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  • 1
    Language: English
    In: Journal of athletic training, March 2017, Vol.52(3), pp.309-317
    Description: Initially, interest in sport-related concussion arose from the premise that the study of athletes engaged in sports associated with high rates of concussion could provide insight into the mechanisms, phenomenology, and recovery from mild traumatic brain injury. Over the last decade, concerns have focused on the possibility that, for some athletes, repetitive concussions may raise the long-term risk for cognitive decline, neurobehavioral changes, and neurodegenerative disease. First conceptualized as a discrete event with variable recovery trajectories, concussion is now viewed by some as a trigger of neurobiological events that may influence neurobehavioral function over the course of the life span. Furthermore, advances in technology now permit us to gain a detailed understanding of the frequency and intensity of repetitive head impacts associated with contact sports (eg, football, ice hockey). Helmet-based sensors can be used to characterize the kinematic features of concussive impacts, as well as the profiles of typical head-impact exposures experienced by athletes in routine sport participation. Many large-magnitude impacts are not associated with diagnosed concussions, whereas many diagnosed concussions are associated with more modest impacts. Therefore, a full understanding of this topic requires attention to not only the effects of repetitive concussions but also overall exposure to repetitive head impacts. This article is a review of the current state of the science on the long-term neurocognitive and neurobehavioral effects of repetitive concussion and head-impact exposure in contact sports.
    Keywords: Neurodegeneration ; Recovery ; Symptom Reporting ; Traumatic Brain Injuries ; Athletic Injuries -- Psychology ; Brain Concussion -- Psychology ; Cognition Disorders -- Etiology ; Nervous System Diseases -- Etiology
    ISSN: 10626050
    E-ISSN: 1938-162X
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  • 2
    Article
    Article
    BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
    Language: English
    In: British Journal of Sports Medicine April 2013, Vol.47(5), p.272
    Description: To conduct a critical review of the literature on instruments currently used in the assessment of sport-related concussion on the day of injury.
    Keywords: Concussion ; Contact Sports ; Head Injuries
    ISSN: 0306-3674
    ISSN: 03063674
    E-ISSN: 1473-0480
    E-ISSN: 14730480
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  • 3
    Language: English
    In: Journal of athletic training, September 2001, Vol.36(3), pp.274-279
    Description: OBJECTIVE: The effects of concussion on mental status are often difficult to assess on routine clinical examination. I investigated the efficacy of standardized mental status testing on the sport sideline to detect abnormalities that result from concussion and provide an objective measure of postinjury cognitive recovery. DESIGN AND SETTING: All subjects underwent a standardized preseason baseline mental status evaluation. Standardized testing of injured and uninjured control subjects was repeated on the sideline immediately after concussion and 48 hours after injury. SUBJECTS: Sixty-three high school and collegiate football players with concussion and 55 uninjured control subjects were studied. MEASUREMENTS: The Standardized Assessment of Concussion (SAC) was administered to evaluate neurocognitive functioning and neurologic status. RESULTS: Immediately after concussion, injured subjects performed significantly below preinjury baseline and below uninjured controls on the SAC. Measurable deficits in orientation, concentration, and memory were evident immediately after concussion. A decline in SAC score at time of injury was 95% sensitive and 76% specific in accurately classifying injured and uninjured subjects on the sideline. Injured subjects demonstrated significant improvements in SAC score 48 hours after injury. CONCLUSIONS: Standardized mental status testing can be a valuable tool to assist the sports medicine clinician in detecting the immediate effects of concussion on mental status, tracking resolution of immediate postconcussive mental status abnormalities, and making more informed decisions on return to play after injury.
    Keywords: Neuropsychological Tests -- Analysis ; Athletes -- Injuries;
    ISSN: 10626050
    E-ISSN: 1938-162X
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  • 4
    Language: English
    In: Pediatrics, February 2015, Vol.135(2), pp.213-23
    Description: To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED). Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory. Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P 〈 .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P 〈 .03) and slower symptom resolution. Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest.
