Progressive Activities of Controlled Exertion-Self-Efficacy (PACE-SE) scale Total score. In these three groups, bivariate correlations examined associations among pre-injury symptoms and self-efficacy.

Results
PACE-SE Total score did not differ based on age or sex. In 9-12-year-olds (n=205), PCSI-2 self-ratings of pre-injury symptoms in the cognitive (r=-.15, p=.03) and emotional (r=-.27, p&lt;.001) domains were negatively associated with the PACE-SE Total score. In 13-18-year-olds (n=742), PCSI-2 self-ratings of pre-injury symptoms in the physical (r=-.20), cognitive (r=-.23), fatigue (r=-.25), and emotional (r=-.34) domains were negatively associated with the PACE-SE Total score (all p&lt;.001). PCSI-2 caregiver-ratings of pre-injury symptoms were not associated with PACE-SE Total score for either age group.

Conclusions
Pre-injury functioning appears to influence confidence in post-injury recovery. Management of concussion recovery should account for pre-injury functioning. Youth who report more difficulties at baseline may benefit from efforts to boost self-efficacy following injury. Future research might further investigate the relationship of the caregiver report of pre-injury functioning with self-efficacy.
A-32 Multidimensionality of the SCAT-3 Symptom Evaluation Before and After Sport-Related Concussion
Authors: Ingram E O , Karr J E 
Published: June 2023

Abstract

Purpose
To determine if a one- or four-factor model (i.e., cognitive, physical, affective, sleep-arousal) of post-concussion symptoms better fits the Sport Concussion Assessment Tool-3 (SCAT-3) Symptom Evaluation at baseline and post-injury time points.

Methods
Participants (N=24,696; 62.6% Male, 61.5% White, 9.2% Hispanic or Latino) were collegiate athletes from universities participating in the Concussion Assessment, Research, and Education Consortium. Student-athletes were given the SCAT-3 during a preseason baseline assessment, and four evaluations based on time since injury following concussion (i.e., 24-48 hours, asymptomatic, unrestricted return-to-play, and 6 months). A series of confirmatory factor analyses were used to test one- and four-factor models of the SCAT-3, using the Comparative Fit Index (CFI) to evaluate fit. A CFI ≥.95 indicated excellent fit and a difference in CFI≥.01 indicated superior fit during model comparison.

Results
The four-factor model showed superior fit at all time points compared to a one-factor model (One-factor: baseline=.89, 24-48 hours=.94, asymptomatic=.96, unrestricted return-to-play=.98, 6-months=.97; four-factor: baseline=.96, 24-48 hours=.97, asymptomatic=.98, unrestricted return-to-play=.99, 6-months=.99).

Conclusions
A multidimensional (i.e., four-factor) approach to the SCAT-3 Symptom Evaluation has a superior fit compared to a total score (i.e., one-factor) interpretation before and after injury. It is not yet clear how, or if, the four-factor model is beneficial in clinical settings for athletes with sport-related concussions. Symptom reporting is a large part of concussion assessment and return-to-play decisions, so future research should examine how concurrent relevant outcomes (i.e., neurocognitive performance, postural stability, long-term health, etc.) are related to symptom factor scores in comparison to total symptom scores.
A-34 Incidence of Sport-Related Concussion in Adaptive Sports: A Scoping Review
Authors: Kaplan D T , Broshek D K , Magill R T , Denton A H , Smetana R M 
Published: June 2023

Abstract

Purpose
Despite an increase in sport-related concussion (SRC) research for non-adaptive athletes, research on para athletes is sparse. The purpose of this scoping review was to examine the incidence of SRCs in para athletes to understand their risk for SRCs.

Methods
This review was registered with Open Science Framework and adhered to PRISMA-ScR guidelines. Searches of electronic databases (CINAHL, Google Scholar, MEDLINE, SPORTDiscus, and Web of Science) were conducted from database creation to February 1, 2023. Articles selected examined SRC incidence in para sports.

Results
Reviewers screened 202 title-abstracts and 32 articles qualified for full-text review, with 12 articles qualifying for data extraction for information on SRC incidence. Incidence rates varied across studies, ranging from no reported concussions to concussions accounting for 43% of injuries in a given sport. Sledge hockey and wheelchair basketball were the most frequently studied populations. Data suggested that para athletes are likely to sustain concussions at a similar rate to non-adaptive athletes. While data on sex differences were scarce, female athletes appeared to sustain more concussions than male athletes.

