Aim: The relationship between post-concussion kinesiophobia and clinical and functional reaction time (RT) beyond clinical recovery remains to be elucidated. Methods: College-aged participants with (n = 20) and without (n = 20) a concussion history completed patient-reported outcomes, and RT tasks. Kinesiophobia, symptoms and RTs were compared using t-tests. Linear regressions were performed to determine if kinesiophobia predicted RT measures and dual-task cost. Results: The concussion history group reported higher scores (p < 0.01) for all patient-reported outcomes. We observed significant single-task RT differences between groups (p = 0.013) such that those without a concussion history (m = 0.51s ± 0.08) were faster (m = 0.59s ± 0.12). There were no clinical or dual-task RT differences between groups (p > 0.05). Kinesiophobia significantly predicted single-task RT (R2 = 0.22). Discussion: Kinesiophobia should be considered when measuring RT.
Aim: Difficulty understanding speech following concussion is likely caused by auditory processing impairments. We hypothesized that concussion disrupts pitch and phonetic processing of a sound, cues in understanding a talker. Patients & methods/results: We obtained frequency following responses to a syllable from 120 concussed and 120 control. Encoding of the fundamental frequency (F0), a pitch cue and the first formant (F1), a phonetic cue, was poorer in concussed children. The F0 reduction was greater in the children assessed within 2 weeks of their injuries. Conclusion: Concussions affect auditory processing. Results strengthen evidence of reduced F0 encoding in children with concussion and call for longitudinal study aimed at monitoring the recovery course with respect to the auditory system.
Aim: Indigenous Australians have higher rates of traumatic brain injury, with 74–90% of such injuries being concussion. This study explores concussion awareness and knowledge in Aboriginal Western Australians with high health literacy. Materials & methods: Participants, aged 18–65 years, engaged in research topic yarning, and thematic analysis of the qualitative data then undertaken. Results: There was awareness that direct head trauma can result in concussion, but a lack of differentiation between concussion and other head injuries. Knowledge was gained from sport, media or lived-experience. Symptom minimization and diversity of concussion symptoms prevented participants from seeking medical treatment. This was exacerbated by a mistrust of the medical system. Conclusion: Research findings highlight knowledge and service gaps where co-designed strategies can be targeted.
Aim: Athletic pre-season testing can establish functional baseline for comparison following concussion. Whether impacts of future concussions may be foretold by such testing is little known. Materials & methods: Two sets of models for a significant burden of concussion were generated: a traditional approach using a series of logistic regressions, and a penalized regression approach using elastic net. Results: 3091 youth and adult athletes were baseline-assessed. 90 subsequently experienced concussion and 35 were still experiencing a significant burden of concussion when tested within two weeks. Both models associated prior history of head injury and visual attention-related metrics with a significant burden of concussion. Conclusion: Pre-season testing of visual attention may identify athletes who are at risk for significant sports-related concussion.
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Plain language summary It is commonly assumed that there is no brain injury if there are no noticeable symptoms following a head impact. There is growing evidence that traumatic brain injuries can occur with no outward symptoms and that the damage from these injuries can accumulate over time resulting in disease and impairment later in life. It is time to rethink the role that symptoms play in traumatic brain injury and adopt a quantitative understanding of brain health at the cellular level to improve the way we diagnose, prevent, and ultimately heal brain injury.
Aim: To report improvements in post-concussion syndrome and concussion incidence following cervical spinal alignment correction. Case presentation: A 27-year-old professional rugby player with 20 documented concussions presented with abnormal cervical spinal alignment and post-concussion syndrome. After 30 sessions of cervical rehabilitation, health outcomes improved. Post-treatment radiographs showed improved cervical lordosis from -13.5° to -37.4° (ideal is -42°) and right head translation from -22.7 to -11.3 mm (ideal is 0 mm). 2-year follow-up radiographs and 6-year follow-up health outcomes showed post-treatment improvements were maintained. The patient reported two documented concussions in the 6 years following treatment while maintaining the same lifestyle and professional rugby career. Conclusion: Correction of abnormal cervical spinal alignment may help athletes with post-concussion syndrome and reduce risk of concussion.
