bluuebunny/crossref_metadata_2025_split huggingface dataset:
A-26 The Prevalence of Invalid Baseline ImPACT® Test Scores in Adolescent Student Athletes
Authors: Liu B C , Gaudet C E , Schatz P , Berkner P , Iverson G L 
Published: July 2022

Abstract
Purpose: Immediate Post-Concussion and Cognitive Testing (ImPACT®) is among the most commonly used neuropsychological measures to establish a baseline estimate of neuropsychological functioning for concussion management. We sought to identify correlates of invalid performance on ImPACT® baseline testing in adolescents. Methods: The sample included 67,009 English-speaking adolescents (ages 14–18, mean: 15.51, SD: 1.22) who completed ImPACT® baseline tests in English between 2009 and 2019. The association between invalid performance (as determined by the embedded invalidity indicators) and demographic and health variables was assessed using chi-square tests and with odds ratios (OR). Results: Overall, 7.2% of adolescents produced invalid baseline tests. Boys (7.9%) produced more invalid baselines than girls (6.2%; χ2 = 70.35, p &lt; 0.001, OR = 1.29, 95% CI = 1.22, 1.37). Adolescents with learning disabilities (16.4%), attention-deficit/hyperactivity disorder (11.1%), and those who have received special education services (16.0%) or repeated more than 1 year of school (11.0%), all obtained invalid baselines at higher frequencies than those who did not endorse these variables (i.e., 6.5%–6.8%; p &lt; 0.001). Adolescents who reported receiving treatment for headaches (9.5%), migraines (9.4%), epilepsy/seizures (11.1%), substance/alcohol use (17.0%), or a psychiatric condition (10.0%) obtained invalid baselines at higher frequencies than those who did not (i.e., 6.6%–6.9%; p &lt; 0.001). Conclusions: Consistent with prior research, approximately 7% of adolescents produced invalid baselines. However, the frequencies of invalid performances were substantially greater for subgroups such as those with learning disabilities, those who have received special education services, and youth who have received past substance abuse treatment.
A-28 Systematic Review And Meta-Analysis Of Factors Influencing Sport Concussion For Athletes with ADHD and/or LD
Authors: Maietta J E , Renn B N , Goodwin G J , Salva C , Maietta L N , Moore S A , Hopkins N A , Donohue B , Allen D N 
Published: July 2022

Abstract
Purpose: Purpose: Athletes with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or Learning Disorder (LD) are at increased risk for sport concussion and require specialized attention. Although systematic reviews of ADHD/LD and concussion are reported, no meta-analyses have been conducted. Additionally, no reviews focused on the most common concussion assessment, ImPACT. Methods: Data Selection: The current review used PRISMA guidelines. Searches utilized PubMed, Web of Science, and PsycINFO. Articles selected for this meta-analysis examined ADHD and/or LD (high school and collegiate athletes) using ImPACT from 2000–2021. Topics included: 1) baseline and 2) post-concussion performance on ImPACT, 3) symptom reporting using the Post-Concussion Symptom Scale, 4) invalid baseline classification on ImPACT, 5) concussion rates, and 6) concussion recovery. 10,163 articles were identified. 39 were included in review and 19 were included in random-effects meta-analyses on topics 1, 3, 4, and 5. Results: Data Synthesis: Meta-analysis results found decreased baseline performance on ImPACT for athletes with ADHD (trivial to small effects), LD (small to medium effects), and ADHD/LD (small to medium effects). Increased symptom reporting was found for athletes with ADHD (small effect). Increased odds of invalid ImPACT baseline performance (trivial effect) and concussion (small effect) were found in ADHD. Conclusions: Athletes with ADHD and/or LD demonstrate differences on ImPACT in cognitive performance, symptom reporting, and concussion risk (particularly for ADHD). Most research focused on ADHD. Future work should further examine athletes with LD and co-occurring ADHD/LD as well as the effects that these conditions can have on concussion recovery, given the mixed literature in that regard.
A-29 Consistency of Clinical Profiles Across Repeat Concussions
Authors: Manderino L M , Preszler J , French J , Kegel N , Blaney N , Collins M W , Kontos A P 
Published: July 2022

