OBJECTIVE:Characterizing cancer-related cognitive impairment (CRCI) remains challenging due to limitations in the sensitivity of neuropsychological tests and diagnostic criteria. This study aimed to (a) classify breast cancer survivors in CRCI groups using self-reported and neuropsychological categories; (b) explore whether CRCI is related to specific cognitive domains; (c) analyze if comorbid symptoms predict CRCI group membership; (d) study the correspondence between Montreal Cognitive Assessment (MoCA) and neuropsychological CRCI; and (e) explore cognitive profiles of CRCI groups considering Boston Process Approach (BPA) indices. METHOD:This cross-sectional study included 82 breast cancer survivors undergoing treatment and presenting mild depressive symptoms. Self-reported CRCI was assessed using the PROMIS-CF 8a, neuropsychological CRCI was defined following recommended criteria. Participants were classified into four independent CRCI groups: (a) non-CRCI; (b) subjective CRCI; (c) objective CRCI; (d) combined CRCI. Logistic regression models examined predictors, χ2 tests assessed MoCA correspondence, and group differences in BPA indices were studied through ANOVA. RESULTS:Participants' mean age was 47.76 years, 71.95% exhibited self-reported CRCI and 48.78% neuropsychological CRCI. Anxiety predicted subjective and combined CRCI, while lower self-efficacy predicted combined CRCI. MoCA showed limited sensitivity and specificity for neuropsychological CRCI. The combined CRCI group exhibited poorer quality of life and lower performance on processing speed and verbal fluency tasks. CONCLUSIONS:CRCI assessment should include self-reported and neuropsychological measures. MoCA should not replace comprehensive neuropsychological assessment, while BPA may provide complementary meaningful information to characterize CRCI profiles. CRCI interventions should target executive functioning, anxiety, and self-efficacy. Longitudinal studies with control groups are required.
The subspecialty of forensic neuropsychology has expanded considerably over the past two decades, along with increasing involvement of neuropsychological assessment in criminal forensic evaluations. Despite this growth, the role of neuropsychology in criminal responsibility (CR) evaluations remains underexamined. This paper (a) outlines the foundational importance of specialized knowledge in forensic neuropsychology as a basis for subspecialty development; (b) examines the potential incremental validity of neuropsychological data in CR evaluations; (c) analyzes the application of neuropsychological findings to key components of CR legal standards; (d) extends this analysis to broader exculpatory doctrines; and (e) frames these discussions in ways that inform multiple forensic stakeholders, including neuropsychologists engaged in forensic practice, forensic psychologists consulting with neuropsychologists, and trainees pursuing integrated training across forensic psychology and neuropsychology.
OBJECTIVE:This exploratory study examined relationships between predisposing factors (age, pre-morbid medical conditions, educational attainment), COVID-19 disease severity indicators (hospitalization status, symptom burden, symptom duration), and self-reported cognitive complaints and emotional symptoms in Puerto Rican adults with prior COVID-19. METHOD:Fifty-nine Puerto Rican adults (71.2% female; M age = 39.27 years, SD = 12.21) with a confirmed history of COVID-19 completed an investigator-developed sociodemographic questionnaire, the Neurobehavioral Symptom Inventory (NSI), and the Neuro-QoL v2.0 Cognitive Function-Short Form Spanish via an online platform. Non-parametric analyses included Spearman correlations, Mann-Whitney U tests, and Kruskal-Wallis tests with effect sizes. A sensitivity power analysis estimated the smallest detectable effects. RESULTS:Symptom burden was the strongest correlate of self-reported cognitive and emotional symptoms, correlating positively with NSI Total (rho = 0.651, p < .001) and NSI Affective (rho = 0.637, p < .001) scores, and negatively with Neuro-QoL (rho = -0.329, p = .011). Pre-morbid conditions were associated with worse NSI Total (rho = 0.298, p = .022) and NSI Cognitive (rho = 0.344, p = .008). Age and education showed no significant associations. Cognitive complaints were strongly associated with emotional symptoms, holding across instruments and after adjusting for symptom burden. Hospitalization comparisons showed small-to-medium but nonsignificant effects, inconclusive given the small hospitalized subgroup. CONCLUSIONS:In this Puerto Rican sample, COVID-19 symptom burden and pre-morbid health status were the primary correlates of cognitive difficulties, which were closely intertwined with emotional symptoms. These exploratory findings offer preliminary empirical evidence to inform future research in Puerto Rico.
