Football Players' Perceptions of Future Risk of Concussion and Concussion-Related Health Outcomes.

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Baugh, Christine M; Kroshus, Emily; Kiernan, Patrick T; Mendel, David; Meehan, William P

2017-02-15

Concussion is increasingly recognized as a risk of participation in contact and collision sports. There have been few examinations of athletes' perceptions of their susceptibility to concussion or concussion-related health consequences. We examine college football players' perceptions of their risk of sustaining a concussion and concussion-related health consequences in their future, whether these perceptions change over time, and how concussion history is related to perceived future risk of concussion and concussion-related health consequences. A survey was administered to National Collegiate Athletic Association Division I Football Championship Series athletes on 10 teams in 2013 and to nine of those teams in 2014. Athletes answered questions assessing their perceptions of concussion and potential concussion-related health consequences. Approximately 40% of athletes believed there was a strong possibility that they would sustain a concussion in the future, while approximately one-in-four thought a concussion would make them miss a few games. About one-in-10 athletes predicted dementia, Alzheimer's disease, or chronic traumatic encephalopathy would develop from concussions. These beliefs were stronger among athletes who had sustained previous concussions. Across the two years studied, athletes' perceptions of the risk of concussion and missing a few games because of concussion decreased significantly. Overall, a substantial proportion of college football players believe they will have long-term health consequences as a result of sustaining sport-related concussions. The true incidence and prevalence of many of these outcomes are unknown. Further research is needed to determine whether athletes have an accurate perception of the risks of these outcomes developing.

Threat, Pressure, and Communication About Concussion Safety: Implications for Parent Concussion Education.

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Kroshus, Emily; Babkes Stellino, Megan; Chrisman, Sara P D; Rivara, Frederick P

2018-04-01

Parental communication about the importance of reporting concussion symptoms can influence a child's attitudes about such reporting, and is likely related to perceived threat of concussion. However, parental investment in child sport achievement might impede this communication. To examine the relationship between perceived threat of concussion and parent-child communication regarding concussion symptom reporting, and the potential interaction with parental pressure regarding child sport achievement. A total of 236 parents of youth soccer players completed an anonymous online survey. There were greater odds of encouraging concussion reporting among parents who perceived that their child had a greater likelihood of sustaining a concussion ( OR = 1.03, 95% CI [1.01, 1.04]) and lower odds among parents who exhibited greater parental sport pressure ( OR = 0.88, 95% CI [0.78, 0.99]). Parents whose child had a prior concussion were much more likely to communicate with their child about concussion reporting ( OR = 7.86, 95% CI [3.00, 20.55]). Initiatives are needed to support healthy sport parenting, particularly focusing on parental encouragement of concussion reporting. Possible directions for concussion education for parents based on the results of this study include providing parents with concrete guidance about the important role they can play in encouraging their child to report symptoms of a concussion, communicating the athletic consequences of continued sport involvement while experiencing symptoms of a concussion, and using narrative messaging with exemplars to personalize the information for parents of youth who have not previously sustained a concussion.

Concussion in Motor Vehicle Accidents: The Concussion Identification Index

Science.gov (United States)

2016-08-03

Motor Vehicle Accidents; TBI (Traumatic Brain Injury); Brain Contusion; Brain Injuries; Cortical Contusion; Concussion Mild; Cerebral Concussion; Brain Concussion; Accidents, Traffic; Traffic Accidents; Traumatic Brain Injury With Brief Loss of Consciousness; Traumatic Brain Injury With no Loss of Consciousness; Traumatic Brain Injury With Loss of Consciousness

Concussion

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... Those most linked to concussions are: football basketball soccer baseball biking, or cycling. How is a concussion ... Crisis Situations Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight Loss and Diet Plans ...

Ankle Sprains. A Round Table.

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Physician and Sportsmedicine, 1986

1986-01-01

Types of ankle sprains, surgical versus nonsurgical treatment, tape versus brace for support, rehabilitation, exercise, and prevention of ankle sprains are discussed by a panel of experts. An acute ankle taping technique is illustrated. (MT)

Hamstring strain - aftercare

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Pulled hamstring muscle; Sprain - hamstring ... There are 3 levels of hamstring strains: Grade 1 -- mild muscle strain or pull Grade 2 -- partial muscle tear Grade 3 -- complete muscle tear Recovery time depends ...

Concussion

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A concussion is a type of brain injury. It involves a short loss of normal brain function. It happens ... damage your brain cells. Sometimes people call a concussion a "mild" brain injury. It is important to ...

Strains and Sprains

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... lot of pressure on a muscle or you push it too far, such as when lifting a heavy object. Strains may be more likely to happen if you haven't warmed up first to get blood circulating to the muscles. They're also common for someone returning to a sport after the off-season. That first time playing ...

Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School Athletes.

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Register-Mihalik, Johna K; Valovich McLeod, Tamara C; Linnan, Laura A; Guskiewicz, Kevin M; Marshall, Stephen W

2017-05-01

Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior. Cross-sectional survey. Classroom. A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey. Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career. The outcomes were recalled concussion disclosure behavior (3 measures) and scales assessing both concussion knowledge and concussion attitude. A greater number of previous concussions was associated with worse attitude to concussion and negative concussion disclosure behavior. For every 3 additional self-recalled concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of concussion (P disclosure behavior were identified in youth athletes with a positive history of concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to concussion.

Sport-related concussions

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Jéssica Natuline Ianof

Full Text Available ABSTRACT Traumatic brain injury (TBI is a major cause of lifelong disability and death worldwide. Sport-related traumatic brain injury is an important public health concern. The purpose of this review was to highlight the importance of sport-related concussions. Concussion refers to a transient alteration in consciousness induced by external biomechanical forces transmitted directly or indirectly to the brain. It is a common, although most likely underreported, condition. Contact sports such as American football, rugby, soccer, boxing, basketball and hockey are associated with a relatively high prevalence of concussion. Various factors may be associated with a greater risk of sport-related concussion, such as age, sex, sport played, level of sport played and equipment used. Physical complaints (headache, fatigue, dizziness, behavioral changes (depression, anxiety, irritability and cognitive impairment are very common after a concussion. The risk of premature return to activities includes the prolongation of post-concussive symptoms and increased risk of concussion recurrence.

Underreporting of Concussions and Concussion-Like Symptoms in Female High School Athletes.

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McDonald, Tracy; Burghart, Mark A; Nazir, Niaman

2016-01-01

Underreporting of concussions and concussion-like symptoms in athletes continues to be a serious medical concern and research focus. Despite mounting worry, little evidence exists examining incidence of underreporting and documenting characteristics of head injury in female athletes participating in high school sports. This study examined the self-reporting behaviors of female high school athletes. Seventy-seven athletes participated, representing 14 high school sports. Nearly half of the athletes (31 participants) reported a suspected concussion, with 10 of the 31 athletes refraining from reporting symptoms to training staff after injury. Only 66% reported receiving concussion education. Concussion education appeared to have no relationship with diagnosed concussion rates in athletes, removing athletes from play, or follow-up medical care after injury. In conclusion, female high school athletes underreport signs and symptoms of concussions. Concussion education should occur at higher rates among female athletes to influence reporting behaviors.

Kinematic analysis of a televised medial ankle sprain

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Francesca E. Wade

2018-04-01

Full Text Available Ankle sprains are one of the most prevalent athletic injuries. Prior work has investigated lateral ankle sprains, but research on generally more severe medial sprains is lacking. This case report performs a kinematic analysis using novel motion analysis methods on a non-contact medial ankle sprain. Peak eversion (50° occurred 0.2 seconds following ground contact, maximum velocity of 426°/s, while peak dorsiflexion (64° occurred with a greater maximum velocity (573°/s. The combination of dorsiflexion at ground contact and rapid eversion is associated with a non-contact eversion sprain. This study provides a quantitative analysis of the eversion ankle sprain injury mechanism. Keywords: Athletic injury, Biomechanics, Ankle injury, Kinematics

Effects of low frequency electromagnetic field on ankle joint swelling of ankle joint sprain and bruise%低频电磁场减轻踝关节扭挫伤患者肿胀疼痛的疗效观察

Institute of Scientific and Technical Information of China (English)

姜乃明; 张宝芬; 祁欣; 范剑非

2002-01-01

Background: Main symptoms of ankle joint sprain and bruise are local swelling, pain and dysfunction. Aim of physical therapy is to reduce swelling and ease pain and resume walking function. Magnetic therapy has effects of reducing swelling and easing pain and promoting local blood circulation. Low frequency electromagnetic field has synthetic treatment function of magnetic heat and concussion massage. But the curative effects are different as the differences of working condition and shaking strength of magnetic head. Objective:To compare curative effects of low frequency full wave and half wave magnetic field on ankle joint swelling of ankle joint sprain and bruise. Unit: Department of Physical Therapy of General Hospital of Shenyang Military District.

Concussion symptoms and neurocognitive performance of high school and college athletes who incur multiple concussions.

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Covassin, Tracey; Moran, Ryan; Wilhelm, Kristyn

2013-12-01

Multiple concussions have been associated with prolonged symptoms, recovery time, and risk for future concussions. However, very few studies have examined the effect of multiple concussions on neurocognitive performance and the recently revised symptom clusters using a large database. To examine concussed athletes with a history of 0, 1, 2, or ≥3 concussions on neurocognitive performance and the recently revised symptom clusters. Cohort study (prognosis); Level of evidence, 2. The independent variables were concussion group (0, 1, 2, and ≥3 concussions) and time (baseline, 3 days, and 8 days). The dependent variables were neurocognitive test scores as measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test battery (verbal and visual memory, processing speed, and reaction time) and 4 concussion symptom clusters (migraine-cognitive-fatigue, affective, somatic, and sleep). All concussed athletes (n = 596) were administered the ImPACT test at a mean 2.67 ± 1.98 and 7.95 ± 4.46 days after injury. A series of 4 (concussion group) × 3 (time) repeated-measures analyses of covariance (age = covariate) were performed on ImPACT composite scores and symptom clusters. Concussed athletes with ≥3 concussions were still impaired 8 days after a concussion compared with baseline scores on verbal memory (P Concussed athletes with a history of ≥3 concussions take longer to recover than athletes with 1 or no previous concussion. Future research should concentrate on validating the new symptom clusters on multiple concussed athletes, examining longer recovery times (ie, >8 days) among athletes with multiple concussions.

Acute ankle sprain in dancers.

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Russell, Jeffrey A

2010-01-01

Ankle sprain is a common injury in dancers. Because of the relative frequency of this injury and its wide acceptance as a likely part of an active lifestyle, in many individuals it may not receive the careful attention it deserves. An extreme ankle range of motion and excellent ankle stability are fundamental to success in dance. Hence, following a proper treatment protocol is crucial for allowing a dancer who suffers an ankle sprain to return to dance as soon as possible without impaired function. This article reviews the basic principles of the etiology and management of ankle sprain in dancers. Key concepts are on-site examination and treatment, early restoration, dance-specific rehabilitation, and a carefully administered safe return to dance. Additionally, injuries that may occur in conjunction with ankle sprain are highlighted, and practical, clinically relevant summary concepts for dance healthcare professionals, dance scientists, dance teachers, and dancers are provided.