Abstract
Purpose: To evaluate the association between concussion profiles within individual patients across repeat concussions. Methods: Retrospective chart review of 100 adolescents (57.3% male) aged 10–21 years presenting to a concussion clinic within 30 days of injury for two separate injuries between 2011 and 2021. Clinicians conducted multidomain assessments including vestibular/ocular motor screening, neurocognitive testing, symptoms and medical/injury history to adjudicate the following concussion clinical profiles: vestibular, ocular, post-traumatic migraine, cognitive fatigue, and anxiety/mood. Chi-square tests with odds ratios (OR) and 95% confidence intervals (CI) were conducted to examine the association of each profile from the first to the second concussion. Results: Chi-square analyses supported associations between the first and second concussions (time between injuries = 667.1 ± 529.2 days) for the vestibular (χ2 = 10.08, p &lt; 0.01, OR = 3.75, 95% CI = 1.63–8.62), ocular (χ2 = 6.51, p &lt; 0.05, OR = 3.51, 95% CI = 1.30–9.46), and migraine (χ2 = 11.056, p &lt; 0.001, OR = 4.01, 95% CI = 1.73–9.29) profiles, such that having that profile at first concussion was associated with increased likelihood of having the same profile at second concussion. Chi-square analyses for cognitive fatigue and anxiety/mood were not significant. Conclusions: Vestibular, ocular, and migraine profiles at first injury predicted their presence at second injury, which may reflect consistent underlying risk factors (e.g., sex migraine history) for these profiles. Conversely, no association was supported for anxiety/mood and cognitive fatigue profiles across injuries. The present findings are the first to demonstrate that certain profiles are likely to recur after repeat concussion. This information can be used by clinicians to inform earlier, targeted treatment recommendations for associated profiles.
A-32 Association Between Adolescent Patient Emotional Factors and Adherence to a Sport-Related Concussion Treatment
Authors: Mian R K , Brayton R P , Price A M , Knell G 
Published: July 2022

Abstract
Purpose: To determine the association between Anxiety Sensitivity Index (ASI) and Positive and Negative Affect Schedule (PANAS) and adherence to an exercise treatment for sport-related concussion (SRC). We hypothesized Positive Affect (PA) score would be positively associated, while ASI and Negative Affect (NA) score would be negatively associated with odds of treatment adherence. Methods: This was a prospective (2020–2021) analysis of adolescents (aged 14–17) diagnosed with SRC by a pediatric specialty concussion clinic and subsequently prescribed daily exercise. Adherence to the exercise protocol was defined as consistently increasing physical activity volume (measured by accelerometer) during recovery. Multivariable logistic regressions evaluated the independent associations between treatment adherence and ASI; PA score; NA score. Results: The mean (standard deviation [SD]) recovery time was 16.1 (9.0) days. Among the 32 (56.1%) adherent and 25 (43.9%) not adherent participants, the majority were aged 15 years (29.8%), male (50.9%), non-Hispanic White (70.2%), and had no concussion history (61.4%). After adjusting for age and sex, the odds of treatment adherence for each additional unit increase in ASI, PA score, and NA score was 1.03 (95% CI: 0.96–1.10), 1.14 (95% CI: 0.97–1.35), and 1.18 (95% CI: 0.95–1.47), respectively. Conclusions: Despite lack of statistical significance, it appears that PA score and NA score may contribute to exercise treatment adherence for SRC. As this study may be underpowered, future studies should aim to have a larger sample and investigate the discriminate utility of PANAS to identify those who may or may not adhere to SRC exercise treatments.
A-33 Criteria For Determining Clinical Recovery From Concussion: A Preliminary Survey Of Sports Neuropsychologists
Authors: Moser R S , Choi D M , Mayer B 
Published: July 2022