OBJECTIVE:Children with neurofibromatosis type 1 (NF1) are at risk for cognitive impairments. Optic pathway gliomas (OPGs) commonly occur in children with NF1, though whether OPG exacerbates cognitive vulnerabilities beyond the NF1 genotype remains unclear. This study compared cognition among children with NF1 and OPG (NF1 + OPG), children with NF1 without OPG (NF1-only), and children with central nervous system (CNS) tumors of the visual system without NF1 (CNS-V), to evaluate whether OPG confers additional cognitive risk beyond NF1. METHOD:This retrospective clinical cohort study included 98 pediatric patients referred for a clinical neuropsychological evaluation: 69 NF1-only, 21 NF1 + OPG, and 8 CNS-V tumor. Intellectual functioning, verbal reasoning, visuospatial reasoning, working memory, and processing speed were examined. Group differences were analyzed using one-way analyses of variance; chi-square tests assessed impairment rates. RESULTS:Children with NF1 with and without OPG did not differ significantly across cognitive domains. Both NF1 groups (NF1-only and NF1 + OPG) demonstrated weaker verbal and visuospatial reasoning abilities compared to the CNS-V group. In contrast, children with CNS-V tumors performed within the average range across domains with significantly stronger intellectual performance than both NF1 groups. CONCLUSIONS:OPG does not appear to exacerbate cognitive vulnerability in children with NF1. Cognitive weaknesses in NF1 likely reflect the underlying genotype rather than added tumor burden. Comparatively, children with non-NF1 visual system tumors demonstrated average performance. These findings underscore the importance of routine neuropsychological monitoring in children with NF1 regardless of tumor status and highlight the need for prospective, adequately powered studies to further disentangle genotype- and tumor-related effects.
Abstract Purpose To evaluate the longitudinal consistency of middle school (MS) student-athletes’ self-reported prior health conditions across repeated baseline concussion assessments. Method Longitudinal analysis of MS student-athletes (N=5,736) between 2017-2022 was conducted using the medical history items from the Child SCAT5 and SCAT5. De-identified self-reported medical history data were retrospectively analyzed from 1,073 MS student-athletes (grades 6-8; mean age=11.7 (0.77); 62.3% male) having at least 2 concussion baseline assessments (median re-test interval=12.1 months (8.3)). Data included history of attention-deficit/hyperactivity disorder (ADHD), learning disorder, psychiatric disorder, headache disorder or migraine, and hospitalization for head injury. First-to-last transition matrices with Wilson confidence intervals quantified reporting consistency; Yes-to-No transitions between assessments indicated inconsistency. Results No-to-No reporting remained highly stable across conditions (>97%), while Yes-to-Yes reporting was highly stable for ADHD (82%) but lower for other conditions (30-40%). New endorsements were infrequent across all conditions (<3%). Among MS student-athletes reporting ADHD at baseline, 18% (95% CI: 10.4%-28.4%) did not re-endorse ADHD at the follow-up baseline assessment. Yes-to-No transitions were higher for learning (60%; CI: 35.8%-80.2%), psychiatric (70%; CI: 52.7%-82.6%), and headache disorders or migraine (63%; CI: 46.3%-76.8%), and hospitalization for head injury (66%; CI: 53.7%-76.0%). Conclusions While self-reported ADHD was most consistent longitudinally and across conditions, inconsistency remained in nearly one-fifth of MS student-athletes, with higher inconsistency for self-reported learning, psychiatric, and headache disorders or migraine, and hospitalization for head injury. Results highlight the need to incorporate caregiver report and/or medical record verification when obtaining medical history to better inform concussion management in MS student-athletes.