Sports and Concussions

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... Staying Safe Videos for Educators Search English Español Sports and Concussions KidsHealth / For Teens / Sports and Concussions ... skiers or snowboarders How Can I Prevent a Sports Concussion? Start With the Right Equipment Everyone should ...

School and Concussions

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... Videos for Educators Search English Español School and Concussions KidsHealth / For Teens / School and Concussions What's in ... a type of brain injury. How Can a Concussion Affect Me at School? All injured body parts ...

Incidence and Cost of Ankle Sprains in United States Emergency Departments

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Shah, Shweta; Thomas, Abbey C.; Noone, Joshua M.; Blanchette, Christopher M.; Wikstrom, Erik A.

2016-01-01

Background: Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments. Hypothesis: There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains. Study Design: Descriptive epidemiological study. Level of Evidence: Level 3. Methods: A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains. Results: The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P sprain of the foot (2.96% vs 0.70%, P ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P ankle sprains (0.87% vs 2.79%, P ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P Ankle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains. Clinical Relevance: The health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains. PMID:27474161

The Incidence of Ankle Sprains in Orienteering.

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Ekstrand, Jan; And Others

1990-01-01

Investigates relationship between ankle sprains and participation time in competitive orienteering. Examined 15,474 competitors in races in the Swedish O-ringen 5-day event in 1987. Injuries requiring medical attention were analyzed, showing 137 (23.9 percent) ankle sprains. Injury incidence was 8.4/10,000 hours. Incidence of ankle sprains was…

Concussion diagnosis and management

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Mann, Aneetinder; Tator, Charles H.; Carson, James D.

2017-01-01

Abstract Objective To assess the knowledge of, attitudes toward, and learning needs for concussion diagnosis and management among family medicine residents. Design E-mail survey. Setting University of Toronto in Ontario. Participants Family medicine residents (N = 348). Main outcome measures To describe relationships between awareness of concussion management and lifestyle, education background, and residency placement, t tests and 2 tests were used as appropriate. Linear regression was used to compare self-reported concussion knowledge with knowledge scores. Thematic analysis was used to interpret answers to the qualitative question asking residents to describe challenges they foresee physicians facing when diagnosing and managing concussion. Results The residents who responded (n = 73, response rate 21%) correctly answered an average of 5.2 questions out of 9 (58%) regarding the diagnosis and management of concussion. Postgraduate year, sex, personal history of concussion, and clinical exposure to concussion were not significant factors in predicting the number of correct answers. Several misconceptions and knowledge gaps were revealed. Of residents who responded, 71% did not recognize chronic traumatic encephalopathy and only 63% recognized second-impact syndrome as consequences of repetitive concussions. Moreover, 32% of residents did not think that every individual with a concussion should see a physician as part of management. Knowledge scores did not predict self-reported concussion knowledge. Thematic analysis revealed 4 themes related to the challenges of concussion diagnosis and management: the nonspecificity and vagueness of symptoms, lack of formal diagnostic criteria, patient compliance with management, and counseling patients with respect to return to play, work, or learning. Conclusion We found substantial gaps in knowledge surrounding concussion diagnosis and management among family medicine residents. This lack of knowledge should be addressed at

Re-sprains during the first 3 months after initial ankle sprain are related to incomplete recovery: an observational study.

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van Middelkoop, Marienke; van Rijn, Rogier M; Verhaar, Jan A N; Koes, Bart W; Bierma-Zeinstra, Sita M A

2012-01-01

What are prognostic factors for incomplete recovery, instability, re-sprains and pain intensity 12 months after patients consult primary care practitioners for acute ankle sprains? Observational study. One hundred and two patients who consulted their general practitioner or an emergency department for an acute ankle sprain were included in the study. Possible prognostic factors were assessed at baseline and at 3 months follow-up. Outcome measures assessed at 12 months follow-up were self-reported recovery, instability, re-sprains and pain intensity. At 3 months follow-up, 65% of the participants reported instability and 24% reported one or more re-sprains. At 12 months follow-up, 55% still reported instability and more than 50% regarded themselves not completely recovered. None of the factors measured at baseline could predict the outcome at 12 months follow-up. Additionally, prognostic factors from the physical examination of the non-recovered participants at 3 months could not be identified. However, among the non-recovered participants at 3 months follow-up, re-sprains and self-reported pain at rest at 3 months were related to incomplete recovery at 12 months. A physical examination at 3 months follow-up for the non-recovered ankle sprain patient seems to have no additional value for predicting outcome at 12 months. However, for the non-recovered patients at 3 months follow-up, self-reported pain at rest and re-sprains during the first 3 months of follow-up seem to have a prognostic value for recovery at 12 months. Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.

Acute ankle sprain: conservative or surgical approach?

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Al-Mohrej, Omar A.; Al-Kenani, Nader S.

2016-01-01

Ankle sprains fall into two main categories: acute ankle sprains and chronic ankle instability, which are among the most common recurrent injuries during occupational activities, athletic events, training and army service. Acute ankle sprain is usually managed conservatively and functional rehabilitation failure by conservative treatment leads to development of chronic ankle instability, which most often requires surgical intervention. Enhancing the in-depth knowledge of the ankle anatomy, biomechanics and pathology helps greatly in deciding the management options. Cite this article: Al-Mohrej OA, Al-Kenani NS. Acute ankle sprain: conservative or surgical approach? EFORT Open Rev 2016;1:34-44. DOI: 10.1302/2058-5241.1.000010. PMID:28461926

Radiological aspects of sprained ankle syndrome

NARCIS (Netherlands)

Sijbrandij, E.S.

2001-01-01

This thesis addresses several problems related to sprained ankle syndrome. The purpose of this thesis is to evaluate the imaging features of sprained ankles, found on new radiological modalities, and to assess the additional diagnostic understanding and treatment planning of helical CT as well as

Utility of providing a concussion definition in the assessment of concussion history in former NFL players.

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Alosco, Michael L; Jarnagin, Johnny; Tripodis, Yorghos; Martin, Brett; Chaisson, Christine; Baugh, Christine M; Torres, Alcy; Nowinski, Christopher J; Cantu, Robert C; Stern, Robert A

2017-01-01

Former National Football League (NFL) players' working knowledge of concussion has not yet been evaluated, despite this population being a major clinical research target due to the association between repetitive head impacts (RHI) and long-term clinical impairments. This study examined former NFL players' understanding of the current concussion definition, and the association between number of concussions with clinical function. 95 former NFL players (mean age = 55.29; mean NFL year = 8.10) self-reported number of concussions before being provided with a concussion definition and after being read a modern definition of concussion. Subjects reported number of concussions with loss of consciousness (LOC). Principal Component Analysis of a battery of tests generated behaviour/mood, psychomotor speed/executive function, and verbal and visual memory factor scores. Post-definition number of concussions (median = 50) was five times the pre-definition (median = 10; p football played, with specific effects for depressive symptoms and impulsivity. LOC did not account for variance beyond number of concussions. Practitioners and clinical researchers should provide a definition of concussion in the assessment of concussion history in former football players to facilitate accuracy and standardization.

Self-reported concussion history: impact of providing a definition of concussion

Directory of Open Access Journals (Sweden)

Robbins CA

2014-05-01

Full Text Available Clifford A Robbins,1 Daniel H Daneshvar,1,2 John D Picano,1,3 Brandon E Gavett,1,4 Christine M Baugh,1,2 David O Riley,1 Christopher J Nowinski,1,2,5 Ann C McKee,1,2,6–8 Robert C Cantu,1,5,9,10 Robert A Stern1,2,8,91Center for the Study of Traumatic Encephalopathy, 2Department of Neurology, Boston University School of Medicine, Boston, MA, USA; 3School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA; 4Department of Psychology, University of Colorado, Colorado Springs, CO, USA; 5Sports Legacy Institute, Waltham MA, USA; 6United States Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA; 7Department of Pathology, 8Alzheimer's Disease Center, 9Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA; 10Department of Neurosurgery, Emerson Hospital, Concord, MA, USABackground: In recent years, the understanding of concussion has evolved in the research and medical communities to include more subtle and transient symptoms. The accepted definition of concussion in these communities has reflected this change. However, it is unclear whether this shift is also reflected in the understanding of the athletic community.What is known about the subject: Self-reported concussion history is an inaccurate assessment of someone's lifetime exposure to concussive brain trauma. However, unfortunately, in many cases it is the only available tool.Hypothesis/purpose: We hypothesize that athletes' self-reported concussion histories will be significantly greater after reading them the current definition of concussion, relative to the reporting when no definition was provided. An increase from baseline to post-definition response will suggest that athletes are unaware of the currently accepted medical definition.Study design: Cross-sectional study of 472 current and former athletes.Methods: Investigators conducted structured telephone interviews with current and former athletes between January

Understanding acute ankle ligamentous sprain injury in sports

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Fong Daniel TP

2009-07-01

Full Text Available Abstract This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms. Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms. The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative

The prevalence of undiagnosed concussions in athletes.

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Meehan, William P; Mannix, Rebekah C; O'Brien, Michael J; Collins, Michael W

2013-09-01

Previous studies suggest athletes underreport concussions. We sought to determine whether athletes in our clinics have sustained previous concussions that went undiagnosed. Multicentered cross sectional study. Two sport concussion clinics. Patients diagnosed with sport-related concussions or concussions with injury mechanisms and forces similar to those observed in sports were included. The proportion of patients who answered "yes" to the following question were defined as having a previously undiagnosed concussion: "Have you ever sustained a blow to the head which was NOT diagnosed as a concussion but was followed by one or more of the signs and symptoms listed in the Post Concussion Symptom Scale?" Of the 486 patients included in the final analysis, 148 (30.5%) patients reported a previously undiagnosed concussion. Athletes reporting previously undiagnosed concussions had a higher mean Post Concussion Symptom Scale (PCSS) score (33 vs 25; P concussions. Nearly one-third of athletes have sustained previously undiagnosed concussions, defined as a blow to the head followed by the signs and symptoms included in the PCSS. Furthermore, these previously undiagnosed concussions are associated with higher PCSS scores and higher loss of consciousness rates when future concussions occur. Many athletes have sustained previous blows to the head that result in the signs and symptoms of concussion but have not been diagnosed with a concussion. These injuries are associated with increased rates of loss of consciousness and higher symptom scale scores with future concussions.

Incidence and Risk of Concussions in Youth Athletes: Comparisons of Age, Sex, Concussion History, Sport, and Football Position.

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Tsushima, William T; Siu, Andrea M; Ahn, Hyeong Jun; Chang, Bolin L; Murata, Nathan M

2018-03-15

This study was designed to determine concussion incidence, risk, and relative risk among middle and high school athletes participating in various sports. Data were retrospectively obtained from 10,334 athletes of 12 different sports in Hawaii. In addition to determining the overall concussion incidence, comparisons of incidence, risk, and relative risk were made according to age, sex, concussion history, sport, and football position. The overall incidence of concussion among youth athletes was 1,250 (12.1%). The relative risk for a concussion was almost two times greater in 18-year olds than in 13-year-old athletes. In comparable sports, girls had a 1.5 times higher concussion risk than boys. Athletes with a prior concussion had 3-5 times greater risk to sustain a concussion than those with no history of a concussion. Among varied sports, wrestling and martial arts had the highest relative risk of a concussion, followed by cheerleading, football, and track and field. No differences in concussion risks were found among the football players in different positions. Older youths, females, those with a history of concussion, and those participating in high contact sports were found to have higher risks of sustaining a concussion. The findings increase awareness of concussion patterns in young athletes and raise concerns regarding protective strategies and concussion management in youth sports.