Abstract
Purpose: To arrive at a consensus of best practices currently employed by sports neuropsychologists regarding specific criteria for determining concussion recovery. Methods: A survey was sent to 120 sports neuropsychologists listed in a public membership directory of the Sports Neuropsychology Society. The survey included demographic, Likert-style, and multiple-choice questions regarding the importance of given criteria in determining concussion recovery for youth (up to age 18) or adult (18+ years). Results: A sample of 22 participants (95% White, 59% male, 68% working with youth and adults, 45% seeing ≥50 patients yearly, 86% ≥10 years of experience) was obtained. The two highest rated criteria for youth and adults were: 1) symptom-free with exercise, and 2) back to work/school without symptoms or accommodations. The two lowest rated criteria were: 1) physician exam without concerns, and 2) opinions from another healthcare professional. Of those who treat adults, 71% reported 1 week symptom free is sufficient. For youth, 63% rated ≥1 week, 31% rated 2–3 weeks, and 6% rated ≥1 month is preferred. Conclusions: Most respondents have worked with youth and adult athletes for at least 10 years. Responses were mostly consistent regarding importance of the various surveyed criteria. There may be a tendency to wait for longer symptom-free periods for youth. Interestingly, the opinions of another health care professional or physician were less important than all other criteria in the survey. The two most important criteria appear to be resolution of symptoms during physical exertion and return to functional activities without symptoms or accommodations.
A-34 An Investigation of Sports Concussion Reporting in Collegiate Club Rugby Players
Authors: Patoilo M , Porter B , Hanayik T , Rorden C , McCall M 
Published: July 2022

Abstract
Purpose: The current study investigates concussion-reporting among U.S. collegiate club rugby players. There is robust evidence that a large proportion of college-aged athletes have sustained unreported concussions and non-disclosure is partially influenced by sport. Despite college rugby being the fastest growing collegiate sport in America, there is no research on concussion-reporting in U.S. college-aged club rugby players. It is predicted that these players self-report significantly fewer professionally diagnosed concussions than total concussions sustained. Methods: Participants completed a survey about health, sports, and concussion history as part of a larger study on cognitive performance following concussion. Participants included 14 male, club rugby athletes (M = 19.62 years old, SD = 0.96, range = 18–21) recruited from a university in the southeast United States. Exclusion criteria included an existing or prior learning disability diagnosis, ADHD, or other serious neurological issues. Results: Participants self-reported experiencing a significantly higher number of concussions (M = 2.29, SD = 1.44) than were documented by a professional (M = 0.93, SD = 0.73); t(13) = 2.85, p = 0.01). Details were provided for 32 total concussions, and 69% (N = 22) were considered rugby related. Of note, 28.6% of participants (N = 4) reported having none of their concussions diagnosed by a professional, and 35.7% of participants (N = 5) indicated their first concussion was never diagnosed. Conclusions: Concussion non-disclosure is a significant issue among college-aged U.S. club rugby athletes. As rugby continues to be a high-contact and internationally popular sport, additional research is needed to understand these reporting behaviors. Current findings highlight the need for efforts to better understand how coaches and those who work with these athletes can promote and increase accurate concussion-reporting.
A-36 Tracking Compliance To A Home Exercise Program For Concussion Using Ecological Momentary Assessment: A Pilot Study
Authors: Price A M , Jones C A , Boucher S J , Ellis C S , Burkhart S O 
Published: July 2022

Abstract
Purpose: The management of pediatric concussions creates a clinical challenge due to unknown patient compliance with prescribed therapies and interventions. The purpose of this pilot study was to describe the logistical use of ecological momentary assessment (EMA) to track compliance to a physical therapy facilitated vestibular/ocular motor home exercise program (HEP) in patients diagnosed with concussion. Methods: A convenience sample of 20 concussed patients (aged 13–18 years [mdn = 14.5, IQR = 14.0–16.8]) was included in this initial pilot study. All participants were evaluated within seven days of injury. Participants were instructed to complete one daily HEP compliance log until medical clearance on their parent or guardians’ mobile device using an EMA application. Results: Participants were evaluated a median 3.5 (IQR = 1.3–6.5) days post injury, recovered in a median 15.5 (IQR = 11.0–25.0) days, and completed a mean 5.85 (SD = 3.9) total EMA logs representing a 47% completion rate. Participants reported completing a mean 1.21 (SD = 0.77) HEPs per day with a range of 0.0 to 3.0. Self-reported HEP compliance did not significantly correlate with recovery time in days (P = 0.26). Conclusions: The overall response rate for EMA logs was 47% and participants reported completing 1.2 HEPs per day. Analysis of this preliminary data did not reveal a correlation between HEP compliance and recovery time in days. Participants reported the primary barrier to completing daily questionnaires was access to their parent or guardians’ mobile device at the time of the prompt. Overall, the data derived from EMA appears useful for tracking the progression of this heterogenous injury.
A-37 Ocular Motor Impairments in Concussion Professional Football Players
Authors: Ree-Fedun Q , Naidu D , Mrazik M , David C , Hansen J , Wagner R , Arends T 
Published: July 2022

