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  • Berkner, Paul D.  (12)
  • Maxwell, Bruce  (12)
  • Zafonte, Ross  (12)
  • 1
    Online Resource
    Online Resource
    Multiple Past Concussions in High School Football Players : Are There Differences in Cognitive Functioning and Symptom Reporting?
    SAGE Publications ; 2016
    In:  The American Journal of Sports Medicine Vol. 44, No. 12 ( 2016-12), p. 3243-3251
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 44, No. 12 ( 2016-12), p. 3243-3251
    Abstract: There is increasing concern about the possible long-term effects of multiple concussions, particularly on the developing adolescent brain. Whether the effect of multiple concussions is detectable in high school football players has not been well studied, although the public health implications are great in this population. Purpose: To determine if there are measureable differences in cognitive functioning or symptom reporting in high school football players with a history of multiple concussions. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants included 5232 male adolescent football players (mean [±SD] age, 15.5 ± 1.2 years) who completed baseline testing between 2009 and 2014. On the basis of injury history, athletes were grouped into 0 (n = 4183), 1 (n = 733), 2 (n = 216), 3 (n = 67), or ≥4 (n = 33) prior concussions. Cognitive functioning was measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery, and symptom ratings were obtained from the Post-Concussion Symptom Scale. Results: There were no statistically significant differences between groups (based on the number of reported concussions) regarding cognitive functioning. Athletes with ≥3 prior concussions reported more symptoms than did athletes with 0 or 1 prior injury. In multivariate analyses, concussion history was independently related to symptom reporting but less so than developmental problems (eg, attention or learning problems) or other health problems (eg, past treatment for psychiatric problems, headaches, or migraines). Conclusion: In the largest study to date, high school football players with multiple past concussions performed the same on cognitive testing as those with no prior concussions. Concussion history was one of several factors that were independently related to symptom reporting.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546516655095
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 2
    Online Resource
    Online Resource
    Multiple Past Concussions in High School Hockey Players: Examining Cognitive Functioning and Symptom Reporting
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Clinical Journal of Sport Medicine Vol. 31, No. 6 ( 2021-11), p. e313-e320
    Details
    In: Clinical Journal of Sport Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 6 ( 2021-11), p. e313-e320
    Abstract: To investigate (1) if there are meaningful differences in baseline preseason cognitive functioning or symptom reporting between high school ice hockey players with and without prior concussions and (2) determine which health history variables predict symptom reporting. Design: Cross-sectional study. Setting: High schools across the state of Maine. Participants: Participants were 1616 male high school ice hockey players (mean age = 15.6 years; SD = 1.5 years) who completed baseline testing between 2009 and 2015. Independent Variables: Athletes were grouped according to their self-reported concussion history [0 (n = 1136), 1 (n = 321), 2 (n = 112), or 3+ (n = 47) previous concussions]. Main Outcome Measures: Cognitive functioning was measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery, and symptom ratings were obtained from the Post-Concussion Symptom Scale. Results: There were no statistically significant differences between groups in cognitive functioning as measured by ImPACT. The group with ≥3 prior concussions endorsed higher total symptom scores, but the effect sizes were small and not statistically significant. In a multivariate model, prior treatment for headaches (not necessarily migraines), prior treatment for a psychiatric condition, and prior treatment for substance/alcohol use all significantly predicted total symptom scores, with concussion history being the weakest independent predictor. Conclusions: Players with a history of prior concussions performed similarly to players with no prior concussions on cognitive testing. Health history factors were more strongly associated with symptom reporting than concussion history.
    Type of Medium: Online Resource
    ISSN: 1050-642X
    URL: Article
    DOI: 10.1097/JSM.0000000000000806
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2045233-0
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  • 3
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    Online Resource
    Baseline cognitive test performance and concussion-like symptoms among adolescent athletes with ADHD: examining differences based on medication use
    Informa UK Limited ; 2017
    In:  The Clinical Neuropsychologist Vol. 31, No. 8 ( 2017-11-17), p. 1341-1352
    Details
    In: The Clinical Neuropsychologist, Informa UK Limited, Vol. 31, No. 8 ( 2017-11-17), p. 1341-1352
    Type of Medium: Online Resource
    ISSN: 1385-4046 , 1744-4144
    URL: Article
    DOI: 10.1080/13854046.2017.1317031
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2017
    detail.hit.zdb_id: 1483047-4
    SSG: 5,2
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  • 4
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    Online Resource
    Investigating Effects of Sex Differences and Prior Concussions on Symptom Reporting and Cognition Among Adolescent Soccer Players
    SAGE Publications ; 2018
    In:  The American Journal of Sports Medicine Vol. 46, No. 4 ( 2018-03), p. 961-968
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 46, No. 4 ( 2018-03), p. 961-968