Wrist Sprains

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... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Sprains Email to a friend * required fields ...

Thumb Sprains

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... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Thumb Sprains Email to a friend * required fields ...

The effect of coach education on reporting of concussions among high school athletes after passage of a concussion law.

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Rivara, Frederick P; Schiff, Melissa A; Chrisman, Sara P; Chung, Shana K; Ellenbogen, Richard G; Herring, Stanley A

2014-05-01

Increasing attention has been paid to concussions and especially sports-related concussions in youth. To prevent an inappropriate return to play while symptomatic, nearly all states have now passed legislation on youth sports-related concussions. To determine (1) the incidence of sports-related concussions in high school athletes using a unique system to collect reports on concussions, (2) the proportion of athletes with concussions who play with concussive symptoms, and (3) the effect of the type and modality of coach education on the likelihood of athletes reporting symptoms to the coach or playing with concussive symptoms. Cohort study; Level of evidence, 2. This study was conducted with high school football and girls' soccer athletes playing in fall 2012 and their coaches and parents in 20 urban or rural high schools in Washington State. The main outcome was the incidence of concussions per 1000 athlete-exposures (AEs), the proportion of concussed athletes who played with concussive symptoms, and the association of coach concussion education with coach awareness of athletes with concussive symptoms. Among the 778 athletes, the rate of concussions was 3.6 per 1000 AEs and was identical for the 2 sports studied. The cumulative concussion incidence over the course of the season was similar in girls' soccer (11.1%) and football (10.4%). Sixty-nine percent of concussed athletes reported playing with symptoms, and 40% reported that their coach was not aware of their concussion. Most measures of coach concussion education were not associated with coach awareness of concussions in their athletes, although the modalities of a video and quiz were associated with a lower likelihood of coach awareness. More objective and accurate methods are needed to identify concussions. Changes in athlete attitudes on reporting concussive symptoms will likely not be accomplished through legislation alone.

Medical treatment of concussion.

Science.gov (United States)

Wright, Justin M

2014-08-01

A concussion is a brain injury, a change in function induced by traumatic forces. The incidence of concussion is increasing, likely due to increased awareness and improvement in recognition. Speech and language pathology professionals working in schools may encounter patients who have suffered concussions. At the root of concussion pathophysiology is altered metabolism and an acquired energy deficit. The mainstay of treatment for concussion is cognitive and physical rest, allowing for normalization of the metabolism and correction of the energy deficit. Once recovered, the student may need accommodations to successfully return to school without added difficulty and should follow a return to play protocol to return to athletics safely. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

BOXING, WRESTLING, AND MARTIAL ARTS RELATED INJURIES TREATED IN EMERGENCY DEPARTMENTS IN THE UNITED STATES, 2002-2005

Directory of Open Access Journals (Sweden)

Evangelos Pappas

2007-10-01

Full Text Available The incidence of injury in combat sports has not been adequately reported although it is important to identify the nature and frequency of injuries prior to the implementation of prevention programs. This study compared injury rates treated in Hospital Emergency Departments between different combat sports of boxing, wrestling, and martial arts. A secondary objective described anatomic region and diagnosis of these injuries. Data were obtained on all boxing, wrestling, and martial arts-related injuries that were in the National Electronic Injury Surveillance System database and resulted in Emergency Department visits between 2002 and 2005. Pearson's chi-square statistics were calculated to compare injury rates for each activity accounting for complex sample design. Martial arts had lower injury rates compared to boxing and wrestling for all diagnoses (p<0.001. Boxing had lower injury rates compared to wrestling for strains/sprains and dislocations. Boxing and wrestling had similar injury rates for concussions. Injury prevention efforts should consider the distribution of injuries and concentrate on preventing strains/sprains in wrestling, concussions in boxing and wrestling, and fractures for all three activities. The findings of the present study do not provide evidence that combat sports have alarmingly high rates of injuries resulting in emergency department visits

[Advances on biomechanics and kinematics of sprain of ankle joint].

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Zhao, Yong; Wang, Gang

2015-04-01

Ankle sprains are orthopedic clinical common disease, accounting for joint ligament sprain of the first place. If treatment is not timely or appropriate, the joint pain and instability maybe develop, and even bone arthritis maybe develop. The mechanism of injury of ankle joint, anatomical basis has been fully study at present, and the diagnostic problem is very clear. Along with the development of science and technology, biological modeling and three-dimensional finite element, three-dimensional motion capture system,digital technology study, electromyographic signal study were used for the basic research of sprain of ankle. Biomechanical and kinematic study of ankle sprain has received adequate attention, combined with the mechanism research of ankle sprain,and to explore the the biomechanics and kinematics research progress of the sprain of ankle joint.

Sports and Concussion

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... this page please turn JavaScript on. Feature: Concussion Sports and Concussion Past Issues / Summer 2015 Table of ... ages—reducing blows to the head by playing sports safely and avoiding falls is vital to a ...

Safe treatment of sport related concussion

NARCIS (Netherlands)

Van Kampen, D.A.; Lovell, M.R.; Diercks, Ron

2006-01-01

Sport related concussion is a hot item. The Health Council of the Netherlands published its report on concussions in 2003 and there is much concern about the negative health effects of sports related concussion. Neuropsychological testing has recently been endorsed as a 'cornerstone' of concussion

Concussions (For Kids)

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... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... for Educators Search English Español Concussions KidsHealth / For Kids / Concussions What's in this article? Signs of a ...

Concussion Management in the Classroom.

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Graff, Danielle M; Caperell, Kerry S

2016-12-01

There is a new emphasis on the team approach to pediatric concussion management, particularly in the classroom. However, it is expected that educators are unfamiliar with the "Returning to Learning" recommendations. The authors' primary objective was to assess and improve high school educators' knowledge regarding concussions and management interventions using an online education tool. A total of 247 high school educators completed a 12 question pretest to assess core knowledge of concussions and classroom management followed by a 20-minute online literature-based education module. Participants then completed an identical posttest. The improvement in core knowledge was statistically significant (P weakness were the description and identification of concussions. Questions regarding concussion classroom management also showed a statistically significant increase in scores (P knowledge of educators regarding concussions and classroom management as well as the significant improvement after an online educational module. © The Author(s) 2016.

Length of Recovery From Sports-Related Concussions in Pediatric Patients Treated at Concussion Clinics.

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Thomas, Donald J; Coxe, Kathryn; Li, Hongmei; Pommering, Thomas L; Young, Julie A; Smith, Gary A; Yang, Jingzhen

2018-01-01

We quantified the length of recovery time by week in a cohort of pediatric sports-related concussion patients treated at concussion clinics, and examined patient and injury characteristics associated with prolonged recovery. A retrospective, cohort design. Seven concussion clinics at a Midwest children's hospital. Patients aged 10 to 17 years with a diagnosed sports-related concussion presenting to the clinic within 30 days of injury. Length of recovery by week. Unadjusted and adjusted multinomial logistic regression analyses were used to model the effect of patient and injury characteristics on length of recovery by week. Median length of recovery was 17 days. Only 16.3% (299/1840) of patients recovered within one week, whereas 26.4% took longer than four weeks to recover. By 2 months postinjury, 6.7% of patients were still experiencing symptoms. Higher symptom scores at injury and initial visit were significantly associated with prolonged symptoms by week. Patients who presented to the clinic more than 2 weeks postinjury or who had 2 or more previous concussions showed increased risk for prolonged recovery. Females were at greater risk for prolonged recovery than males (odds ratio = 2.08, 95% confidence interval = 1.49-2.89). Age was not significantly associated with recovery length. High symptom scores at injury and initial visit, time to initial clinical presentation, presence of 2 or more previous concussions, and female sex are associated with prolonged concussion recovery. Further research should aim to establish objective measures of recovery, accounting for treatment received during the recovery. The median length of recovery is 17 days among pediatric sports-related concussion patients treated at concussion clinics. Only 16.3% of patients recovered within one week, whereas 26.4% took longer than 4 weeks to recover.

An overview of concussion in sport.

Science.gov (United States)

Khurana, Vini G; Kaye, Andrew H

2012-01-01

Concussion is a sudden-onset, transient alteration of consciousness due to a combination of functional and structural brain disturbances following a physical impact transmitted to the brain. It is a common, although likely underreported, condition encountered in a wide range of sports. In the Australian Football League, concussion is estimated to occur at a rate of approximately seven injuries per team per season. While many instances of concussion are clinically mild, there is emerging evidence that a player's full recovery from a concussive injury may be more delayed and the sequelae of repeated concussions more severe than previously thought. In this light, a more conservative and rigorous approach to managing players with concussive injuries may be warranted, with the guiding principle being the player's immediate and long-term welfare. The current paper reviews the sports concussion literature. The definition, epidemiology, aetiology, pathophysiology, structural pathology, clinical features, assessment and investigation, treatment principles, and short-term and potential long-term complications of concussion are discussed. Special considerations in paediatric sports concussion, and the return-to-play implications of immediate, evolving and repetitive brain injury are also considered, as are the emerging concept and possible implications of subconcussive injury. Copyright © 2011 Elsevier Ltd. All rights reserved.

Managing ankle ligament sprains and tears: current opinion

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McGovern, Ryan P; Martin, RobRoy L

2016-01-01

The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. PMID:27042147

The Epidemiology of High Ankle Sprains in National Collegiate Athletic Association Sports.

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Mauntel, Timothy C; Wikstrom, Erik A; Roos, Karen G; Djoko, Aristarque; Dompier, Thomas P; Kerr, Zachary Y

2017-07-01

Ankle sprains are among the most common injuries experienced by collegiate athletes. The type of ankle sprain is rarely differentiated in epidemiological studies. This differentiation is necessary, as each ankle sprain type has a unique injury mechanism and recovery period. High ankle sprains commonly result in long recovery periods. Thus, a further examination of the epidemiology of high ankle sprains is warranted. To describe the epidemiology of high ankle sprains in National Collegiate Athletic Association (NCAA) sports during the 2009/2010-2014/2015 academic years. Descriptive epidemiology study. NCAA Injury Surveillance Program high ankle sprain data and athlete-exposures (AEs) from 25 sports were evaluated. Certified athletic trainers recorded sport-related injury, event, and AE data during team-sanctioned events. High ankle sprain injury rates per 10,000 AEs were calculated. Percentage distributions were calculated for the amount of time lost from sport and percentage of recurrent injuries. Injury rate ratios (RRs) and 95% CIs compared injury rates by event type, participation restriction time, and sex. 95% CIs not containing 1.00 were considered statistically significant. The overall high ankle sprain injury rate was 1.00 per 10,000 AEs. Overall, 56.7% of high ankle sprain injuries occurred during competitions, and 9.8% of high ankle sprain injuries were recurrent. Men's football (2.42/10,000 AEs), wrestling (2.11/10,000 AEs), and ice hockey (1.19/10,000 AEs) had the highest high ankle sprain injury rates. In sex-comparable sports, men had higher injury rates (RR, 1.77; 95% CI, 1.28-2.44). Player contact was the most common injury mechanism (60.4%), and 69.0% of injuries resulted in ≥1 day of participation restriction, with 47.1% resulting in ≥7 days of participation restriction and 15.8% resulting in >21 days of participation restriction. High ankle sprains resulted in significant participation restriction time from sport participation. The majority of

Functional bandage for ankle sprains. Recommendations for nursing

Directory of Open Access Journals (Sweden)

Mª Isabel Arcos Cirauqui

2011-11-01

Full Text Available Three quarters of ankle injuries are diagnosed as sprains. For the most part sprains are caused by a forced inversion movement with involvement of the lateral collateral ligament (LCL. One of the recommended guidelines is immobilization by taping. The aim of this article is to unify the recommendations for nursing, on taping in the treatment of ankle sprains. The methodology used was a literature review, analyzing the information found in books and journals in hospital libraries and nursing databases on the Internet. The main results are a set of guidelines for the most accurate and therapeutic taping.

Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains.

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Bridgman, S A; Clement, D; Downing, A; Walley, G; Phair, I; Maffulli, N

2003-11-01

To estimate the incidence of ankle sprains and severe ankle sprains attending accident and emergency (A&E) units; to describe current practice for severe ankle sprains in A&E units in the United Kingdom. Crude age and sex specific incidence rates were calculated for four health districts from cases ascertained from data on seven A&E clinical information systems. Case records of patients with ankle sprains at an A&E unit in another health district were audited and the proportion of severe ankle sprains calculated. UK A&E units were surveyed about their usual treatment of patients with severe ankle sprains. The estimate of the crude incidence rate of ankle sprains was a minimum of 52.7 per 10 000, rising to 60.9 (95% CI 59.4 to 62.4) when figures were adjusted for the proportion of patients without a diagnostic code (13.7%). There were important age-sex differences with unadjusted rates observed from 127.8 per 10 000 (CI 115.5 to 140.0) in girls aged 10-14 years to 8.2 (CI 4.2 to 12.3) in men aged 70-74 years. As 14% of ankle sprains attending A&E were classed as severe, this would equate to 42 000 severe ankle sprains per year in the UK. In the UK wide survey, there was a response rate of 79% (211 of 266). Among the responders, Tubigrip was used routinely in 55%, below knee casts in 3%, and braces in 2%. Boots were not used routinely in any unit. While there is considerable variation in severe ankle sprain management in UK A&E units, most are treated with the minimal mechanical support of Tubigrip.

Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion.

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Echlin, Paul Sean; Tator, Charles H; Cusimano, Michael D; Cantu, Robert C; Taunton, Jack E; Upshur, Ross E G; Czarnota, Michael; Hall, Craig R; Johnson, Andrew M; Forwell, Lorie A; Driediger, Molly; Skopelja, Elaine N

2010-11-01

The authors investigated return-to-play duration for initial and recurrent concussion in the same season in 2 teams of junior (16-21-year-old) ice hockey players during a regular season. The authors conducted a prospective cohort study during 1 junior regular season (2009-2010) of 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years [SD], range 16-21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments that were determined using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete a baseline SCAT2 and ImPACT. If the protocol was not followed, the postinjury test results of a player without true baseline test results were compared with previously established age- and sex-matched group normative levels. Each game was directly observed by a physician and at least 1 neutral nonphysician observer. Players suspected of suffering a concussion were evaluated by the physician during the game. If a concussion was diagnosed, the player underwent clinical evaluation at the physician's office within 24 hours. The return-to-play decision was based on clinical evaluation guided by the Zurich return-to-play protocol (contained in the consensus statement of international expert opinion at the 3rd International Conference on Concussion in Sport held in Zurich, November 2008). This clinical evaluation and return-to-play protocol was augmented by the 2 tests (SCAT2 and ImPACT) also recommended by the Zurich consensus statement, for which baseline values had been obtained. Seventeen players sustained a physician-observed or self-reported, physician-diagnosed concussion during a physician-observed ice hockey game. The mean clinical return-to-play duration (in 15 cases) was 12.8 ± 7.02 days (median 10 days, range 7-29 days); the mean number of physician office visits

Immobilisation for acute ankle sprain. A systematic review

NARCIS (Netherlands)

Kerkhoffs, G. M.; Rowe, B. H.; Assendelft, W. J.; Kelly, K. D.; Struijs, P. A.; van Dijk, C. N.

2001-01-01

The variation of practice with respect to the treatment of the acutely sprained ankle suggests a lack of evidence-based management strategies for this problem. The objective of this review was to assess the effectiveness of the various methods of immobilisation for acute ankle sprain. An electronic

Sport-Related Concussions

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Brady, Don; Brady, Flo

2011-01-01

Sport-related concussions (SRC) are not limited to specific age ranges, professional athletes, or gender. The primary focus of much of SRC research pertains to the assessment, management, and return to play (RTP) of the concussed athlete. This article highlights some major issues of SRC along with some controversies that presently exist within the…

The cognitive effects and decrements following concussion

Directory of Open Access Journals (Sweden)

Tracey Covassin

2010-05-01

Full Text Available Tracey Covassin, Robert J ElbinMichigan State University, Department of Kinesiology, East Lansing, MI, USAAbstract: Sports-related concussion is an injury that continues to receive attention from both the popular media and sports medicine community. The many different symptom presentations and cognitive decrements that follow concussions, have made this injury difficult to detect and manage. Furthermore, concussed athletes should not always be entrusted to appropriately self-report their concussion symptoms; therefore the burden falls on the clinician and coach. Recent management recommendations call for using a multi-faceted approach to managing concussion, which consists of neurocognitive testing before (ie, baseline/preseason and after injury. In addition age, sex, and previous history of concussion have been found to influence the risk and recovery from this injury.Keywords: cognitive function, neurocognitive testing, concussion

Threat, Pressure, and Communication about Concussion Safety: Implications for Parent Concussion Education

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Kroshus, Emily; Babkes Stellino, Megan; Chrisman, Sara P. D.; Rivara, Frederick P.

2018-01-01

Background: Parental communication about the importance of reporting concussion symptoms can influence a child's attitudes about such reporting, and is likely related to perceived threat of concussion. However, parental investment in child sport achievement might impede this communication. Purpose: To examine the relationship between perceived…

Managing ankle ligament sprains and tears: current opinion

Directory of Open Access Journals (Sweden)

McGovern RP

2016-03-01

Full Text Available Ryan P McGovern,1 RobRoy L Martin,1,2 1Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 2Centers for Sports Medicine – University of Pittsburgh, Pittsburgh, PA, USA Abstract: The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI, interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. Keywords: reinjury, chronic ankle instability, rehabilitation techniques, diagnosis, intervention, athlete

Concussion Prevalence in Competitive Ultimate Frisbee Players

Science.gov (United States)

Lazar, Damien J.; Lichtenstein, Jonathan D.; Tybor, David J.

2018-01-01

Background: Ultimate Frisbee (ultimate) is a fast-growing, popular sport played nationally by over 4 million athletes. While several studies have examined injury rates in ultimate, no work has investigated the prevalence of concussions specifically or players’ knowledge and management of those injuries. Purpose: To estimate the lifetime prevalence of concussions in ultimate and to assess players’ knowledge of concussions as well as their concussion management behaviors. Study Design: Descriptive epidemiology study. Methods: From June to November 2015, we collected ultimate-related concussion data via an anonymous web-based survey, the Concussion in Ultimate Frisbee Survey, from a convenience sample of 787 male and female ultimate players across the United States. Results: There were 553 male and 234 female respondents included in the analysis; 26.58% of men and 24.79% of women reported that they had sustained at least 1 concussion while playing ultimate, with 45.58% and 43.10% of those men and women, respectively, reporting multiple concussions. A total of 67.81% of men and 78.21% of women stated that they would remove themselves from play after sustaining a given concussion, although 45.99% of men and 37.62% of women indicated that they had returned to play in the same game or practice. Conclusion: Our preliminary data suggest that concussions do commonly occur in competitive ultimate and that better education and management of concussions in ultimate athletes are needed. This study is an important first step in deepening our understanding of these issues. PMID:29552572

Intrinsic predictive factors for ankle sprain in active university students: a prospective study.

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de Noronha, M; França, L C; Haupenthal, A; Nunes, G S

2013-10-01

The ankle is the joint most affected among the sports-related injuries. The current study investigated whether certain intrinsic factors could predict ankle sprains in active students. The 125 participants were submitted to a baseline assessment in a single session were then followed-up for 52 weeks regarding the occurrence of sprain. The baseline assessment were performed in both ankles and included the questionnaire Cumberland ankle instability tool - Portuguese, the foot lift test, dorsiflexion range of motion, Star Excursion Balance Test (SEBT), the side recognition task, body mass index, and history of previous sprain. Two groups were used for analysis: one with those who suffered an ankle sprain and the other with those who did not suffer an ankle sprain. After Cox regression analysis, participants with history of previous sprain were twice as likely to suffer subsequent sprains [hazard ratio (HR) 2.21 and 95% confidence interval (CI) 1.07-4.57] and people with better performance on the SEBT in the postero-lateral (PL) direction were less likely to suffer a sprain (HR 0.96 and 95% CI 0.92-0.99). History of previous sprain was the strongest predictive factor and a weak performance on SEBT PL was also considered a predictive factor for ankle sprains. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Youth Sport-Related Concussions: Perceived and Measured Baseline Knowledge of Concussions Among Community Coaches, Athletes, and Parents.

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Nanos, Katherine N; Franco, John M; Larson, Dirk; Mara, Kristin; Laskowski, Edward R

2017-12-01

To assess concussion knowledge of athletes, coaches, and parents/guardians in a community setting and to understand trends/gaps in knowledge among subgroups to tailor efforts toward creating educational interventions. This prospective cross-sectional study involved 262 individuals (142 [55%] female): 115 athletes participating in noncontact and contact sports (ages 13-19 years), 15 coaches, and 132 parents. Recruitment occurred from August 30, 2015, through August 30, 2016, at 3 local high schools. Participants completed a questionnaire developed by the investigators to assess concussion experience and basic knowledge. Females, health care employees, and parents showed stronger concern for potential long-term sequelae of concussion, whereas athletes were most concerned about not being able to return to sport. Those with higher perceived concussion knowledge were slightly older (median age, 42.5 vs 33 years), more educated (college or higher: 42 [70%] vs 100 [50%]), and more likely to be health care workers (22 [37.9%] vs 34 [17.7%]) and scored higher on knowledge questions (average correct: 75.5% vs 60%). Most participants could identify potential concussion sequelae, but only 86 (34.3%) identified a concussion as a brain injury. Of the subgroups, coaches scored highest on knowledge questions. Those with a concussion history tended to consider themselves more knowledgeable but were also less concerned about sequelae. Overall, those with a concussion history scored slightly higher on knowledge questions (average correct: 69.8% vs 61.9%). Participants involved in contact sports were more likely to have had a concussion vs those in noncontact sports (57 [26%] vs 4 [10.3%]). Significant differences in perceived and actual concussion knowledge across different subgroups of study participants involved in high school sports were identified. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers.