Aim: To understand academic support structures for Washington state public high school students with concussion during the COVID-19 pandemic. Materials & methods: Prospective, repeated cross-sectional study of 21 schools in 2020 and 2021. Results: About 28% of schools reported not providing any return-to-learn (RTL) accommodations for students with concussion throughout the COVID-19 pandemic. RTL accommodation provision was associated with larger student body size (β = 0.002) and higher graduation rate (β = 0.261) but was not associated with presence of RTL school policy. About 38.1% of schools received no guidance on how to provide RTL accommodations during the COVID-19 pandemic, and many reported that students with concussion struggled more. Conclusion: Schools struggled to provide RTL accommodations for students with concussion during the COVID-19 pandemic, highlighting the need for evidence-based guidance and resource allocation to vulnerable schools.
“ These recent neuro-optometric, therapeutic advances are promising. However, investigations into the sensory, motor, and perceptual dysfunctions and their clinical ramifications remains in its infancy
Aim: To examine the impact of concussion on objective measures of school performance. Materials & methods: Population-based matched cohort study using linked health and education records of young people aged ≤18 years hospitalized with concussion in New South Wales, Australia, during 2005–2018, and matched comparisons not hospitalized with any injury. Results: Young people with concussion had higher risk of not achieving the national minimum standards for literacy and numeracy assessments, ranging from 30% for numeracy to 43% for spelling, and not completing high school, ranging from 29% for year 10 to 77% for year 12, compared with matched peers. Conclusion: Young people hospitalized with concussion have impaired school performance compared with uninjured matched peers.
Aim:To understand sex differences and sources of concussion education for college students. The literature for college students primarily focuses on sports concussions and general knowledge. Understanding how non-students-athletes learn is critical to developing interventions to improve concussion knowledge.Participants:A random sample of 208 students from four-year institutions.Methods:A 22-question online survey explored postsecondary students' current knowledge and education regarding concussions.Results:Findings indicated that sex differences emerged with concussion knowledge and sources of concussion knowledge (e.g., leaflets, pamphlets, parents, and television). The top choices for where they wanted to learn about concussions were health educators, health centers, and campus peer educators.Conclusion:This study provides an initial evaluation and implications for future research on providing concussion education.
Aim: Continuing medical education (CME) informs physicians on current research. The Concussion Awareness Training Tool (CATT) provides education on concussion diagnosis and treatment. The aims of this study were to explore physician CME practices and preferences, understand barriers and facilitators to implementing the CATT as CME, and provide recommendations. Materials & methods: Physicians in British Columbia, Canada participated in an online survey and telephone interview. Descriptive analysis of quantitative data, and text-based data analysis were undertaken to identify themes. Results: Barriers included lack of time and awareness of the resource. Facilitators were its ease of use, accessibility, conciseness and comprehensiveness. Conclusion: The perceptions of barriers and facilitators reported by physicians are important to understand and better promote the use of the CATT.
Aim This study investigates if scores on the Balance Error Scoring System (BESS) are affected when administered remotely. Materials & methods Participants included 26 undergraduate students, aged 19-32 (mean: 21.85 ± 2.95). Each participant received the BESS test remotely and in person, and scores on each were compared. To minimize potential practice effects, participants were randomly assigned to two equal sized groups to take the BESS remotely first or in person first. Results The mean difference between scores for the remote and in-person assessments was 0.711 (95% CI: 0.708–2.131). There was no significant difference between scores (p = 0.312) indicating the BESS maintains reliability when administered remotely. Conclusion Administration of the BESS remotely was possible without any significant challenges.
Aim: To explore high school athletic trainers’ experience with, and perceptions of, a multifaceted approach to concussion management. Participants: A total of 20 high school athletic trainers that are certified and licensed to practice (if their state requires a license to practice) participated in this study. Materials & methods: A general qualitative design with descriptive coding and saturation was met at 20 interviews. Results: Lack of standardization allows assessment, referral and return-to-play experiences to vary significantly; referral experiences vary pending upon athletic trainers ability to refer to a trusted and responsive physician; barriers include clearances from unqualified physicians; pressure from coaches, parents and students to return students to play; benefits include increased knowledge and awareness resulting in more effective care for students. Conclusion: Athletic trainers have varying experiences and perceptions regarding their approaches to concussion management. However, there were many notable similarities in the experiences, pressures, barriers and benefits when applying their concussion protocol.