Conclusions
Based on limited published data, the incidence of SRCs in para athletes appears to be most prevalent in wheelchair basketball and sledge hockey and more common in female than male athletes. Given the limitations of published data, knowledge regarding incidence in other para sports is minimal. It will be important for future research to capture data across multiple para sports to determine concussion risk and inform the development and implementation of protocols for assessing and managing SRCs.
A-36 Performance of Children with Attention Deficit/Hyperactivity Disorder on the Sway Medical Mobile Balance and Cognitive Tests
Authors: Liu B C , Cook N E , Iverson G L 
Published: June 2023

Abstract

Purpose
There is a recognized need for more research relating to preseason balance and cognitive testing, as part of a sport-related concussion medical management program, for middle school children. We examined if preseason baseline performance on the Sway Medical Mobile Balance and Cognitive Tests differs by self-reported ADHD diagnosis in 12- and 13-year-old children.

Methods
Data from 2,501 children (49.1% girls) between 12- and 13-years-old (mean=13.64 years, standard deviation=0.48), tested in 2022, without a self-reported concussion in the past 6 months, were examined. Mann-Whitney U tests were used to compare balance and four cognitive test scores between children with and without self-reported ADHD, stratified by gender, and significance was set at p&lt;.01.

Results
There were no significant differences on balance testing for boys or girls with ADHD compared to those without ADHD. Boys with ADHD performed slightly slower on the Impulse Control (p=.001, Hedge’s g=.14) and Inspection Time (p=.002, g=.22) tests than boys without ADHD. Girls with ADHD performed slightly slower on the Reaction Time test (p=.001, g=.33) than girls without ADHD. No differences were found on the Memory test for girls or boys.

Conclusions
Middle school aged boys and girls with ADHD did not perform worse on balance testing and some of the cognitive tests compared to children without ADHD. There were small magnitude differences on timed tests of Impulse Control and Inspection Time for boys and Reaction Time for girls, with youth who self-reported having ADHD performing slower than youth without ADHD.
A-37 Performance of Adolescents with Attention Deficit/Hyperactivity Disorder on Sway Medical Mobile Balance and Cognitive Tests
Authors: Liu B C , Cook N E , Iverson G L 
Published: June 2023

Abstract

Purpose
Prior research has revealed differences on some cognitive and balance tests between adolescents with and without attention deficit/hyperactivity disorder (ADHD). We examined if preseason baseline performance on the Sway Medical Mobile Balance and Cognitive Tests differs by self-reported ADHD diagnosis in in adolescents ages 14-18.

Methods
Test data from 26,460 adolescents (48.7% girls) between 14- and 18-years-old (mean=15.90 years, standard deviation=1.45), who underwent baseline testing in the summer of 2022 and denied having sustained a concussion in the past 6 months, were examined. Mann-Whitney U tests were used to compare balance and cognitive test scores between adolescents with and without a self-reported ADHD diagnosis within boys and girls, and significance was set at p&lt;.01.

Results
For both boys and girls, adolescents with ADHD obtained worse scores (i.e., slower performance) on the Reaction Time, Impulse Control, and Inspection Time tests (p&lt;.001) and lower scores (i.e., worse performance) on Memory tests (p&lt;.001) and on balance testing (p&lt;.001). Effect sizes for these differences ranged from tiny to small (Hedge’s g=.05-.24).

Conclusions
Adolescents aged 14-18 with a self-reported ADHD diagnosis performed slightly worse on the Sway Medical Mobile Balance and Cognitive Tests, with minimal to small effect sizes. For boys and girls, the largest differences (though small in magnitude) were noted on balance testing and the Memory and Inspection Time tests.
A-39 A Comparison of Concussion Reporting between the Olympic and Paralympic Games
Authors: Magill R , Broshek D , Kaplan D , Denton A , Smetana R 
Published: June 2023

Abstract

Purpose
Research has established that the Paralympic Games have a higher injury rate than the Olympic Games, but less is known about how concussion rates may differ between these two populations. Concussions in Paralympic athletes are more difficult to accurately diagnose due to the lack of robust concussion guidelines specific to para athletes. This literature review sought to compare reporting of concussion symptoms and incidence between the Paralympic and Olympic Games since 2010. Data Selection: Searches of Google Scholar, PubMed, and ResearchGate were performed to identify Paralympic and Olympic injury and surveillance study data. Hand-searching citation lists yielded additional results. Articles were included if they reported head injury and/or concussion data.

Results
Fourteen articles were included that provided injury surveillance study data from 2010 to 2022. Data on head injury and concussion incidence and diagnosis were extracted and reviewed. Between 2010 and 2018, higher concussion rates were reported in Olympic athletes, possibly due to the lack of concussion-specific injury questions for Paralympic athletes. When concussion-specific injury questions for Paralympic athletes were implemented in 2018, data suggests that Paralympic athletes sustained more concussions than Olympic athletes. Additionally, the review suggested potential under-reporting of concussions in Paralympic athletes, despite symptoms, suggesting incidence may be higher than reported.

Conclusions
Higher concussion rates in the Paralympic Games and possible under-reporting of concussions highlights the need for improved identification and evaluation of concussions in Paralympic athletes. Establishing robust guidelines for the identification, evaluation, and management of concussions for para athletes is critical to increase their safety.