    Keywords: Adolescent ; Brain Injury ; Concussion ; Discharge Instructions ; Rest ; Bed Rest ; Brain Concussion -- Therapy ; Post-Concussion Syndrome -- Prevention & Control
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 5
    Language: English
    In: The American Journal of Sports Medicine, July 2013, Vol.41(7), pp.1490-1496
    Description: Background: Headache-related symptoms may be predictive of delayed recovery in student athletes after sport-related concussion. Purpose and Hypothesis: To compare balance performance, cognitive function, and symptom recovery in concussed student athletes with no headache, those with posttraumatic headache, and those with characteristics of posttraumatic migraine following a sport-related concussion. It was hypothesized that those with posttraumatic migraine would take longer to recover on all clinical measures. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: A total of 296 student athletes who sustained sport-related concussions (migraine, 52; headache, 176; no headache, 68) were evaluated on measures of balance performance, cognition, and symptoms. Patients were categorized into posttraumatic migraine, posttraumatic headache, and no headache groups based on symptoms reported 1 day after injury. Serial testing was conducted with the Balance Error Scoring System, the Standardized Assessment of Concussion, and a graded symptom checklist to evaluate balance performance, cognition, and symptoms, respectively, at baseline, at the time of injury, after the event, and at days 1, 2, 3, 5, 7, and 90. Results: Student athletes with posttraumatic migraine experienced greater symptom severity scores than did those with posttraumatic headache and no headache at the time of injury, after the event, and through day 7 (P 〈 .001 for all). By day 7, symptom severity scores reported by patients with posttraumatic migraine still demonstrated deficits relative to baseline (Δ = 5.6 ± 1.2) compared with patients with headache (Δ = −0.8 ± 0.7) and those with no headache (Δ = −1.4 ± 1.1). Patients with headache experienced greater symptom severity scores than patients with no headache at the time of injury (P 〈 .001), after the event (P 〈 .001), and at day 1 (P 〈 .001), day 2 (P = .005), and day 3 (P = .038). Much smaller differences were observed between the headache and no headache groups beyond day 3 (P 〉 .05). There were no group differences on balance performance (P = .439) and cognitive testing (P = .200) over time. Female patients were 2.13 times more likely than males to report posttraumatic migraine characteristics after concussion. Conclusion: Posttraumatic migraine characteristics are related to prolonged symptom recovery after sport-related concussion. Clinicians should exercise caution in making decisions about return to participation for athletes with migraine-like symptoms given the increased short-term impairments and delayed symptom recovery we observed.
    Keywords: Athlete ; Concussion ; Evaluation ; Headache ; Return-to-Participation ; Medicine
    ISSN: 0363-5465
    E-ISSN: 1552-3365
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  • 6
    Language: English
    In: Medicine & Science in Sports & Exercise, 2018, Vol.50, p.3
    ISSN: 0195-9131
    Source: Wolters Kluwer - Ovid (via CrossRef)
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  • 7
    Language: English
    In: Medicine & Science in Sports & Exercise, 2017, Vol.49, p.835
    ISSN: 0195-9131
    Source: Wolters Kluwer - Ovid (via CrossRef)
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  • 8
    Language: English
    In: Sports medicine (Auckland, N.Z.), July 2018, Vol.48(7), pp.1761
    Description: The article Test-Retest Reliability and Interpretation of Common Concussion Assessment Tools.
    Keywords: Medicine & Public Health ; Sports Medicine ; Medicine;
    ISSN: 01121642
    E-ISSN: 1179-2035
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  • 9
    Language: English
    In: Sports Medicine, 2018, Vol.48(5), pp.1255-1268
    Description: Background Concussion diagnosis is typically made through clinical examination and supported by performance on clinical assessment tools. Performance on commonly implemented and emerging assessment tools is known to vary between administrations, in the absence of concussion. Objective To evaluate the test-retest reliability of commonly implemented and emerging concussion assessment tools across a large nationally representative sample of student-athletes. Methods Participants ( n  = 4874) from the Concussion Assessment, Research, and Education Consortium completed annual baseline assessments on two or three occasions. Each assessment included measures of self-reported concussion symptoms, motor control, brief and extended neurocognitive function, reaction time, oculomotor/oculovestibular function, and quality of life. Consistency between years 1 and 2 and 1 and 3 were estimated using intraclass correlation coefficients or Kappa and effect sizes (Cohen’s d ). Clinical interpretation guidelines were also generated using confidence intervals to account for non-normally distributed data. Results Reliability for the self-reported concussion symptoms, motor control, and brief and extended neurocognitive assessments from year 1 to 2 ranged from 0.30 to 0.72 while effect sizes ranged from 0.01 to 0.28 (i.e., small). The reliability for these same measures ranged from 0.34 to 0.66 for the year 1–3 interval with effect sizes ranging from 0.05 to 0.42 (i.e., small to less than medium). The year 1–2 reliability for the reaction time, oculomotor/oculovestibular function, and quality-of-life measures ranged from 0.28 to 0.74 with effect sizes from 0.01 to 0.38 (i.e., small to less than medium effects). Conclusions This investigation noted less than optimal reliability for most common and emerging concussion assessment tools. Despite this finding, their use is still necessitated by the absence of a gold standard diagnostic measure, with the ultimate goal of developing more refined and sound tools for clinical use. Clinical interpretation guidelines are provided for the clinician to apply with a degree of certainty in application. Electronic supplementary material The online version of this article (10.1007/s40279-017-0813-0) contains supplementary material, which is available to authorized users.
    Keywords: Original Research Article;
    ISSN: 0112-1642
    E-ISSN: 1179-2035
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  • 10
    Language: English
    In: The Clinical Neuropsychologist, 01 January 2011, Vol.25(1), pp.3-11
    Keywords: Anatomy & Physiology
    ISSN: 1385-4046
    E-ISSN: 1744-4144
    Source: Taylor & Francis (Taylor & Francis Group)
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