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  • 1
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    Concussion-Recovery Trajectories Among Tactical Athletes: Results From the CARE Consortium
    Journal of Athletic Training/NATA ; 2020
    In:  Journal of Athletic Training Vol. 55, No. 7 ( 2020-07-01), p. 658-665
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 55, No. 7 ( 2020-07-01), p. 658-665
    Abstract: Assessments of the duration of concussion recovery have primarily been limited to sport-related concussions and male contact sports. Furthermore, whereas durations of symptoms and return-to-activity (RTA) protocols encompass total recovery, the trajectory of each duration has not been examined separately. Objective To identify individual (eg, demographics, medical history), initial concussion injury (eg, symptoms), and external (eg, site) factors associated with symptom duration and RTA-protocol duration after concussion. Design Cohort study. Setting Three US military service academies. Patients or Other Participants A total of 10 604 cadets at participating US military service academies enrolled in the study and completed a baseline evaluation and up to 5 postinjury evaluations. A total of 726 cadets (451 men, 275 women) sustained concussions during the study period. Main Outcome Measure(s) Number of days from injury (1) until the participant became asymptomatic and (2) to complete the RTA protocol. Results Varsity athlete cadets took less time than nonvarsity cadets to become asymptomatic (hazard ratio [HR] = 1.75, 95% confidence interval = 1.38, 2.23). Cadets who reported less symptom severity on the Sport Concussion Assessment Tool, third edition (SCAT3), within 48 hours of concussion had 1.45 to 3.77 times shorter symptom-recovery durations than those with more symptom severity. Similar to symptom duration, varsity status was associated with a shorter RTA-protocol duration (HR = 1.74, 95% confidence interval = 1.34, 2.25), and less symptom severity on the SCAT3 was associated with a shorter RTA-protocol duration (HR range = 1.31 to 1.47). The academy that the cadet attended was associated with the RTA-protocol duration (P & lt; .05). Conclusions The initial total number of symptoms reported and varsity athlete status were strongly associated with symptom and RTA-protocol durations. These findings suggested that external (varsity status and academy) and injury (symptom burden) factors influenced the time until RTA.
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    URL: Article
    DOI: 10.4085/1062-6050-10-19
    DOI: 10.2308/accr-52507
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2020
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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  • 2
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    Head-Impact–Measurement Devices: A Systematic Review
    Journal of Athletic Training/NATA ; 2017
    In:  Journal of Athletic Training Vol. 52, No. 3 ( 2017-03-01), p. 206-227
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 52, No. 3 ( 2017-03-01), p. 206-227
    Abstract: With an estimated 3.8 million sport- and recreation-related concussions occurring annually, targeted prevention and diagnostic methods are needed. Biomechanical analysis of head impacts may provide quantitative information that can inform both prevention and diagnostic strategies. Objective: To assess available head-impact devices and their clinical utility. Data Sources: We performed a systematic search of the electronic database PubMed for peer-reviewed publications, using the following phrases: accelerometer and concussion, head impact telemetry, head impacts and concussion and sensor, head impacts and sensor, impact sensor and concussion, linear acceleration and concussion, rotational acceleration and concussion, and xpatch concussion. In addition to the literature review, a Google search for head impact monitor and concussion monitor yielded 15 more devices. Study Selection: Included studies were performed in vivo, used commercially available devices, and focused on sport-related concussion. Data Extraction: One author reviewed the title and abstract of each study for inclusion and exclusion criteria and then reviewed each full-text article to confirm inclusion criteria. Controversial articles were reviewed by all authors to reach consensus. Data Synthesis: In total, 61 peer-reviewed articles involving 4 head-impact devices were included. Participants in boxing, football, ice hockey, soccer, or snow sports ranged in age from 6 to 24 years; 18% (n = 11) of the studies included female athletes. The Head Impact Telemetry System was the most widely used device (n = 53). Fourteen additional commercially available devices were presented. Conclusions: Measurements collected by impact monitors provided real-time data to estimate player exposure but did not have the requisite sensitivity to concussion. Proper interpretation of previously reported head-impact kinematics across age, sport, and position may inform future research and enable staff clinicians working on the sidelines to monitor athletes. However, head-impact–monitoring systems have limited clinical utility due to error rates, designs, and low specificity in predicting concussive injury.