Abstract Purpose Beginning in 2017, the Sport Concussion Assessment Tool (SCAT5), and later the SCAT6, introduced without elaboration the questions: (1) “If 100% is perfectly normal, what percent of normal do you feel?” and (2) “If not 100%, why?” We assessed whether these items provided useful information regarding respondent effort and performance in baseline concussion evaluations. Method The SCAT5 was administered during preparticipation medical testing to 1,069 university athletes, aged 17-25 (M=19.69, SD=1.50; 64% male). Reasons for feeling less than 100% normal included: sleep/tired (46%), physical (21%), emotional (11%), cognitive (1%), travel-related (4%), multiple (6%), and other (11%). Results 46.1% of participants reported feeling 100% normal. Only 25% (n=269) of the participants reported feeling both 100% normal and endorsed zero symptoms on the SCAT5 symptom evaluation. Higher % normal scores were associated with lower SCAT5 symptom totals and symptom severity scores (r = -.413 & -.414, respectively, p <.001). However, when compared across five categories of % normal, no difference was found for the various SCAT5 cognitive and balance domains (Λ = .972, F(24, 3678) = 1.26, p = .177, ηp2 = .007). Conclusions The current results show less than ideal reliability of reports of feeling normal given the disconnect with the symptom evaluation responses. Moreover, the finding of no difference between feelings of normalcy and performance on the cognitive and balance domains of the SCAT5 suggests that the % normal item is irrelevant in interpreting SCAT5 performance.
Abstract Purpose Neuropsychological testing underpins return-to-play and return-to-duty decisions following traumatic brain injury (TBI). Yet, the face validity of performance and symptom validity tests (PVTs and SVTs) remains unexamined in TBI populations. In performance-driven contexts such as sport, where identity and pressure to return are powerful, perceived test credibility may shape effort, engagement, and symptom reporting. This review critically examined the empirical literature on face validity in neuropsychological assessment of adults with TBI. Data Selection An English-language systematic search was conducted in February 2026 across PubMed, PsycINFO, and SPORTDiscus. Studies were included if they were quantitative, peer-reviewed, involved adults (≥18 years) with TBI, incorporated PVTs/SVTs, and explicitly examined or operationalized face validity. Two independent reviewers screened studies, and eligible articles were coded using a standardized extraction form. Data Synthesis Six studies were identified; after screening, three met the inclusion criteria. None directly measured face validity; instead, it was inferred from task features such as perceived cognitive demand (Test of Effort), contextual realism (Charge of Quarters Duty Test), or item transparency (Personality Assessment Inventory). Although measures (Reliable Digit Span, Test of Memory Malingering, Dot Counting Test) demonstrated convergent or discriminant validity, none were assessed for perceived face validity. Overall, face validity was treated as a conceptual assumption rather than a measurable determinant of engagement or assessment integrity. Conclusions Despite the high-stakes nature of sport-related concussion management, face validity remains unexamined, mainly in neuropsychological assessment. Its potential influence on engagement and performance has not been directly evaluated. Systematic investigation is needed to strengthen return-to-play decision-making and promote athlete safety.
Abstract Purpose TBI produces tau acetylation (ac-tau) which may represent both an available blood-based biomarker (BBB) and may lead to neurodegeneration as ac-tau accumulates with repetitive TBI. The current exploratory study examines ac-tau and other common BBBs and their relationship to neurocognitive performance in college athletes pre/post-season. Method Student athletes with varying degrees of contact exposure from 3 universities in Northeast Ohio completed ac-tau biomarker assays pre/post-season. A subsample consented for processing by an outside lab (Quanterix Corp) for traditional BBBs (GFAP, UCH-L1, NfL, and total-tau). Results 34 athletes (M age=19.00,SD=1.30;59% female;18% Black/Non-White;76% collision/contact sport; 35% previous concussions) completed pre/post-season ac-tau assays and ImPACT testing. In the ac-tau sample and the Quanterix subsample (n=18;67% female; 6% Black/Non-White;72% collision/contact sport; 44% previous concussions), BBB changes were uncorrelated to ImPACT pre/post-season (p>.05) and elevations were not common or more frequent by contact exposure (p>.05). Athletes with concussion history did show greater increase in ac-tau post-season (F(1,26)=4.11,p<.05,partial eta-squared=0.14), though this was unrelated to contact exposure during the season. Other rare findings (e.g.UCH-L1 correlation to Verbal Memory, r=0.69,p<.01; NfL correlation to symptom endorsement, r=-.49,p<.05) were in the wrong direction for clinical utility (better outcome associated with BBB elevation) and are likely spurious in this small sample. Conclusions Ac-tau and BBB elevations were uncommon and changes were unrelated to contact/neurocognitive performance in uninjured college athletes. This finding supports that a single sports season may not produce significant neuronal injury and suggests BBB elevations may be specific to injury/TBI and not sensitive to contact exposure/athletic participation alone.