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Dretsch, Michael N; Silverberg, Noah D; Iverson, Grant L

2015-09-01

The extent to which multiple past concussions are associated with lingering symptoms or mental health problems in military service members is not well understood. The purpose of this study was to examine the association between lifetime concussion history, cognitive functioning, general health, and psychological health in a large sample of fit-for-duty U.S. Army soldiers preparing for deployment. Data on 458 active-duty soldiers were collected and analyzed. A computerized cognitive screening battery (CNS-Vital Signs(®)) was used to assess complex attention (CA), reaction time (RT), processing speed (PS), cognitive flexibility (CF), and memory. Health questionnaires included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Zung Depression and Anxiety Scales (ZDS; ZAS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Alcohol Use and Dependency Identification Test (AUDIT). Soldiers with a history of multiple concussions (i.e., three or more concussions) had significantly greater post-concussive symptom scores compared with those with zero (d=1.83, large effect), one (d=0.64, medium effect), and two (d=0.64, medium effect) prior concussions. Although the group with three or more concussions also reported more traumatic stress symptoms, the results revealed that traumatic stress was a mediator between concussions and post-concussive symptom severity. There were no significant differences on neurocognitive testing between the number of concussions. These results add to the accumulating evidence suggesting that most individuals recover from one or two prior concussions, but there is a greater risk for ongoing symptoms if one exceeds this number of injuries.

Concussion occurrence and knowledge in italian football (soccer).

Science.gov (United States)

Broglio, Steven P; Vagnozzi, Roberto; Sabin, Matthew; Signoretti, Stefano; Tavazzi, Barbara; Lazzarino, Giuseppe

2010-01-01

The purpose of the study was to investigate concussion history, knowledge, injury identification, and management strategies among athletes, coaches, and medical staff in Italian club level football (soccer) clubs. Surveys (N=727) were distributed among Italian football clubs. Athletes' surveys were designed to evaluate athlete knowledge of concussive signs and symptoms and injury reporting. Coaches' surveys explored the understanding of concussive signs and symptoms and management practices. Medical staff surveys explored the standard of care regarding concussions. A total of 342 surveys were returned, for a 47% response rate. Descriptive analyses indicated 10% of athletes sustaining a concussion in the past year and 62% of these injuries were not reported, primarily due to the athletes not thinking the injury was serious enough. Coaches consistently identified non-concussion related symptoms (98.7%), but were unable to identify symptoms associated with concussion (38.9%). Most understood that loss of consciousness is not the sole indicator of injury (82.6%). Medical staff reported a heavy reliance on the clinical exam (92%) and athlete symptom reports (92%) to make the concussion diagnosis and return to play decision, with little use of neurocognitive (16.7%) or balance (0.0%) testing. Italian football athletes appear to report concussions at a rate similar to American football players, with a slightly higher rate of unreported injuries. Most of these athletes were aware they were concussed, but did not feel the injury was serious enough to report. Although coaches served as the primary person to whom concussions were reported, the majority of coaches were unable to accurately identify concussion related symptoms. With little use for neurocognitive and postural control assessments, the medical personnel may be missing injuries or returning athletes to play too soon. Collectively, these findings suggest that athletes, coaches, and medical personnel would benefit

Postural stability and ankle sprain history in athletes compared to uninjured controls

NARCIS (Netherlands)

Huurnink, A.; Fransz, D.P.; Kingma, I.; Verhagen, E.A.L.M.; van Dieen, J.H.

2014-01-01

Background Diminished postural stability is a risk factor for ankle sprain occurrence and ankle sprains result in impaired postural stability. To date, ankle sprain history has not been taken into account as a determinant of postural stability, while it could possibly specify subgroups of interest.

Bodychecking rules and concussion in elite hockey.

Directory of Open Access Journals (Sweden)

Laura Donaldson

Full Text Available Athletes participating in contact sports such as ice hockey are exposed to a high risk of suffering a concussion. We determined whether recent rule changes regulating contact to the head introduced in 2010-11 and 2011-12 have been effective in reducing the incidence of concussion in the National Hockey League (NHL. A league with a longstanding ban on hits contacting the head, the Ontario Hockey League (OHL, was also studied. A retrospective study of NHL and OHL games for the 2009-10 to 2011-12 seasons was performed using official game records and team injury reports in addition to other media sources. Concussion incidence over the 3 seasons analyzed was 5.23 per 100 NHL regular season games and 5.05 per 100 OHL regular season games (IRR 1.04; 95% CI 1.01, 1.50. When injuries described as concussion-like or suspicious of concussion were included, incidences rose to 8.8 and 7.1 per 100 games respectively (IRR 1.23; 95% CI 0.81, 1.32. The number of NHL concussions or suspected concussions was lower in 2009-10 than in 2010-11 (IRR 0.61; 95% CI 0.45, 0.83, but did not increase from 2010-11 to 2011-12 (IRR 1.05; 95% CI 0.80, 1.38. 64.2% of NHL concussions were caused by bodychecking, and only 28.4% of concussions and 36.8% of suspected concussions were caused by illegal incidents. We conclude that rules regulating bodychecking to the head did not reduce the number of players suffering concussions during NHL regular season play and that further changes or stricter enforcement of existing rules may be required to minimize the risk of players suffering these injuries.

In-office management of sport-related concussion.

Science.gov (United States)

Reynolds, Erin; Collins, Michael W

2014-01-01

The field of sport-related concussion has grown exponentially over the past decade, with more concussion-specific clinics being identified in major hospital systems as well as independent practitioner's offices. To date, there is no standardized in-office protocol for managing ongoing symptoms. The University of Pittsburgh Medical Center (UPMC) Sports Concussion Program, established in 2000, is one of the largest programs in the USA, pioneering the way in clinical management, research, and education of sport-related concussion. This report will outline the essential components of a successful concussion clinic, using the UPMC Sports Concussion Program as a case example of best practice. We will share several case studies illustrating the individualized and complex nature of this injury, as well as review important rehabilitation components. © 2014 S. Karger AG, Basel.

Current Concepts in Sports-Related Concussion.

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Chatterjee, Dipal; Frumberg, David B; Mulchandani, Neil B; Eldib, Ahmed M; Xavier, Fred; Barbash, Scott E; Saha, Subrata; Urban, William P

2015-01-01

Traumatic brain injury, specifically concussion, is prevalent in contact sports. In the United States (US) each year, 170 million adults participate in physical recreational activities, and 38 million children and adolescents participate in organized sports. The Centers for Disease Control estimate that in this group ~1.6 to 3.8 million concussions occur annually. Recent class-action lawsuits in the US filed by professional athletes against their respective leagues allege negligence in protecting them from concussions, and this has contributed to the attention received in the popular media. In response, concussion-related publications have increased exponentially during the past several years. Recent studies have challenged earlier assumptions that the effects of concussion are transient. Stronger links between concussion and neurodegenerative processes such as Alzheimer's disease-like conditions, depression, and heightened risk for suicide are being elucidated. In this article, we explore the current knowledge on concussion, including pathophysiology, management, and long-term effects. We conclude that more evidence-based results regarding guidelines for diagnosis, treatment, and return to play (RTP) are needed and should be the focus of future investigations. Attributing the etiology of certain neurodegenerative conditions to a history of concussion has been suggested in the current literature, but additional quantitative data regarding the pathophysiology and causality are needed as well. Bioengineers can have an important role in measuring the dynamic forces encountered during head impacts and their effects on the brain. These results can be effective in designing better helmets as well as improved playing surfaces to reduce the impact of such injuries. At this time, we believe that groups of people with heightened risk for concussion should be followed closely during longer periods of time and compared to matched controls. Such long-term studies are urgently

Concussion History and Time Since Concussion Do not Influence Static and Dynamic Balance in Collegiate Athletes.

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Merritt, Eric D; Brown, Cathleen N; Queen, Robin M; Simpson, Kathy J; Schmidt, Julianne D

2017-11-01

Dynamic balance deficits exist following a concussion, sometimes years after injury. However, clinicians lack practical tools for assessing dynamic balance. To determine if there are significant differences in static and dynamic balance performance between individuals with and without a history of concussion. Cross sectional. Clinical research laboratory. 45 collegiate student-athletes with a history of concussion (23 males, 22 females; age = 20.0 ± 1.4 y; height = 175.8 ± 11.6 cm; mass = 76.4 ± 19.2 kg) and 45 matched controls with no history of concussion (23 males, 22 females; age = 20.0 ± 1.3 y; height = 178.8 ± 13.2 cm; mass = 75.7 ± 18.2 kg). Participants completed a static (Balance Error Scoring System) and dynamic (Y Balance Test-Lower Quarter) balance assessment. A composite score was calculated from the mean normalized Y Balance Test-Lower Quarter reach distances. Firm, foam, and overall errors were counted during the Balance Error Scoring System by a single reliable rater. One-way ANOVAs were used to compare balance performance between groups. Pearson's correlations were performed to determine the relationship between the time since the most recent concussion and balance performance. A Bonferonni adjusted a priori α balance performance did not significantly differ between groups. No significant correlation was found between the time since the most recent concussion and balance performance. Collegiate athletes with a history of concussion do not present with static or dynamic balance deficits when measured using clinical assessments. More research is needed to determine whether the Y Balance Test-Lower Quarter is sensitive to acute balance deficits following concussion.

Proprioceptive Training for the Prevention of Ankle Sprains: An Evidence-Based Review.

Science.gov (United States)

Rivera, Matthew J; Winkelmann, Zachary K; Powden, Cameron J; Games, Kenneth E

2017-11-01

Reference:  Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238-244.   Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population?   The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof.   Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates.   Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate.   Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to

Efforts to Prevent Concussions Target Schools

Science.gov (United States)

Samuels, Christina A.

2010-01-01

The number of sports-related concussions reported by young athletes is on the rise, prompting awareness campaigns from athletic and medical groups, as well as proposed federal legislation to set minimum standards for concussion management in public schools. Concussions are caused by a jolt to the body or a blow to the head that causes the head to…

CONCUSSION OCCURRENCE AND KNOWLEDGE IN ITALIAN FOOTBALL (SOCCER

Directory of Open Access Journals (Sweden)

Steven P. Broglio

2010-09-01

Full Text Available The purpose of the study was to investigate concussion history, knowledge, injury identification, and management strategies among athletes, coaches, and medical staff in Italian club level football (soccer clubs. Surveys (N=727 were distributed among Italian football clubs. Athletes' surveys were designed to evaluate athlete knowledge of concussive signs and symptoms and injury reporting. Coaches' surveys explored the understanding of concussive signs and symptoms and management practices. Medical staff surveys explored the standard of care regarding concussions. A total of 342 surveys were returned, for a 47% response rate. Descriptive analyses indicated 10% of athletes sustaining a concussion in the past year and 62% of these injuries were not reported, primarily due to the athletes not thinking the injury was serious enough. Coaches consistently identified non-concussion related symptoms (98.7%, but were unable to identify symptoms associated with concussion (38.9%. Most understood that loss of consciousness is not the sole indicator of injury (82.6%. Medical staff reported a heavy reliance on the clinical exam (92% and athlete symptom reports (92% to make the concussion diagnosis and return to play decision, with little use of neurocognitive (16.7% or balance (0.0% testing. Italian football athletes appear to report concussions at a rate similar to American football players, with a slightly higher rate of unreported injuries. Most of these athletes were aware they were concussed, but did not feel the injury was serious enough to report. Although coaches served as the primary person to whom concussions were reported, the majority of coaches were unable to accurately identify concussion related symptoms. With little use for neurocognitive and postural control assessments, the medical personnel may be missing injuries or returning athletes to play too soon. Collectively, these findings suggest that athletes, coaches, and medical personnel would

A systematic review of concussion in rugby league.