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050.52.2.05
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2017
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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  • 3
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    Interpreting Clinical Reaction Time Change and Recovery After Concussion: A Baseline Versus Norm-Based Cutoff Score Comparison
    Journal of Athletic Training/NATA ; 2021
    In:  Journal of Athletic Training Vol. 56, No. 8 ( 2021-08-01), p. 851-859
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 56, No. 8 ( 2021-08-01), p. 851-859
    Abstract: Preseason testing can be time intensive and cost prohibitive. Therefore, using normative data for postconcussion interpretation in lieu of preseason testing is desirable. Objective To establish the recovery trajectory for clinical reaction time (RTclin) and assess the usefulness of changes from baseline (comparison of postconcussion scores with individual baseline scores) and norm-based cutoff scores (comparison of postconcussion scores with a normative mean) for identifying impairments postconcussion. Design Case-control study. Setting Multisite clinical setting. Patients or Other Participants An overlapping sample of 99 participants (age = 19.0 ± 1.1 years) evaluated within 6 hours postconcussion, 176 participants (age = 18.9 ± 1.1 years) evaluated at 24 to 48 hours postconcussion, and 214 participants (age = 18.9 ± 1.1 years) evaluated once they were cleared to begin a return-to-play progression were included. Participants with concussion were compared with 942 control participants (age = 19.0 ± 1.0 years) who did not sustain a concussion during the study period but completed preseason baseline testing at 2 points separated by 1 year (years 1 and 2). Main Outcome Measure(s) At each time point, follow-up RTclin (ie, postconcussion or year 2) was compared with the individual year 1 preseason baseline RTclin and normative baseline data (ie, sex and sport specific). Receiver operating characteristic curves were calculated to compare the sensitivity and specificity of RTclin change from baseline and norm-based cutoff scores. Results Clinical reaction time performance declined within 6 hours (18 milliseconds, 9.2% slower than baseline). The decline persisted at 24 to 48 hours (15 milliseconds, 7.6% slower than baseline), but performance recovered by the time of return-to-play initiation. Within 6 hours, a change from baseline of 16 milliseconds maximized combined sensitivity (52%) and specificity (79%, area under the curve [AUC] = 0.702), whereas a norm-based cutoff score of 19 milliseconds maximized combined sensitivity (46%) and specificity (86%, AUC = 0.700). At 24 to 48 hours, a change from baseline of 2 milliseconds maximized combined sensitivity (64%) and specificity (61%, AUC = 0.666), whereas a norm-based cutoff score of 0 milliseconds maximized combined sensitivity (63%) and specificity (62%, AUC = 0.647). Conclusions Norm-based cutoff scores can be used for interpreting RTclin scores postconcussion in collegiate athletes when individual baseline data are not available, although low sensitivity and specificity limit the use of RTclin as a stand-alone test.
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050-457-20
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2021
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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  • 4
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    The Persistent Influence of Concussive Injuries on Cognitive Control and Neuroelectric Function
    Journal of Athletic Training/NATA ; 2014
    In:  Journal of Athletic Training Vol. 49, No. 1 ( 2014-01-01), p. 24-35
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 49, No. 1 ( 2014-01-01), p. 24-35
    Abstract: Increasing attention is being paid to the deleterious effects of sport-related concussion on cognitive and brain health. Objective: To evaluate the influence of concussion incurred during early life on the cognitive control and neuroelectric function of young adults. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Forty young adults were separated into groups according to concussive history (0 or 1+). Participants incurred all injuries during sport and recreation before the age of 18 years and were an average of 7.1 ± 4.0 years from injury at the time of the study. Intervention(s): All participants completed a 3-stimulus oddball task, a numeric switch task, and a modified flanker task during which event-related potentials and behavioral measures were collected. Main Outcome Measure(s): Reaction time, response accuracy, and electroencephalographic activity. Results: Compared with control participants, the concussion group exhibited decreased P3 amplitude during target detection within the oddball task and during the heterogeneous condition of the switch task. The concussion group also displayed increased N2 amplitude during the heterogeneous version of the switch task. Concussion history was associated with response accuracy during the flanker task. Conclusions: People with a history of concussion may demonstrate persistent decrements in neurocognitive function, as evidenced by decreased response accuracy, deficits in the allocation of attentional resources, and increased stimulus-response conflict during tasks requiring variable amounts of cognitive control. Neuroelectric measures of cognitive control may be uniquely sensitive to the persistent and selective decrements of concussion.