Abstract Purpose To investigate whether headers incurred during a single competitive match were associated with acute changes in neurocognitive function. Method Fifty-seven recreational male football players (20.9 + 3.0 years) completed a battery of neurocognitive tests before and after a single competitive match. Due to testing duration, the battery was divided into a Part A (n=31; short-term and working memory, inhibitory control, sustained attention) and Part B (n=26; visual attention, task-switching, motor control). All matches were video-recorded, and headers were classified as high- or low-force using a validated framework. Hierarchical linear regression analyses examined whether total headers, the number of high-force headers or their interaction explained additional variance (ΔR2) in neurocognitive outcomes after controlling for necessary regressor variables. Results A total of 220 headers were identified. Players in Part A performed between 0-13 headers (4.3 + 3.0; 38% high-force) and 0-15 headers (4.9 + 3.3; 44% high-force) in Part B. Across most domains, neither total headers nor the number of high-force headers explained additional variance beyond covariate-only models (ΔR2=.001-.186; ps >.05). A significant interaction between total and high-force headers was observed for short-term memory (ΔR2=.245, p=.018) indicating that pre- to post-match changes varied as a function of the combined effects of total and high-force heading exposure. Conclusions Match-play heading was not associated with acute impairment across most cognitive domains. Observed effects were limited to a task-specific interaction in short-term memory, suggesting any immediate effects of heading are subtle and exposure-dependent.
Abstract Purpose Anxiety and depression have been associated with worse performance on baseline balance and neurocognitive testing, and increased symptom reporting, using the SCAT, ImPACT, and BESS. This study replicated these findings using the Sway Sports+ Battery. Method A sample of 10,885 middle/high school, and collegiate athletes, ages 13-22, completed a pre-season baseline assessment. The Sway Sports+ Battery contains a Balance module and yields Reaction Time, Inspection Time, Impulse Control, and Memory scores. Total Symptom scores were documented as well as Total Symptoms without Emotion (removing “Sadness”, “More Emotional”, “Irritability” and “Nervous or Anxious”). Athletes also completed a Patient Health Questionnaire (PHQ9) and Generalized Anxiety Disorder assessment (GAD7), and were assigned to groups based on their PHQ9 and GAD7 scores (Minimal: 0-4; Mild 5-9; Moderate-to-Severe 10+). Results 12.0% of athletes obtained GAD7 scores consistent with mild and 4.5% with moderate-to-severe anxiety; 13.3% of athletes obtained PHQ9 scores consistent with mild and 5.6% with moderate-to-severe depression. Athletes with moderate-to-severe anxiety scored significantly worse on Impulse Control (p<.001, Effect Size (ES)=.01) and Inspection Time (p<.001; ES=.01), and the three groups were significantly different with respect to endorsement of Total Symptoms (p<.001; ES=.20) and Total Symptoms without Emotion (p<.001; ES=.16), with small effect sizes. A similar pattern was obtained for PHQ9 scores, although Memory scores were also significant (p<.001; ES=.01). There were no significant differences on Balance performance. Conclusions Anxiety and depression is not related to decreased balance performance, but athletes with anxiety and depression perform worse on baseline cognitive testing using Sway, and endorse significantly more concussion-related symptoms. Purpose Exercise intolerance, defined as the exacerbation of neurobehavioral symptoms during physical exertion, is commonly associated with the acute recovery phase after a mild traumatic brain injury (mTBI). However, Repetitive Head Trauma-Associated Persistent Exercise Intolerance (RHT-PEI) in individuals with remote, repetitive mTBIs has not been characterized.