Abstract
Purpose: The purpose of this study was to examine baseline and post-concussion injury characteristics of ocular eye movements using the Sync Think visual eye tracking apparatus in professional football players in the Canadian Football League (CFL). Methods: The visual tracking testing protocol uses an integrated stimulus presentation-eye tracking apparatus (EyeLink CL; SR Research, Ontario, Canada) with which eye movements were recorded at 500 Hz using infrared video-oculography. The standard deviation of radial errors (SDRE) and tangential errors (SDTE) were used to determine poor visual tracking. Participants were (n = 748) rostered players in the Canadian Football League. All participants completed assessments at baseline. Sixteen players completed post-concussion assessments and 98 players completed post-exertional assessments during the 2021 season to evaluate the impact of physical exertion on ocular movement metrics. Results: Participants with diagnosed concussions (n = 16+) demonstrated significantly poorer performance on measures of both gaze stability and smooth pursuit (p &lt; 0.001). The poorer results were correlated with significantly higher subjective ratings of dizziness (p &lt; 0.01) and fogginess (p &lt; 0.001). In contrast, healthy participants who completed the same ocular motor assessments demonstrated no significant differences compared to baseline test performance. Conclusions: Findings suggest that subtle differences in oculomotor functioning arise from sport concussion in professional football players. Further research with larger sample sizes and correlation with other cognitive and physical outcomes is warranted.
A-41 Establishing Empirically-Based Normative Cut-Offs For Identifying Anxiety Following Sports-Related Concussion
Authors: Schatz P , Legido G , Womble M N , Elbin R J 
Published: July 2022

Abstract
Purpose: The State–Trait Anxiety Inventory (form Y-1; STAI) is widely used for identifying anxiety in non-clinical and clinical samples. Cutoff scores ≥40 are widely used to identify clinically significant anxiety. However, these scores correspond with the 50th–60th percentile in STAI normative tables. Given that anxiety is recognized as a common post-concussion symptom, and as a post-injury clinical profile, establishing statistically appropriate cutoffs for clinical anxiety is warranted. Methods: We compared rates of individuals falling above static (≥40) versus empirically-derived (&gt;1, &gt;1.5, &gt;2 standard deviations) cutoffs, using a sample of 137 acutely concussed high school and college athletes (59% male, mean age 16.11 ± 1.56 years) who completed the STAI within 7 days of injury (mean 3.79 ± 1.4 days). Results: Approximately 47% of concussed athletes fell above the static cutoff of ≥40, whereas use of empirically-derived cutoffs identified 18% (1SD), 8% (1.5SD) and 3% (2SD). These empirically-derived cutoffs reflect the normal curve, and distribution of scores expected to fall outside 1, 1.5, and 2SD. Conclusions: Use of a static cutoff of ≥40 on the STAI identifies approximately 50% of high school and college athletes as anxious. As such, use of empirically-derived cutoffs are recommended over static cutoffs for clinical anxiety when using the STAI.
A-43 Effects of Subthreshold Exercise on Post-concussive Symptom Endorsement and Cognition: A Pilot Randomized Clinical Trial
Authors: Soden D , Meyer J E , Briskin S M , Dundr J M , Brennan B , Smith P M , Bailey C M 
Published: July 2022

Abstract
Purpose: The current study examined the effects of subthreshold exercise on symptom endorsement and neurocognitive functioning in adolescents with persisting concussion symptoms (&gt;1 month). Methods: Sixteen participants (age M = 16.2, SD = 1.4) with persisting concussion symptoms were randomly assigned to control or subthreshold exercise intervention groups (Leddy et al., 2019). Participants engaged in concussion education before assignment to 6 weeks (3x weekly) of intervention: control (stretching) or subthreshold exercise. Both groups completed evaluations at baseline, midpoint, and follow-up, including a hybrid battery of assessments (yielding composites of processing speed and memory), a concussion symptom scale (PCS-R), and psychological inventories. Results: Both the intervention group and control group reported significant reduction in concussive symptom severity during the study period (PCS-R Change M = -21.29, SD = 13.54). Baseline endorsement of anxiety significantly differed across groups (p &lt; 0.05); when controlling for anxiety, the intervention group demonstrated greater reduction in symptom endorsement compared to controls (F(1,13) = 7.30, p &lt; 0.05, partial eta2 = 0.40). In contrast, after controlling for performance validity and the baseline anxiety difference, there was no significant difference (p &gt; 0.05) in processing speed performance (partial eta2 = 0.14) or memory performance (partial eta2 = 0.11) by intervention group. Both groups remained generally intact normatively from the baseline to the follow-up evaluation across measures. Conclusions: Current results support the use of subthreshold exercise to reduce persisting symptoms of concussion post-acutely; additionally, results suggest that anxiety significantly impacted response to intervention. Lastly, there was no effect on cognitive indices by the intervention, suggesting that subthreshold exercise may have less impact on cognition than symptom endorsement in the post-acute phase of recovery.
A-44 Experiences of Adversity and Validity of Baseline Concussion Testing
Authors: Sorensen A , Salas Atwell M , Koroukian S , Bailey C , Briggs F 
Published: July 2022