    Abstract: There has been increasing concern regarding the possible effect of multiple concussions on the developing brain, especially for adolescent females. Hypothesis/Purpose: The objectives were to determine if there are differences in cognitive functioning, symptom reporting, and/or sex effects from prior concussions. In a very large sample of youth soccer players, it was hypothesized that (1) there would be no differences in cognitive test performance between those with and without prior concussions, (2) baseline preseason symptoms would be better predicted by noninjury factors than concussion history, and (3) males and females with prior concussions would not have differences in cognition or symptoms. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants included 9314 youth soccer players (mean = 14.8 years, SD = 1.2) who completed preseason baseline cognitive testing, symptom reporting, and a health/injury history questionnaire from the ImPACT battery (Immediate Post-concussion Assessment and Cognitive Testing). On the basis of injury history, athletes were grouped by number of prior concussions: 0 (boys, n = 4012; girls, n = 3963), 1 (boys, n = 527; girls, n = 457), 2 (boys, n = 130; girls, n = 97), or ≥3 (boys, n = 73; girls, n = 55). The primary measures were the 4 primary cognitive scores and the total symptom ratings from ImPACT. Primary outcomes were assessed across injury groups, controlling for age, sex, learning disability, attention-deficit/hyperactivity disorder (ADHD), treatment for headaches/migraines, substance abuse, and mental health problems. Results: Cognitive test performance was not associated with concussion history but was associated with sex, age, learning disability, ADHD, and prior mental health problems. Greater symptom reporting was more strongly associated with psychiatric problems, older age, learning disability, substance abuse, headaches, being female, and ADHD than with a history of multiple concussions. Boys and girls did not differ on cognitive scores or symptom reporting based on a history of concussion. Conclusion: In this very large sample of youth soccer players with prior concussion, there was no evidence of negative effects on cognition, very weak evidence of negative effects on symptom reporting, and no evidence of sex × concussion differences in cognition or symptom reporting.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546517749588
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 5
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    Online Resource
    Greater Acute Concussion Symptoms Are Associated With Longer Recovery Times in Adolescents
    SAGE Publications ; 2022
    In:  Journal of Child Neurology Vol. 37, No. 12-14 ( 2022-12), p. 970-978
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 37, No. 12-14 ( 2022-12), p. 970-978
    Abstract: We examined the association between the severity of acute concussion symptoms and time to return to school and to sports in adolescent student athletes. We hypothesized that there would be an association between the severity of acute symptoms experienced in the first 72 hours and functional recovery such that adolescents with the lowest burden of acute symptoms would have the fastest return to school and sports and those with the highest burden of symptoms would have the slowest return to school and sports. This injury surveillance cohort included 375 adolescent student athletes aged 14-19 years who sustained a sport-related concussion between 2014 and 2020. Athletic trainers documented time to return to school and to sports. A greater proportion of adolescents with the highest acute symptoms remained out of school at 3 (odds ratio [OR] = 2.5, 95% confidence interval [CI] 1.5-4.4), 5 (OR = 2.4, 95% CI 1.4-4.0), 7 (OR = 2.6, 95% CI 1.5-4.3), and 10 days (OR = 2.3, 95% CI 1.3-3.9) compared to those with the lowest acute symptoms. Similarly, a greater proportion of athletes with the highest acute symptoms remained out of sports at 7 (OR = 3.5, 95% CI 1.5-8.1), 10 (OR = 3.1, 95% CI 1.8-5.6), 14 (OR = 1.8, 95% CI 1.1-3.0), and 21 days (OR = 1.9, 95% CI 1.0-3.6) compared to those with the lowest acute symptoms. This study underscores the adverse effect of high acute symptom burden following concussion on return to school and to sports among adolescent student athletes. Conversely, student athletes with a low burden of acute symptoms have a faster return to school and to sports.
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/08830738221125986
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2068710-2
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  • 6
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    Online Resource
    Preseason Symptom Reporting and Cognition in Middle School Athletes with Past Concussions
    Georg Thieme Verlag KG ; 2022
    In:  International Journal of Sports Medicine Vol. 43, No. 06 ( 2022-06), p. 553-560
    Details
    In: International Journal of Sports Medicine, Georg Thieme Verlag KG, Vol. 43, No. 06 ( 2022-06), p. 553-560
    Abstract: This study examined the association between past concussions and current preseason symptom reporting and cognitive performance in 9,257 youth ages 11–13. Participants completed neurocognitive testing prior to participating in a school sports between 2009 and 2019. We stratified the sample by gender and number of prior concussions and assessed group differences on the Post-Concussion Symptom Scale total score and the ImPACT cognitive composite scores. Those with≥2 prior concussions reported more symptoms than those with 0 concussions (d=0.43–0.46). Multiple regressions examining the contribution of concussion history and developmental/health history to symptom reporting showed the most significant predictors of symptoms scores were (in descending order): treatment for a psychiatric condition, treatment for headaches, history of learning disability (in boys only), history of attention-deficit/hyperactivity disorder, and age. Concussion history was the weakest statistically significant predictor in boys and not significant in girls. Cognitively, boys with 1 prior concussion had worse speed those with 0 concussions (d=0.11), and girls with≥2 prior concussions had worse verbal/visual memory than girls with 0 concussions (ds=0.38–0.39). In summary, youth with≥2 prior concussions reported more symptoms than those with no concussions. Boys with multiple concussions performed similarly on cognitive testing, while girls had worse memory scores.