Abstract Purpose To compare the sport-related concussion (SRC) incidence and recovery duration among middle school (MS) student-athletes receiving special education services (R-SES) across categories and peers not receiving special education services (N-SES). Method De-identified demographic and concussion data from MS student-athletes (2015- 2022) were analyzed. Special education disability classifications were obtained from school district records. Other Health Impairment (OHI; including ADHD), Specific Learning Disability (SLD), and Speech/Language Impairment (SI) were the only R-SES categories with observed SRC and were compared with student-athletes N-SES. SRC rates per 1,000 athlete-exposures, and incidence rate ratios (IRR) were estimated using zero-inflated negative binomial regression with an exposure offset. Recovery duration (days to unrestricted return-to-sport) was compared using Wilcoxon rank-sum tests with Benjamini-Hochberg adjustment (α = 0.05). Results 272 SRC occurred: 248 in N-SES and 24 in R-SES (8 per subgroup). OHI students had a higher SRC rate than N-SES (1.07 vs 0.47; IRR=2.28, 95% CI: 1.13-4.62), whereas SI (IRR=1.51, 95% CI: 0.75-3.06) and SLD (IRR=1.01, 95% CI: 0.50-2.03) did not differ from N-SES or within R-SES subgroups. Median (IQR) recovery duration was 15 (11) days for N-SES, 15.5 (5.2) for OHI, 14.5 (14) for SI, and 12 (9) for SLD, with no differences versus N-SES (all p>0.14) or within R-SES subgroups. Conclusions In this MS cohort, student-athletes with OHI (ADHD the most common diagnosis) had a two-fold higher SRC rate than N-SES peers, consistent with some prior research in athletes with ADHD. These findings suggest targeted risk-reduction strategies for MS athletes with OHI may be warranted.
Abstract Purpose To investigate whether lifetime stressor exposure (personal, sport-related, or retirement-specific) and concussion history are associated with health-related quality of life (HRQoL) in retired Team USA elite athletes, and whether concussion contributes uniquely beyond lifetime stress exposure. Method A convenience sample of 53 retired Team USA athletes (M age= 42.04 years [SD = 6.60]; 51% female) completed an online survey, with 24.5% endorsing a concussion history. Mental and physical HRQoL (VR-12), personal stressors (Adult STRAIN total count), sport-related stressors (Sport SAM), and retirement-specific stressors (Elite Athlete Retirement Stressor Index) were assessed. Results Concussion history was associated with greater personal stress exposure (t(51)=3.29, p=.002). In predicting mental HRQoL, stress variables explained 31% variance beyond age (p < .001), among which retirement-specific stress emerged as the strongest independent predictor (β=−.55, p<.001). Concussion did not contribute unique variance (ΔR2 < .001, p=.99). For physical HRQoL, stress variables accounted for 16% of variance (p=.035), with sport-related stress independently predicting poorer outcomes (β =−.37, p=.017). Concussion again was not significant (ΔR2=.001, p =.815). Conclusions Concussion history did not independently predict mental or physical HRQoL beyond lifetime stress burden. Instead, retirement-specific stress most strongly predicted mental HRQoL, whereas sport-related stress most strongly predicted physical HRQoL. These findings suggest that long-term well-being in retired elite athletes may be more related to cumulative psychosocial stress exposure than concussion history alone, underscoring the importance of comprehensive stress assessment and integrated models of athlete healthcare.