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Gardner, Andrew; Iverson, Grant L; Levi, Christopher R; Schofield, Peter W; Kay-Lambkin, Frances; Kohler, Ryan M N; Stanwell, Peter

2015-04-01

Concussion remains one of the inherent risks of participation in rugby league. While other injuries incurred by rugby league players have been well studied, less focus and attention has been directed towards concussion. The current review examined all articles published in English from 1900 up to June 2013 pertaining to concussion in rugby league players. Publications were retrieved via six databases using the key search terms: rugby league, league, football; in combination with injury terms: athletic injuries, concussion, sports concussion, sports-related concussion, brain concussion, brain injury, brain injuries, mild traumatic brain injury, mTBI, traumatic brain injury, TBI, craniocerebral trauma, head injury and brain damage. Observational, cohort, correlational, cross-sectional and longitudinal studies were all included. 199 rugby league injury publications were identified. 39 (20%) were related in some way to concussion. Of the 39 identified articles, 6 (15%) had the main aim of evaluating concussion, while the other 33 reported on concussion incidence as part of overall injury data analyses. Rugby league concussion incidence rates vary widely from 0.0 to 40.0/1000 playing hours, depending on the definition of injury (time loss vs no time loss). The incidence rates vary across match play versus training session, seasons (winter vs summer) and playing position (forwards vs backs). The ball carrier has been found to be at greater risk for injury than tacklers. Concussion accounts for 29% of all injuries associated with illegal play, but only 9% of injuries sustained in legal play. In comparison with other collision sports, research evaluating concussion in rugby league is limited. With such limited published rugby league data, there are many aspects of concussion that require attention, and future research may be directed towards these unanswered questions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

Sports-related concussions - media, science and policy.

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Mannix, Rebekah; Meehan, William P; Pascual-Leone, Alvaro

2016-08-01

Although growing awareness about the potential long-term deleterious effects of sport-related concussion has led to increased attention to the risks of collision sports, calls to ban these sports, such as American football, might be premature. Collision sports have a relatively high incidence of concussions, but participation in these sports also confers a host of benefits. In addition, the associated risks of participation, including concussion, have not been definitively shown to outweigh the benefits they provide, and the risk-benefit ratio might vary among individuals. The risks of concussion and repetitive concussions associated with collision sports are unknown in the general population and not well characterized even in elite athlete populations. In this article, we discuss current knowledge on sports-related concussion, its neurological consequences, and implications for regulation of the practice of collision sports.

Multiple Past Concussions in High School Football Players

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Brooks, Brian L.; Mannix, Rebekah; Maxwell, Bruce; Zafonte, Ross; Berkner, Paul D.; Iverson, Grant L.

2017-01-01

Background 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. PMID:27474382

Epidemiological Patterns of Ankle Sprains in Youth, High School, and College Football.

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Clifton, Daniel R; Koldenhoven, Rachel M; Hertel, Jay; Onate, James A; Dompier, Thomas P; Kerr, Zachary Y

2017-02-01

Variations in ankle injury rates and distributions among competition levels are unclear, but such data may help inform strategies to prevent ankle sprains during American football. To describe the epidemiological patterns of ankle sprains in youth, high school (HS), and collegiate American football. Descriptive epidemiological study. Data regarding youth, HS, and college football athletes were collected from 3 injury surveillance programs: (1) the Youth Football Safety Study (YFSS), (2) the National Athletic Treatment, Injury and Outcomes Network (NATION), and (3) the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). During the 2012-2014 seasons, the YFSS, NATION, and NCAA ISP included 310, 184, and 71 football team-seasons, respectively. Athletic trainers (ATs) attended each practice and game and reported injuries and athlete-exposures (AEs) via their preferred injury documentation application. Ankle sprain rates for each type of ankle sprain were calculated overall, by event type (ie, practices and games), and specifically for severe injuries (ie, participation restriction time >21 days) and recurrent injuries (as defined by ATs). Rate ratios (RRs) were used to compare ankle sprain rates by competition level and event type. Injury proportion ratios (IPRs) were used to compare differences in severity, surgical needs, recurrence, injury mechanism, and injury activity by competition level. RRs and IPRs with 95% confidence intervals excluding 1.00 were considered statistically significant. A total of 124, 897, and 643 ankle sprains were reported in youth, HS, and college football, respectively. This led to respective rates of 0.59, 0.73, and 1.19 sprains per 1000 AEs. The ankle sprain rate in college football was higher than the rates in HS (RR = 1.64; 95% CI, 1.48-1.82) and youth (RR = 2.01; 95% CI, 1.65-2.43) football. The proportion of ankle sprains that were recurrent in youth football was higher than the proportions in HS (IPR

CONCUSSION IN SPORT: PRACTICAL MANAGEMENT ...

African Journals Online (AJOL)

Enrique

The monitoring of symptoms of concussion is important in order to manage the concussed player ... develop prolonged disability charac- terised by poor ... Feeling 'dinged', stunned or 'dazed' .... The baseline test ensures reliable com- parative ...

Know the Facts: Understand Concussion

Centers for Disease Control (CDC) Podcasts

2010-03-17

This podcast discusses concussions and provides information to help people better understand concussion.  Created: 3/17/2010 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 3/17/2010.

Influence of Concussion History and Genetics on Event-Related Potentials in Athletes: Potential Use in Concussion Management

Directory of Open Access Journals (Sweden)

Taylor Guth

2018-01-01

Full Text Available Sports-related concussions are an increasing public health issue with much concern about the possible long-term decrements in cognitive function and quality of life that may occur in athletes. The measurement of cognitive function is a common component of concussion management protocols due to cognitive impairments that occur after sustaining a concussion; however, the tools that are often used may not be sensitive enough to expose long term problems with cognitive function. The current paper is a brief review, which suggests that measuring cognitive processing through the use of event related potentials (ERPs may provide a more sensitive assessment of cognitive function, as shown through recent research showing concussion history to influence ERPs components. The potential influence of genetics on cognitive function and ERPs components will also be discussed in relation to future concussion management.

Prediction of core and lower extremity strains and sprains in collegiate football players: a preliminary study.

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Wilkerson, Gary B; Giles, Jessica L; Seibel, Dustin K

2012-01-01

Poor core stability is believed to increase vulnerability to uncontrolled joint displacements throughout the kinetic chain between the foot and the lumbar spine. To assess the value of preparticipation measurements as predictors of core or lower extremity strains or sprains in collegiate football players. Cohort study. National Collegiate Athletic Association Division I Football Championship Subdivision football program. All team members who were present for a mandatory physical examination on the day before preseason practice sessions began (n = 83). Preparticipation administration of surveys to assess low back, knee, and ankle function; documentation of knee and ankle injury history; determination of body mass index; 4 different assessments of core muscle endurance; and measurement of step-test recovery heart rate. All injuries were documented throughout the preseason practice period and 11-game season. Receiver operating characteristic analysis and logistic regression analysis were used to identify dichotomized predictive factors that best discriminated injured from uninjured status. The 75th and 50th percentiles were evaluated as alternative cutpoints for dichotomization of injury predictors. Players with ≥2 of 3 potentially modifiable risk factors related to core function had 2 times greater risk for injury than those with football injury risk factors that can be identified on preparticipation screening. These predictors need to be assessed in a prospective manner with a larger sample of collegiate football players.

Recovery Time for Sports Concussions

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... this issue Health Capsule Recovery Time for Sports Concussions En español Send us your comments Scientists look ... an athlete to return to play after a concussion. Paul Burns/Blend Images/Thinkstock A brain injury- ...

The effect of days since last concussion and number of concussions on cognitive functioning in Division I athletes.

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Thoma, Robert J; Cook, Julia A; McGrew, Christopher; King, John H; Mayer, Andrew R; Lewine, Jeffrey D; Yeo, Ronald A; Campbell, Richard

2015-01-01

Cognitive recovery from sports concussion may be incomplete after resolution of other symptoms. It was hypothesized that independent effects of the number of days since last concussion (Days) and total number of concussions (Number) would predict poorer cognitive functioning. Cognition was assessed in an NCAA Division I student-athlete population (n = 87) using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery. In a MANOVA, the five ImPACT Composite scores were dependent variables, with Group (Concussion, Unaffected) as the independent variable and prior number of concussions (Number) and days since last concussion (Days; 68-2495 days) entered as covariates. The hypothesis that Days and Number would each independently affect cognitive functioning (as assessed by ImPACT Composite scores) was only partly supported. A significant, multivariate, main effect of Days (p = 0.01) indicated that more Days predicted better cognitive functioning overall (p = 0.01). Univariate effects emerged such that more Days specifically predicted better visual memory (p = 0.004) and faster reaction times (p = 0.02). A trend toward a Group*Days*Number three-way interaction for reaction time emerged (p = 0.06), such that smaller Number and more Days each predicted slower reaction time. Cognitive recovery following sports concussion may take far longer than was previously thought, the aetiology of cognitive reductions may be very complex and the ImPACT appears to be sensitive to subtle changes in cognition across time.

Factors associated with delayed recovery in athletes with concussion treated at a pediatric neurology concussion clinic.

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Bock, Suzanne; Grim, Rod; Barron, Todd F; Wagenheim, Andrew; Hu, Yaowen Eliot; Hendell, Matthew; Deitch, John; Deibert, Ellen

2015-11-01

With the increase in knowledge and management of sport-related concussion over the last 15 years, there has been a shift from a grading scale approach to an individualized management approach. As a result, there is an increased need to better understand the factors involved in delayed recovery of concussion. The purpose of this retrospective study was to examine factors that may be associated with recovery from sport-related concussion in student athletes aged 11 to 18 years old. Of the 366 patients who met the inclusion criteria, 361 were included in our analysis. The primary dependent variable included days until athlete was able to return to play (RTP). Independent variables of interest included age, gender, academic performance, comorbid factors, sports, on-field markers, days until initial neurological evaluation, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) scores, acute headache rescue medications, chronic headache medication, sleep medication, and referral to concussion rehabilitation program. Variables associated with longer median RTP were being female (35 days), having a referral to concussion rehabilitation program (53 days), being prescribed acute headache rescue therapy (34 days), and having chronic headache treatment (53 days) (all p fashion in order to prevent delayed recovery and return to play.

Brain tissue strains vary with head impact location: A possible explanation for increased concussion risk in struck versus striking football players.

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Elkin, Benjamin S; Gabler, Lee F; Panzer, Matthew B; Siegmund, Gunter P

2018-03-29

On-field football helmet impacts over a large range of severities have caused concussions in some players but not in other players. One possible explanation for this variability is the struck player's helmet impact location. We examined the effect of impact location on regional brain tissue strain when input energy was held constant. Laboratory impacts were performed at 12 locations distributed over the helmet and the resulting head kinematics were simulated in two finite element models of the brain: the Simulated Injury Monitor and the Global Human Body Model Consortium brain model. Peak kinematics, injury metrics and brain strain varied significantly with impact location. Differences in impact location explained 33 to 37% of the total variance in brain strain for the whole brain and cerebrum, considerably more than the variance explained by impact location for the peak resultant head kinematics (8 to 23%) and slightly more than half of the variance explained by the difference in closing speed (57 to 61%). Both finite element models generated similar strain results, with minor variations for impacts that generated multi-axial rotations, larger variations in brainstem strains for some impact locations and a small bias for the cerebellum. Based on this experimental and computational simulation study, impact location on the football helmet has a large effect on regional brain tissue strain. We also found that the lowest strains consistently occurred in impacts to the crown and forehead, helmet locations commonly associated with the striking player. Copyright © 2018 Elsevier Ltd. All rights reserved.