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050-49.1.01
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2014
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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  • 5
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    National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players
    Journal of Athletic Training/NATA ; 2022
    In:  Journal of Athletic Training Vol. 57, No. 2 ( 2022-02-01), p. 113-124
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 57, No. 2 ( 2022-02-01), p. 113-124
    Abstract: To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries. Background In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy. Conclusions The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.
    Type of Medium: Online Resource
    ISSN: 1938-162X , 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050-0062.21
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2022
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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  • 6
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    Sport-Related Concussion and Sensory Function in Young Adults
    Journal of Athletic Training/NATA ; 2014
    In:  Journal of Athletic Training Vol. 49, No. 1 ( 2014-01-01), p. 36-41
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 49, No. 1 ( 2014-01-01), p. 36-41
    Abstract: The long-term implications of concussive injuries for brain and cognitive health represent a growing concern in the public consciousness. As such, identifying measures sensitive to the subtle yet persistent effects of concussive injuries is warranted. Objective: To investigate how concussion sustained early in life influences visual processing in young adults. We predicted that young adults with a history of concussion would show decreased sensory processing, as noted by a reduction in P1 event-related potential component amplitude. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Thirty-six adults (18 with a history of concussion, 18 controls) between the ages of 20 and 28 years completed a pattern-reversal visual evoked potential task while event-related potentials were recorded. Main Outcome Measure(s): The groups did not differ in any demographic variables (all P values & gt; .05), yet those with a concussive history exhibited reduced P1 amplitude compared with the control participants (P = .05). Conclusions: These results suggest that concussion history has a negative effect on visual processing in young adults. Further, upper-level neurocognitive deficits associated with concussion may, in part, result from less efficient downstream sensory capture.
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050-49.1.02
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2014
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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  • 7
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    Similar Concussion Rates in Spring Football and Preseason: Findings From the Concussion Assessment, Research and Education Consortium
    Journal of Athletic Training/NATA ; 2023
    In:  Journal of Athletic Training Vol. 58, No. 3 ( 2023-03-01), p. 220-223
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 58, No. 3 ( 2023-03-01), p. 220-223
    Abstract: Increasing attention has been directed toward identifying aspects of football participation for targeted policy change that reduces the concussion risk. Prior researchers evaluated concussion risks during the preseason and regular seasons, leaving the spring season largely unexplored. Design In this nationally representative observational investigation of 19 National Collegiate Athletic Association Division I collegiate football programs, we assessed concussion rates and head impact exposures during the preseason, regular season, and spring practices from 2014 to 2019. All participating programs recorded the incidence of concussions, and a subset (n = 6) also measured head impact exposures. Results Analyses by time of year and session type indicated that concussion rates and head impact exposures during all practice sessions and contact practices were higher in the spring and preseason than those in the regular season (P & lt; .05). Concussion rates during the spring season and preseason were statistically similar. Conclusions We identified comparable concussion risks in the spring season and preseason, highlighting the need for targeted policy interventions to protect athlete health and safety.