Abstract Purpose To determine if minutes spent in light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) are associated with recovery outcomes (i.e., days to symptom resolution, days to full medical clearance [FMC]) in college-aged individuals following concussion. Method A prospective study of individuals who sustained a concussion within 5 days of enrollment was conducted. At the initial visit, participants completed demographics, injury information and were given an Axivity AX6 watch to track free-living PA minutes over the next seven days. At the FMC visit, days to symptom resolution was recorded. Hierarchical multiple regressions examined relationships between free-living LPA, MVPA and recovery outcomes, while controlling for initial visit symptom severity, based on prior literature. Statistical significance was set at p<0.05. Results Forty-two college-aged individuals (31[74%] female; age=21.2±2.6 years; days to symptom resolution=15.1±13.5, FMC=18.5±12.9) were included. Individuals spent an average of 428.4±135.6 minutes in LPA and 825.3±376.0 minutes in MVPA over seven days. When controlling for initial visit symptom severity, time spent in LPA (β =0.23, p=0.29) and MVPA (β =-0.16, p=0.46) did not predict days to symptom resolution, F(3,38)=0.40, p=0.75, Adj.R2=-0.05. LPA (β =0.29, p=0.19) and MVPA (β =-0.22, p=0.33) also did not predict days to FMC, F(3,38)=0.63, p=0.60, Adj.R2=-0.03. Conclusions Individuals averaged high amounts of MVPA and LPA over seven days. Adjusting for initial visit symptom severity, free-living PA did not significantly predict recovery outcomes. This may reflect clinicians encouraging aerobic PA throughout recovery which aligns with current guidelines. Low variability between participants may suggest uniform prescription rather than targeted treatment.
Abstract Purpose Knowledge regarding concussion diagnosis, management, treatment, and is evolving too rapidly for some providers to remain current. Injured children without access to expertise face greater risk for long-term consequences. This feasibility pilot project evaluated launching a Concussion Guidance and Education Program (CGEP) for primary care pediatric providers across Wisconsin. Method The MCW Sport Concussion Clinic at Children’s is a multidisciplinary clinic recognized as southeast Wisconsin’s leader in concussion care, with funding from an Advancing Healthier Wisconsin pilot grant. Educational materials for pediatric concussion care were distributed to non-specialty front-line physicians. A survey assessed physicians’ experience, interests, and needs for pediatric concussion management. Across Wisconsin, 60 providers participated: 73% from southern/eastern and 27% from more rural northern/western regions. Results Regarding concussion management, 63% of respondents indicated they “need all the help they can get” or would “like help or guidance.” Of those, 93.8% treat up to five pediatric concussion patients per month. While 80.5% report feeling “comfortable” or “very comfortable” managing simple or first lifetime concussions, 77.8% report “discomfort” or “complete discomfort” with long-term symptoms. Descriptive statistics show 75% prefer recorded webinars for education. Data also supports preferences for design and utilization of a consultation service, with 76% likely or very likely to use email. Conclusions Primary care providers across a predominantly rural state manage concussions without adequate resources or support. They express interest in direct education, desire materials for patient visits, and support online consultation. Next project steps include developing online resources and a virtual consultation model.
Abstract Purpose Concussions are followed by a reduction in cerebral blood flow and oxygen. Hyperbaric oxygen chambers aid concussion recovery but have low clinical feasibility.1,2 The purpose of this study was to examine the effects of portable concentrated oxygen on acute concussion symptoms and return to play (RTP) time in collegiate athletes. Method Twenty-three collegiate athletes (age = 19.33+1.19, 12 females) with a concussion participated. Both groups (13 oxygen, 10 control) received daily concussion symptom checklists until RTP. The oxygen group received concentrated oxygen to inhale for one minute, thrice daily, until the canister emptied. T-tests compared daily number of symptoms and total symptom score, as well as days to RTP. Results T-tests revealed faster RTP for the oxygen group (15.00±5.86 days vs. 19.80±11.50 days), but this difference was not statistically significant, p=.205. The difference between groups on number of symptoms and total symptoms score was nearest to significance on days three (symptoms: oxygen=7.64+9.22, control=12.00+5.13, p=.272, total score: oxygen=13.55+19.46, control=24.00+13.28, p= .232) and five (symptoms: oxygen=3.58+4.44, control = 6.86+5.55, p = .175, total score: oxygen=5.08+6.63, control=9.00+7.57, p=.254). Coincidentally, the average days of canister use was three. Conclusions The study suggests feasibility of concentrated oxygen as an intervention for concussion in regard to acceptability, implementation, and limited-efficacy testing. Therefore, this modality requires further examination using a larger sample. Additional research could establish the clinical relevance of canister oxygen during concussion recovery.