Vestibular and balance issues following sport-related concussion.

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Valovich McLeod, Tamara C; Hale, Troy D

2015-01-01

To review relevant literature regarding the effect of concussion on vestibular function, impairments, assessments and management strategies. REASONING: Dizziness and balance impairments are common following sport-related concussion. Recommendations regarding the management of sport-related concussion suggest including tests of balance within the multifactorial assessment paradigm for concussive injuries. The literature was searched for guidelines and original studies related to vestibular impairments following concussion, oculomotor and balance assessments and treatment or rehabilitation of vestibular impairments. The databases searched included Medline, CINAHL, Sport Discus and the Cochrane Database of Systematic Reviews through October 2013. Dizziness following concussion occurs in ∼67-77% of cases and has been implicated as a risk factor for a prolonged recovery. Balance impairments also occur after concussion and last 3-10 days post-injury. Assessments of balance can be done using both clinical and instrumented measures with success. Vestibular rehabilitation has been shown to improve outcomes in patients with vestibular impairments, with one study demonstrating success in decreasing symptoms and increasing function following concussion. Best practices suggest that the assessment of vestibular function through cranial nerve, oculomotor and balance assessments are an important aspect of concussion management. Future studies should evaluate the effectiveness of vestibular rehabilitation for improving patient outcomes.

Concussions

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... Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Concussions Teen Sports Center Image About Us Contact Us Partners Editorial ...

English professional football players concussion knowledge and attitude

Directory of Open Access Journals (Sweden)

Joshua M. Williams

2016-06-01

Conclusion: The results of this study suggest that Championship Level English footballers have moderate concussion knowledge, safe attitudes, and good concussion symptom recognition when assessed with pen and paper questionnaires. However, within the semi-structured interview many respondents reported unsafe concussion behaviors despite accurately identifying the potential risks. Further, multiple barriers to concussion reporting were identified which included perceived severity of the injury, game situations, and the substitution rule. These findings can help form the foundation of educational interventions to potentially improve concussion reporting behaviors amongst professional footballers.

The identification of risk factors for ankle sprains sustained during netball participation.

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Attenborough, Alison S; Sinclair, Peter J; Sharp, Tristan; Greene, Andrew; Stuelcken, Max; Smith, Richard M; Hiller, Claire E

2017-01-01

Ankle sprains account for a large percentage of injuries sustained in netball. The identification of risk factors for ankle sprain is the preliminary action required to inform future prevention strategies. Prospective study. Ninety-four netball players from club and inter-district teams. Preseason data were collected for; vertical jump height, perceived ankle instability, sprain history, arthrometry inversion-eversion angles, star excursion balance test reach distances, the number of foot lifts during unilateral stance and demi-pointe balance test results. Participants were followed for the duration of one netball season and ankle sprains were recorded. Eleven sprains were recorded for eleven players using a time-loss definition of injury. Ankle sprains occurred at an incidence rate of 1.74/1000 h of netball exposure. One risk factor was identified to increase the odds of sustaining an ankle sprain during netball participation - a reach distance in the posterior-medial direction of the star excursion balance test of less than or equal to 77.5% of leg length (OR = 4.04, 95% CI = 1.00-16.35). The identified risk factor can be easily measured and should be considered for preseason injury risk profiling of netball players. Netball players may benefit from training programs aimed at improving single leg balance. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Expression of c-jun protein after experimental rat brain concussion].

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Wang, Feng; Li, Yong-hong

2010-02-01

To observe e-jun protein expression after rat brain concussion and explore the forensic pathologic markers following brain concussion. Fifty-five rats were randomly divided into brain concussion group and control group. The expression of c-jun protein was observed by immunohistochemistry. There were weak positive expression of c-jun protein in control group. In brain concussion group, however, some neutrons showed positive expression of c-jun protein at 15 min after brain concussion, and reach to the peak at 3 h after brain concussion. The research results suggest that detection of c-jun protein could be a marker to determine brain concussion and estimate injury time after brain concussion.

Heart rate variability and implication for sport concussion.

Science.gov (United States)

Bishop, Scott A; Dech, Ryan T; Guzik, Przemyslaw; Neary, J Patrick

2017-11-16

Finding sensitive and specific markers for sports-related concussion is both challenging and clinically important. Such biomarkers might be helpful in the management of patients with concussion (i.e. diagnosis, monitoring and risk prediction). Among many parameters, blood flow-pressure metrics and heart rate variability (HRV) have been used to gauge concussion outcomes. Reports on the relation between HRV and both acute and prolonged concussion recovery are conflicting. While some authors report on differences in the low-frequency (LF) component of HRV during postural manipulations and postexercise conditions, others observe no significant differences in various HRV measures. Despite the early success of using the HRV LF for concussion recovery, the interpretation of the LF is debated. Recent research suggests the LF power is a net effect of several intrinsic modulatory factors from both sympathetic and parasympathetic branches of the autonomic nervous system, vagally mediated baroreflex and even some respiratory influences at lower respiratory rate. There are only a few well-controlled concussion studies that specifically examine the contribution of the autonomic nervous system branches with HRV for concussion management. This study reviews the most recent HRV- concussion literature and the underlying HRV physiology. It also highlights cerebral blood flow studies related to concussion and the importance of multimodal assessment of various biological signals. It is hoped that a better understanding of the physiology behind HRV might generate cost-effective, repeatable and reliable protocols, all of which will improve the interpretation of HRV throughout concussion recovery. © 2017 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Concussion management in US college football: progress and pitfalls

Science.gov (United States)

Kroshus, Emily

2015-01-01

Reducing the frequency and severity of concussions from sport is an important issue in public health currently addressed by a multifaceted approach. Given the large number of participants and the comparatively high risk of injury, American football is an important sport to consider when examining concussion management practices. Focusing on American football at the collegiate level, this manuscript describes current research regarding concussion epidemiology, policy, implementation of clinical diagnosis, management and return-to-play standards and athlete concussion education. Although American collegiate sports leagues have put forth concussion-related policies in recent years, the implementation of these policies and related effects on athlete concussion education, clinical management of concussion and ultimately athlete health outcomes are not well understood. Additional research is needed. PMID:27064258

The Rise of Concussions in the Adolescent Population.

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Zhang, Alan L; Sing, David C; Rugg, Caitlin M; Feeley, Brian T; Senter, Carlin

2016-08-01

Concussion injuries have been highlighted to the American public through media and research. While recent studies have shown increased traumatic brain injuries (TBIs) diagnosed in emergency departments across the United States, no studies have evaluated trends in concussion diagnoses across the general US population in various age groups. To evaluate the current incidence and trends in concussions diagnosed across varying age groups and health care settings in a large cross-sectional population. Descriptive epidemiological study. Administrative health records of 8,828,248 members of a large private-payer insurance group in the United States were queried. Patients diagnosed with concussion from years 2007 through 2014 were stratified by year of diagnosis, age group, sex, classification of concussion, and health care setting of diagnosis (eg, emergency department vs physician's office). Chi-square testing was used for statistical analysis. From a cohort of 8,828,248 patients, 43,884 patients were diagnosed with a concussion. Of these patients, 55% were male and over 32% were in the adolescent age group (10-19 years old). The highest incidence of concussion was seen in patients aged 15 to 19 years (16.5/1000 patients), followed by those aged 10 to 14 years (10.5/1000 patients), 20 to 24 years (5.2/1000 patients), and 5 to 9 years (3.5/1000 patients). Overall, there was a 60% increase in concussion incidence from 2007 to 2014. The largest increases were in the 10- to 14-year (143%) and 15- to 19-year (87%) age groups. Based on International Classification of Disease-9th Revision classification, 29% of concussions were associated with some form of loss of consciousness. Finally, 56% of concussions were diagnosed in the emergency department and 29% in a physician's office, with the remainder in urgent care clinics or inpatient settings. The incidence of concussion diagnosed in the general US population is increasing, driven largely by a substantial rise in the adolescent

Exploration of US men's professional sport organization concussion policies.

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Cochrane, Graham Dean; Owen, Matthew; Ackerson, Joseph D; Hale, Matthew H; Gould, Sara

2017-05-01

Concussion policies are increasingly being developed and adopted among professional sports organizations. We sought to compare the policies of the National Hockey League (NHL), the National Basketball Association (NBA), the National Football League (NFL), and Major League Baseball (MLB). Our objective was to summarize each policy and evaluate the extent to which each policy is organization-specific and/or consistent with medical guidelines. We visited websites for the NHL, NBA, NFL, and MLB. We searched media articles reporting concussion policy. We utilized only publically available data. We collected information on each league's approach to the definition of concussion, education provided about concussion, baseline testing requirements, minimum return to play time and return to play protocol. We found that concussion policies vary across these organizations. Most organizations utilize the Concussion in Sport Group (CISG) definition (2013) to define concussion. The NFL and NBA mandate preseason education. All organizations require some type of baseline testing. All organizations require sideline evaluation after suspected concussion. The NFL and MLB require Sport Concussion Assessment Tool (SCAT) testing for sideline evaluation of suspected concussion. MLB is the only organization to require minimum time before return to play. There is a return to play protocol in place for each organization. The NFL and MLB require independent neurologic consultation as part of their return to play protocol. There is variability in concussion policy among the professional sports organizations. The most pronounced variation from the CISG consensus statement is the variability in the minimum time to return to play. Further, the rules of the individual sports have a role in how concussion policy can be designed and implemented. Professional sports set an example for thousands of recreational sports enthusiasts so their publically available policies on concussion have a large impact.

The Relation of Q Angle and Anthropometric Measures with Ankle Sprain; a Case-control study

Directory of Open Access Journals (Sweden)

Hamid Zamani Moghadam

2016-12-01

Full Text Available Introduction: Since most studies on ankle sprain are medical and sports-related and not much epidemiologic and etiologic data from the general population exist in this field, the present study evaluates the relationship between Q angle and anthropometric measures with ankle sprain in the general population.Methods: In the present case-control study, all of the patients over 18 years age presenting to emergency departments (ED of two educational Hospitals, complaining from ankle sprain, were evaluated during more than 1 year. A checklist consisting of demographic data, height, weight, body mass index (BMI, and history of ankle sprain, as well as degree of Q angle was filled for all participants. The correlation of mentioned variables with incidence of ankle sprain was calculated using SPSS 22.Results: 300 patients with ankle sprain were evaluated (53.5% male. Mean age of the patients was 37.03 ± 14.20 years. Mean weight, height, and BMI were 71.71 ± 11.26 (43 – 114, 168.74 ± 8.63 (143 – 190 and 25.14 ± 3.19 (18.41 – 38.95, respectively. Mean Q angle of the patients was 12.78 ± 3.19 degrees (5 – 23. There was a significant correlation between weight (p < 0.001, BMI (p = 0.001, history of sprain (r: 0.26, p < 0.001 and Q angle (p = 0.002 with incidence of ankle sprain. In addition, there was a significant statistical correlation between weight (p = 0.031, BMI (p = 0.020 and Q angle (p = 0.004 with history of ankle sprain. In patients with a history of ankle sprain, Q angle was wider by about 2 degrees.Conclusion: It seems that the prevalence of ankle sprain directly correlates with high weight, BMI, and Q angle and is more prevalent in those with a history of sprain. Although the findings of the present study show a statistically significant correlation between these factors and ankle sprain, the correlation is not clinically significant.