Abstract
Purpose: This study examined the relationship between individual-level experiences of social adversity and baseline computerized concussion testing validity (Immediate Post-Concussion Assessment and Cognitive Testing; ImPACT). Methods: This study involved 6495 student-athletes born between 1995 and 2005 who completed a baseline ImPACT test between 10 and 18 years old and could be identified in the Child-Household Integrated Longitudinal Data (CHILD) System, a continuously updated integrated and comprehensive data system that captures detailed individual-level demographic, social service usage, and educational outcomes on every child born or living in Cuyahoga County, Ohio from 1989 to present. Multivariable logistic regression models were conducted with experiences of SNAP/TANF enrollment, substantiated abuse or neglect incidents, and extreme neighborhood deprivation occurring in the sensitive developmental periods of early childhood and adolescence as key predictors of baseline test validity. Results: Our findings suggest that social mobility may play an important role in baseline validity. Youth with upward social mobility (poverty or neighborhood deprivation in early childhood only) were not significantly different than youth without such experiences (OR = 0.91, p = 0.74). Youth with persistent adversity across childhood or downward social mobility (poverty or high neighborhood deprivation in adolescence only) had 50–72% lower odds of achieving a valid baseline test (persistent poverty: OR = 0.59, p = 0.05; adolescent poverty only: OR = 0.50, p = 0.004; adolescent neighborhood deprivation only: OR = 0.28, p &lt; 0.0001). Conclusions: These findings suggest certain patterns of social adversity may predispose youth to invalid computerized concussion baseline testing scores, potentially increasing their risk of inaccurate injury management and poor outcomes.
A-47 Affective Comorbidity Neurocognitive Variability in College Athletes at Baseline
Authors: Thomas G , Riegler K , Bradson M , Arnett P 
Published: July 2022

Abstract
Purpose: Research on the neurocognitive effects of comorbid mood/anxiety disturbance in college athletes is limited. Previous work demonstrated that athletes with comorbid depression/anxiety performed worse on measures of attention/processing speed at baseline compared to healthy controls (HCs). However, this work only examined mean performance. The current study expands upon this work by examining intraindividual variability (IIV) in relation to affective disturbance. Methods: 835 (M = 624, F = 211) collegiate athletes completed baseline neuropsychological testing. Athletes were separated into 4 groups (HCs [n = 582], Depression Only [n = 137], Anxiety Only [n = 54], Comorbid Depression/Anxiety [n = 62]) based on self-reported anxiety and depression. IIV was examined via intraindividual standard deviation (ISD) with higher scores indicating greater variability. ISD was examined globally and within composites of attention/processing speed (A/PS) and memory. Results: Linear regression results revealed that the comorbid group exhibited greater variability within the memory composite compared to HCs, (t(829) = 3.28, p = 0.001, d = 0.39), the depression group, (t(829) = −2.62, p = 0.009, d = 0.35), and the anxiety group (t(829) = −2.76, p = 0.006, d = 0.49). The depression group and anxiety group did not differ from HCs on memory ISD. None of the groups differed on A/PS or global ISD. Conclusions: Athletes with comorbid depression/anxiety demonstrated greater variability in performance on memory tasks. Greater dispersion is predictive of greater cognitive decline following concussion; therefore, it is important that we interpret neuropsychological performance beyond measures of central tendency. These findings also highlight the importance of having baseline data available for athletes with affective disturbance as these underlying secondary factors may influence performance, place athlete at risk for poorer outcomes, and skew future post-concussion comparisons.