Abstract Purpose Athletes who experience mental health (MH) symptoms tend to endorse other symptoms that resemble those commonly reported post-concussion. These associations suggest pre-existing MH symptoms may bias baseline symptom reporting, raising concerns regarding its utility and interpretation in post-concussion management decisions. This study examined the possible influence of MH symptoms on baseline cognitive testing and symptom reporting in a sample of elite Canadian athletes. Method Participants were 70 elite/international-level athletes without a concussion history (age: M=21.95, SD=3.82; 34 females) from a Canadian national sport institute who completed baseline testing using the SCAT-5 and the Vienna Test System (VTS), a computerized cognitive battery. Participants were divided into high and low MH symptom groups based on endorsement of emotional symptoms on the SCAT-5. Results Compared to the low MH group, the high MH group captured all athletes who reported a prior MH diagnosis. Independent-samples t tests revealed the high MH group reported significantly higher total symptom severity, t(64)=-5.76, p<.001, d=-1.17, and total number of symptoms endorsed, t(52)=-6.97, p< .001, d=-1.50, on the SCAT-5. When controlling for the emotional symptoms used to define group membership, the high MH group still reported significantly higher symptom severity, t(51)=-4.09, p<.001, d=0.92. The groups did not significantly differ in performance on the VTS. Conclusions Groups did not differ in terms of cognitive performance, however, the high MH group endorsed significantly more symptoms on the SCAT-5 even when controlling for emotional symptoms. These findings highlight the importance of tracking MH symptoms for concussion management in elite athletes.
Abstract Purpose The purpose of this retrospective chart review was to confirm and expand research related to factors associated with medical disqualification (MDQ) from varsity sport participation among collegiate athletes with sports-related concussions (SRC). Method Division I collegiate athletes (n= 14.7% female) who were varsity athletes between the 2014-2015 and 2024-2025 academic years, who had an MDQ due to SRC, participated in this study. All participants completed a multidimensional pre-injury (baseline) and a post-traumatic symptom-free assessment to determine clinical recovery after their first, and each subsequent, SRC diagnosed by an athletic trainer or physician. Paired t-tests were used to compare baseline and post-trauma symptom-free assessment clinical outcome scores, given the decreasing sample sizes after each successive SRC. Frequencies were calculated for evidence-based factors associated with MDQ, along with subjective factors such as familial involvement and concerns over long-term brain health (α=0.05). Results During the initial post-trauma symptom-free assessment, Equilibrium Score, as measured by the Sensory Organization Test (SOT), significantly improved (t(12)= 2.24,p=0.02), and ImPACT’s total symptom severity score significantly decreased (t(13)=3.36,p=0.003). All remaining clinical outcome scores were similar to baseline performance (all p>0.05). The most frequent factors associated with MDQ were a history of three or more concussions (12/14 [85.7%]), persisting symptoms after concussion (8/14 [57%]), and concerns over long-term health (7/14 [50%]). Conclusions SRC history, persisting symptoms, and concerns over long-term brain health were the most documented factors associated with collegiate athlete MDQ. Our findings emphasize the need for a shared decision-making process to guide MDQ decisions due to SRC for collegiate athletes.