    Type of Medium: Online Resource
    ISSN: 0172-4622 , 1439-3964
    URL: Article
    DOI: 10.1055/a-1538-0075
    RVK:
    ZX 1000
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 2041541-2
    SSG: 31
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  • 7
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    Architecture of Physical, Cognitive, and Emotional Symptoms at Preseason Baseline in Adolescent Student Athletes With a History of Mental Health Problems
    Frontiers Media SA ; 2020
    In:  Frontiers in Neurology Vol. 11 ( 2020-3-20)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 11 ( 2020-3-20)
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    DOI: 10.3389/fneur.2020.00175
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2020
    detail.hit.zdb_id: 2564214-5
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  • 8
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    Online Resource
    Multiple prior concussions are associated with symptoms in high school athletes
    Wiley ; 2014
    In:  Annals of Clinical and Translational Neurology Vol. 1, No. 6 ( 2014-06), p. 433-438
    Details
    In: Annals of Clinical and Translational Neurology, Wiley, Vol. 1, No. 6 ( 2014-06), p. 433-438
    Type of Medium: Online Resource
    ISSN: 2328-9503 , 2328-9503
    URL: Article
    DOI: 10.1002/acn3.70
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 2740696-9
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  • 9
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    Online Resource
    Examining Criteria for Defining Persistent Post-concussion Symptoms in Children and Adolescents
    Frontiers Media SA ; 2021
    In:  Frontiers in Neurology Vol. 12 ( 2021-2-23)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 12 ( 2021-2-23)
    Abstract: Researchers operationalize persistent post-concussion symptoms in children and adolescents using varied definitions. Many pre-existing conditions, personal characteristics, and current health issues can affect symptom endorsement rates in the absence of, or in combination with, a recent concussion, and the use of varied definitions can lead to differences in conclusions about persistent symptoms and recovery across studies. This study examined how endorsement rates varied by 14 different operational definitions of persistent post-concussion symptoms for uninjured boys and girls with and without pre-existing or current health problems. This cross-sectional study included a large sample (age range: 11–18) of girls ( n = 21,923) and boys ( n = 26,556) without a recent concussion who completed the Post-Concussion Symptom Scale at preseason baseline. Endorsements rates varied substantially by definition, health history, and current health issues. The most lenient definition (i.e., a single mild symptom) was endorsed by most participants (54.5% of boys/65.3% of girls). A large portion of participants with pre-existing mental health problems (42.7% of boys/51.5% of girls), current moderate psychological distress (70.9% of boys/72.4% of girls), and insufficient sleep prior to testing (33.4% of boys/47.6% of girls) endorsed symptoms consistent with mild ICD-10 postconcussional syndrome; whereas participants with no current or prior health problems rarely met this definition (1.6% of boys/1.6% of girls). The results illustrate the tremendous variability in the case definitions of persistent symptoms and the importance of harmonizing definitions across future studies.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    DOI: 10.3389/fneur.2021.614648
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2564214-5
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  • 10
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    Online Resource
    Greater Acute Concussion Symptoms Are Associated With Longer Recovery Times in NCAA Division III Collegiate Athletes
    Frontiers Media SA ; 2022
    In:  Frontiers in Neurology Vol. 12 ( 2022-1-21)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 12 ( 2022-1-21)
    Abstract: We examined the association between the severity of acute concussion symptoms and time to return to school and to sports in National Collegiate Athletic Association (NCAA) Division III collegiate athletes. We hypothesized that students with the lowest burden of acute symptoms, measured in the first 72 h, would have the fastest return to school and sports and those with the highest burden of symptoms would have the slowest return to school and sports. This injury surveillance cohort included 808 athletes from 11 NCAA Division III colleges who sustained a concussion between 2014 and 2019. Athletic trainers documented time to return to school and to sports. Kruskal-Wallis tests with post-hoc planned comparison Mann-Whitney U tests were used to assess whether athletes took longer to return based on their acute symptom burden (Low, Medium, or High). Survival analysis (Kaplan Meier with log rank tests) was used to compare the recovery times based on acute symptom burden (censored at 28 days). Chi-square tests compared the proportion of those who had not yet returned to school or sports at various recovery benchmarks (i.e., 1 week, 10 days, 2 weeks, 3 weeks, 4 weeks) based on acute symptom burden. Women (median = 5 days) took slightly longer than men (median = 4 days) to return to school ( p = 0.001; r = −0.11, small effect). Women and men did not differ on time to return to sports ( p = 0.32, r = −0.04). A greater proportion with high acute symptoms remained out of school at 5 (odds ratio, OR = 4.53), 7 (OR = 4.98), and 10 (OR = 4.80) days compared to those with low acute symptoms. A greater proportion with high acute symptoms remained out of sports at 10 (OR = 4.11), 14 (OR = 3.46), and 21 (OR = 3.01) days compared to those with low acute symptoms. This study shows a strong association between having a high burden of acute post-concussion symptoms and having a slower return to school and sports in Division III collegiate athletes. Moreover, it also illustrates the converse: that those athletes with a low burden of acute symptoms have a faster return to school and sports.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    DOI: 10.3389/fneur.2021.801607
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2564214-5
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