Aim: To assess the rate of self-reported concussion in midwestern skiers and snowboarders. Patients: Recreational skiers and snowboarders between the ages of 14 and 69 years during a single winter ski season (2020–2021) at a ski area in Wisconsin, USA. Methods: Survey study. Results: Among this survey population (n = 161), 9.32 and 19.25% reported one or more diagnosed concussion and suspected concussion respectively as a result of a skiing- or snowboarding-related incident. Skiers and snowboarders that self-identified as advanced, those who utilized terrain park features, and those that participated in freestyle competition had significantly higher self-reported rates of concussion. Conclusion: Self-reported concussion history indicates a concussion prevalence that is higher than expected based on previous studies. Participants reported significantly more suspected concussions than diagnosed concussions, indicating a possible issue with underreporting in this population.
Aim: Patients with chronic mild or moderate traumatic brain injury have some regions of brain atrophy (including cerebral white matter) but even more regions of abnormal brain enlargement (including other cerebral regions). Hypothesis: Ipsilateral injury and atrophy cause the eventual development of contralateral compensatory hypertrophy. Materials & methods: 50 patients with mild or moderate traumatic brain injury were compared to 80 normal controls (n = 80) with respect to MRI brain volume asymmetry. Asymmetry-based correlations were used to test the primary hypothesis. Results: The group of patients had multiple regions of abnormal asymmetry. Conclusion: The correlational analyses supported the conclusion that acute injury to ipsilateral cerebral white matter regions caused atrophy, leading eventually to abnormal enlargement of contralateral regions due to compensatory hypertrophy.
Aim: To explore soft-shell padded headgear (HG) use, player behavior and injuries associated with HG in junior Australian football. Methods: Prospective case-crossover with head impact measurement, injury surveillance and video review. Results: 40 players (mean age: 12.43 years, standard deviation: 1.36) across 15 matches were observed. Frequency of head/neck (p = 0.916) or body (p = 0.883) contact events, and match incidents were similar between HG and no HG conditions. Without HG, females had higher frequency of body contacts compared with males (p = 0.015). Males sustained more body contacts with HG than without HG (p = 0.013). Conclusion: Use of HG in junior football was not associated with injury or head contact rate. Associations between HG use and body contact may differ across sexes. (ID: ACTRN12619001165178).
Aim & Patients:We conducted a randomized clinical trial to determine if an e-learning intervention can enhance recovery in adult patients with persistent post-concussion headaches (PPCH).Materials & Methods:The intervention consisted of three e-learning modules administered at baseline, 6 and 12 weeks. Data were collected on symptoms, community integration, quality of life and healthcare utilization at baseline and 12-week follow-up. ANCOVA was conducted to compare changes.Results:No statistically significant difference was observed on symptoms although we observed a trend toward reduced healthcare utilization and improved quality of life in the intervention group.Conclusion:E-learning modules for patients experiencing PPCH warrant further investigation with data on participant compliance and measures focusing on simpler short-term outcomes.Clinical Trial Registration: NCT03391583 (ClinicalTrials.gov).
Concussion is predominant among the vast number of traumatic brain injuries that occur worldwide. Difficulties in timely identification, whether concussion led to neuronal injury or not, diagnosis and the lack of prognostic tools for adequate management could lead this type of brain injury to progressive neurodegenerative diseases. Tau has been extensively studied in recent years, particularly in repetitive mild traumatic brain injuries and sports-related concussions. Tauopathies, the group of neurodegenerative diseases, have also been studied with advanced functional imaging. Nevertheless, neurodegenerative diseases, such as chronic traumatic encephalopathy, are still conclusively diagnosed at autopsy. Here, we discuss the diagnostic dilemma and the relationship between concussion and neurodegenerative diseases and review the literature on tau as a promising biomarker for concussion.
Aim: This cross-sectional study aimed to better understand parental knowledge and attitudes regarding pediatric sport-related concussions, and association with parent/child biopsychosocial factors. Methods: A community sample of ninety families (n = 140 children) were included. Parental concussion knowledge and attitudes, concussion history, sport participation and social risk status score (SRS) were collected. Results: Parents scored an average of 76% accuracy on factual concussion knowledge, with 74% confidence in responses. Parents endorsed a favorable attitude toward concussion reporting and management. Low SRS had higher perceived accuracy of knowledge than medium or high SRS (p = 0.003). SRS influenced over-and-underestimations of factual knowledge (p = .04). Age at first sport and sport contact level influenced factual and perceived concussion knowledge. Conclusion: These findings identify common gaps in concussion knowledge in parents.