Abstract Purpose In professional mixed martial arts (MMA), knockout (KO) and technical knockout (TKO) losses by head strikes are common bout-ending outcomes and raise concern for acute neurological injury. Limited evidence describes real-world return-to-competition timing in Ultimate Fighting Championship (UFC) athletes or whether return timing is associated with competitive outcomes. The current study examined return-to-competition timing following head strike KO or TKO and associations with subsequent bout outcomes. Method A retrospective cohort study included UFC fighters sustaining a KO or TKO loss by head strikes between 01/2015 and 12/2023 with at least one subsequent fight. Return to competition time was both dichotomized (i.e., <6 vs. ≥6 months) and stratified into five intervals (0-3, 3-6, 6-12, 12-24, and ≥24 months). Analyses used chi-square tests, independent-samples t-tests, and one-way ANOVAs. Results 705 fighters met inclusion criteria; 37.7% returned in <6 months and 62.3% in ≥6 months. Fight 1 head strike exposure and KO versus TKO characteristics did not differ between groups. Return timing was most commonly 6-12 months (45.7%) or 3-6 months (34.2%), while only 3.5% returned within 3 months. Fighters who lost their subsequent fight following KO/TKO loss had longer return intervals than winners (8.4±6.7 vs. 7.4±5.2 months, p=.030); win rates did not differ across return timing intervals (p=.317). Conclusions Most UFC fighters returned 3-12 months following head strike KO or TKO. Return timing was not associated with head strike exposure, KO loss risk, or improved competitive outcomes. Findings quantify return-to-competition patterns in elite MMA and may inform future post-fight management research.
Abstract Purpose The purpose of this study was to better understand the presentation of anxiety symptoms in concussed youth athletes by examining the State Trait Anxiety Inventory (STAI-Y) factor structure along with the Post-Concussion Symptom Scale (PCSS). Method Patients (15-25 yrs) seeking care for a concussion completed the STAI and the PCSS at their first clinical visit. Principal Components Factor Analyses were conducted on the STAI alone and on the STAI and PCSS combined, using Varimax Rotation. Results 295 participants (M=16.72, SD=2.23 yrs) completed both measures within 7-14 days of sustaining a sports-related concussion (M=9.86 days, SD=2.19). Factor Analysis of the STAI alone yielded two factors (KMO=.934, X2=2200, p<.001), retaining all STAI items other than “I feel calm” and “I feel upset”, with the primary factor reflecting reduced response to positive valence items, and the second factor reflecting presence of negative valence items. Factor Analysis of the STAI and PCSS combined yielded seven factors (KMO=.902, X2=3826, p<.001). STAI items presented as two unique factors (negative valence items, low response to positive valence items), with no overlap or shared variance with PCSS factors (Cognitive/Fatigue/Headache, Mood, Sleep, Nausea, Physical). Conclusions Following sport-related concussion, the STAI provides unique clinical information related to post-injury anxiety beyond that represented in the mood symptoms of the PCSS. Clinicians should consider supplementing the PCSS with the STAI for youth and adolescent athletes endorsing mood symptoms on the PCSS.
Abstract Purpose To compare knee kinematics between athletes recently returned to play after a concussion and matched controls during an unanticipated run-to-cut maneuver to identify injury-related movement patterns. Method Seven post-concussion athletes (within 48hrs post return to play) were matched by age, sport, and sex to uninjured athletes (age=21.71±2.29, female=76/108;70.4%). Athletes ran 4.5±0.45 mph along a 12-ft runway and executed a contralateral 45° cut to the right or left in response to a directional Flanker stimulus presented 915 ms after gait initiation. Planting knee angles were measured at initial contact and at the time of peak ground reaction force (GRF) and compared using independent t-tests. Results For the left leg, there were no significant differences in knee angles (flexion, valgus, external rotation) at initial contact or at peak GRF between athletes with and without a history of concussion (all p>0.132). For the right leg, athletes in the concussion group demonstrated greater external rotation (3.38±9.99° vs -7.59±8.56°; p=0.024) at initial contact and greater external rotation (7.72±7.44° vs 0.36±7.64°; p=0.046) and greater valgus angle (4.9±3.14° vs 0.35±3.04°; p=0.009) at peak GRF when compared to healthy controls. All other knee angles were not significantly different (p>0.05). Conclusions Athletes with a history of concussion exhibit altered knee movement strategies during unanticipated cutting tasks. While these strategies may allow task completion, they may reflect compensatory motor patterns that reduce the capacity to safely absorb and redirect forces during rapid direction changes, potentially increasing the risk of musculoskeletal injury during unanticipated movements.