    Type of Medium: Online Resource
    ISSN: 1938-162X , 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050-0132.22
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2023
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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  • 8
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    A Prospective Study of Concussions and Health Outcomes in High School Football Players
    Journal of Athletic Training/NATA ; 2020
    In:  Journal of Athletic Training Vol. 55, No. 10 ( 2020-10-01), p. 1013-1019
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 55, No. 10 ( 2020-10-01), p. 1013-1019
    Abstract: Football is the most popular sport among US high school students and among the highest for sport-related concussion (SRC) incidence. Limited data detail how SRCs affect high school football players' psychosocial and health status beyond short-term injury recovery. Objective To longitudinally assess how SRCs affected symptoms, depression, and health-related quality of life (HRQoL) in high school football players up to 12 months after SRC. Design Prospective cohort study. Setting Thirty-one Wisconsin high schools. Patients or Other Participants A total of 1176 interscholastic football players (age = 16.0 ± 1.2 years). Main Outcome Measure(s) Participants completed the Post-concussion Symptom Scale (PCSS) from the Sport Concussion Assessment Tool 3 (SCAT3), Patient Health Questionnaire-9 (PHQ-9) for depression, and Pediatric Quality of Life Inventory 4.0 (PedsQL) for HRQoL at enrollment. Participants who sustained an SRC repeated each measure within 72 hours of their injury (onset) and at 7 days (D7), return to play (RTP), and 3 months (M3), 6 months (M6), and 12 months (M12) after SRC. Scores at each time point were compared with each participant's baseline using linear mixed models for repeated measures while controlling for age and previous SRC with participant as a random effect. Results Sixty-two participants sustained an SRC. Participants reported a higher number of PCSS symptoms, greater symptom severity, and lower PedsQL physical summary scores at onset and D7. From RTP through M12, PCSS symptoms, PCSS severity scores, PedsQL total scores, physical summary, and psychosocial summary were unchanged or improved relative to baseline. The PHQ-9 scores were not higher than baseline at any post-SRC interval. Conclusions High school football players in this study who sustained an SRC described no sustained adverse health outcomes (increased PCSS symptoms or symptom severity, increased depression symptoms, or lower HRQoL) after their RTP through M12 after injury.
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050-141-19
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2020
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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  • 9
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    Clinical Reaction Time After Concussion: Change From Baseline Versus Normative-Based Cutoff Scores
    Journal of Athletic Training/NATA ; 2020
    In:  Journal of Athletic Training ( 2020-12-22)
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, ( 2020-12-22)
    Abstract: Context: Pre-season testing is often used to establish baseline scores for post-concussion interpretation. However, pre-season testing can be time-intensive and cost-prohibitive, in which case normative data may be used for post-injury interpretation. Objective: To compare change from baseline and normative-based cutoff scores in interpreting clinical reaction time (RTclin) following concussion. Design: Prospective case-control study. Setting: Multi-site study with testing completed in university athletic training rooms. Patients or Other Participants: An overlapping sample of 99 participants (age=19.0±1.1 years) evaluated within 6 hours post injury, 176 participants (age 18.9±1.1 years) evaluated 24–48 hours post injury, and 214 participants (18.9±1.1 years) evaluated at the time they were cleared to begin a return-to-play progression. Concussion participants were compared to 942 control participants (age=19.0±1.0 years) who did not sustain a concussion during the study period but completed preseason baseline testing one year apart. Main Outcome Measures: At each time point, follow-up RTclin (i.e., post injury or year 2) was compared to individualized year 1 preseason baseline RTclin and to normative baseline data (i.e., sex- and sport-specific). Receiver operating characteristic curves were used to compare sensitivity and specificity of RTclin change from baseline and normative-based cutoff scores. Results: Within 6h, change from baseline of 16ms maximized combined sensitivity (52%) and specificity (78%, AUC=0.702), while normative-based cutoff scores of 19ms maximized combined sensitivity (45%) and specificity (86%, AUC=0.700). At 24–48h, change from baseline of 2ms maximized combined sensitivity (64%) and specificity (61%, AUC=0.666), while normative-based cutoff scores of 0ms maximized combined sensitivity (63%) and specificity (62%, AUC=0.647). Conclusions: Normative-based cutoff scores can be used for interpreting RTclin scores following concussion when individualized baseline data is not available, although low sensitivity and specificity may limit clinical use as a stand-alone test.
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    DOI: 10.4085/JAT0457-20
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2020
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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  • 10
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    National Athletic Trainers' Association Position Statement: Management of Sport Concussion
    Journal of Athletic Training/NATA ; 2014
    In:  Journal of Athletic Training Vol. 49, No. 2 ( 2014-03-01), p. 245-265
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 49, No. 2 ( 2014-03-01), p. 245-265
    Abstract: To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. Background: An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical providers available onsite to identify and evaluate these injuries. Recommendations: The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations.
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050-49.1.07
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2014
    detail.hit.zdb_id: 2070051-9
    SSG: 31
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