Epidemiology of Knee Sprains in Youth, High School, and Collegiate American Football Players.

Science.gov (United States)

Clifton, Daniel R; Onate, James A; Schussler, Eric; Djoko, Aristarque; Dompier, Thomas P; Kerr, Zachary Y

2017-05-01

  Variations in knee-sprain incidence among competition levels are unclear but may help inform prevention strategies in American football players.   To describe the epidemiology of knee sprains in youth, high school, and collegiate football players.   Descriptive epidemiology study.   Injury and athlete-exposure (AE) data were collected from 3 injury-surveillance programs at the youth, high school, and collegiate competition levels.   Data from 310 youth, 184 high school, and 71 collegiate football team-seasons were collected during the 2012 through 2014 seasons.   Knee-sprain rates and risks were calculated for each competition level. Injury rate ratios (IRRs) and risk ratios (RRs) compared knee-sprain rates by competition level. Injury proportion ratios (IPRs) compared differences in surgery needs, recurrence, injury mechanism, and injury activity by competition level.   Knee-sprain rates in youth, high school, and collegiate football were 0.16/1000 AEs, 0.25/1000 AEs, and 0.69/1000 AEs, respectively. Knee-sprain rates increased as the competition level increased (high school versus youth: IRR = 1.60; 95% confidence interval [CI] = 1.12, 2.30; collegiate versus high school: IRR = 2.73; 95% CI = 2.38, 3.96). Knee-sprain risk was highest in collegiate (4.3%), followed by high school (2.0%) and youth (0.5%) athletes. Knee-sprain risk increased as the competition level increased (high school versus youth: RR = 3.73; 95% CI = 2.60, 5.34; collegiate versus high school: RR = 2.14; 95% CI = 1.83, 2.51). Collegiate football had the lowest proportion of knee sprains that were noncontact injuries (collegiate versus youth: IPR = 0.54; 95% CI = 0.31, 0.95; collegiate versus high school: IPR = 0.59; 95% CI = 0.44, 0.79) and the lowest proportion that occurred while being tackled (collegiate versus youth: IPR = 0.44; 95% CI = 0.26, 0.76; collegiate versus high school: IPR = 0.71; 95% CI = 0.51, 0.98).   Knee-sprain incidence was highest in collegiate football

A systematic video analysis of National Hockey League (NHL) concussions, part II: how concussions occur in the NHL.

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Hutchison, Michael G; Comper, Paul; Meeuwisse, Willem H; Echemendia, Ruben J

2015-04-01

Concussions in sports are a growing cause of concern, as these injuries can have debilitating short-term effects and little is known about the potential long-term consequences. This work aims to describe how concussions occur in the National Hockey League. Case series of medically diagnosed concussions for regular season games over a 3.5-year period during the 2006-2010 seasons. Digital video records were coded and analysed using a standardised protocol. 88% (n=174/197) of concussions involved player-to-opponent contact. 16 diagnosed concussions were a result of fighting. Of the 158 concussions that involved player-to-opponent body contact, the most common mechanisms were direct contact to the head initiated by the shoulder 42% of the time (n=66/158), by the elbow 15% (n=24/158) and by gloves in 5% of cases (n=8/158). When the results of anatomical location are combined with initial contact, almost half of these events (n=74/158) were classified as direct contact to the lateral aspect of the head. The predominant mechanism of concussion was consistently characterised by player-to-opponent contact, typically directed to the head by the shoulder, elbow or gloves. Also, several important characteristics were apparent: (1) contact was often to the lateral aspect of the head; (2) the player who suffered a concussion was often not in possession of the puck and (3) no penalty was called on the play. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Interprofessional management of concussion in sport.

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Pabian, Patrick S; Oliveira, Leonardo; Tucker, Jennifer; Beato, Morris; Gual, Carlos

2017-01-01

Due to the high incidence of sports concussion, various health and medical providers are likely to encounter athletes who have sustained such an injury. Management of concussion necessitates coordinated care by the members of the sports medicine team due to its pathophysiology and complexity of management during recovery. All members of the sports medicine team must possess contemporary knowledge of concussion management as well as strong interprofessional communication skills to ensure effective care and safe return to sports participation. Therefore, the aim of this manuscript is to review the current best practices in interdisciplinary management of sports concussion with a special emphasis on the required interprofessional communication among the sports medicine team. Copyright © 2016 Elsevier Ltd. All rights reserved.

EFFECT OF KINESIO TAPE VERSUS ATHLETIC TAPE ON MYOELECTRIC ACTIVITY OF ANKLE MUSCLES IN PATIENTS WITH CHRONIC ANKLE SPRAIN

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Asmaa F Abdelmonem

2018-04-01

Full Text Available Background: Sprained ankle a common orthopedic injury. The standard treatment for ankle sprains remains nonoperative. Ankle taping was used to protect and prevent ligaments excessive strain. So, the current study aimed at investigating the effect of spa-care Kinesio tape versus standard white athletic tape on myoelectric activities (EMG of ankle evertors (peroneus longus and invertors (tibialis anterior in a chronic ankle sprain. Methods: A convenient sample of 30 patients with a chronic ankle sprain (18 females and 12 males were included in this study. Their mean age ±SD was 24 ±1.2 years. Their height was 175±4.8 cm among men & 163±5.2 cm for females, and weight was 85±5.2 kg for males & 74±5.5 kg for women. It was a within-group design in which the same participant experienced the two types of taping compared to no taping condition. Root mean square (RMS was measured while participants were moving the isokinetic dynamometer at an angular velocity of 120°/sec using concentric contraction mode through full ankle range of motion. The EMG (RMS of evertors and invertors was measured immediately after the three taping ways (no tape, Kinesio tape, and athletic tape with a one-week interval between each taping. Results: Spa-care Kinesiotape significantly reduced evertors and invertors EMG (RMS compared with no tape or athletic tape in patients with chronic ankle sprain. Mean± SD of the evertors was 0.7 (±0.1 for no tape and 0.58 (±0.2 for Kinesio tape. The P value was 0.000 for kinesio tape in evertors compared with no tape. Also, mean± SD of the invertors was 0.87 (±0.23 for no tape, and 0.54 (±0.1 for Kinesio tape and the P value was 0.001 for Kinesio tape in invertors compared with no tape. Conclusion: Spa-care Kinesio tape may be useful for reducing EMG activity of ankle muscles in a chronic ankle sprain.

Descriptive Analysis of a Baseline Concussion Battery Among U.S. Service Academy Members: Results from the Concussion Assessment, Research, and Education (CARE) Consortium.

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O'Connor, Kathryn L; Dain Allred, C; Cameron, Kenneth L; Campbell, Darren E; D'Lauro, Christopher J; Houston, Megan N; Johnson, Brian R; Kelly, Tim F; McGinty, Gerald; O'Donnell, Patrick G; Peck, Karen Y; Svoboda, Steven J; Pasquina, Paul; McAllister, Thomas; McCrea, Michael; Broglio, Steven P

2018-03-28

The prevalence and possible long-term consequences of concussion remain an increasing concern to the U.S. military, particularly as it pertains to maintaining a medically ready force. Baseline testing is being used both in the civilian and military domains to assess concussion injury and recovery. Accurate interpretation of these baseline assessments requires one to consider other influencing factors not related to concussion. To date, there is limited understanding, especially within the military, of what factors influence normative test performance. Given the significant physical and mental demands placed on service academy members (SAM), and their relatively high risk for concussion, it is important to describe demographics and normative profile of SAMs. Furthermore, the absence of available baseline normative data on female and non-varsity SAMs makes interpretation of post-injury assessments challenging. Understanding how individuals perform at baseline, given their unique individual characteristics (e.g., concussion history, sex, competition level), will inform post-concussion assessment and management. Thus, the primary aim of this manuscript is to characterize the SAM population and determine normative values on a concussion baseline testing battery. All data were collected as part of the Concussion Assessment, Research and Education (CARE) Consortium. The baseline test battery included a post-concussion symptom checklist (Sport Concussion Assessment Tool (SCAT), psychological health screening inventory (Brief Symptom Inventory (BSI-18) and neurocognitive evaluation (ImPACT), Balance Error Scoring System (BESS), and Standardized Assessment of Concussion (SAC). Linear regression models were used to examine differences across sexes, competition levels, and varsity contact levels while controlling for academy, freshman status, race, and previous concussion. Zero inflated negative binomial models estimated symptom scores due to the high frequency of zero scores

Mismanaging Concussions in Intercollegiate Football

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Moser, Austin; Miller, John J.

2014-01-01

In 2011, Adrian Arrington filed a class action lawsuit against the National Collegiate Athletic Association (NCAA) on behalf of himself and other athletes who had sustained concussions that resulted in long-term injuries. In the lawsuit, Arrington alleged that the NCAA employed a negligent approach to concussed student-athletes.

[EEG and brain-stem evoked potentials in 125 recent concussions].

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Geets, W; Louette, N

1983-12-01

EEG and ipsi/contralateral BEPs have been recorded in 125 cases of concussion at most 48 h after the cerebral trauma. In 100 cases of minor concussion the temporary loss of consciousness lasted not more than 2 min. In 25 cases of mild concussion, the loss of consciousness lasted until their arrival at the hospital. In minor concussions an abnormal EEG was found in 17% of the cases and in mild concussions, in 56%. The abnormalities of the BEP, more often seen in mild concussions (60%) than in minor concussions (8%), are an increase of interpeak latencies or distorted responses with average to bad reproducibility. The results are discussed.

A surgical ankle sprain pain model in the rat: Effects of morphine and indomethacin

OpenAIRE

Young Kim, Hee; Wang, Jigong; Chung, Kyungsoon; Mo Chung, Jin

2008-01-01

Ankle sprain is a frequent injury in humans that results in pain, swelling and difficulty in walking on the affected ankle. Currently a suitable animal model resembling human ankle sprain is lacking. Here, we describe an animal ankle sprain model induced by ankle ligament injury (ALI) in rats. Cutting combinations of the lateral ankle ligament complex produced pain, edema and difficulty of weight bearing, thereby mimicking severe (grade III) ankle sprain in humans. Analgesic compounds, morphi...

High School Football Players' Knowledge and Attitudes About Concussions.

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Anderson, Brit L; Gittelman, Michael A; Mann, Jessica K; Cyriac, RoseAnn L; Pomerantz, Wendy J

2016-05-01

To assess high school (HS) football players' knowledge of concussions and to determine whether increased knowledge is correlated with better attitudes toward reporting concussion symptoms and abstaining from play. Two survey tools were used to assess athletes' knowledge and attitudes about concussions. Surveys collected information about demographics, knowledge about concussions, and attitudes about playing sports after a concussion. All athletes present completed one of the 2 surveys. A knowledge and attitude score for each survey was calculated. Frequencies and mean values were used to characterize the population; regression analysis, analysis of variance, and t tests were used to look for associations. A football camp for HS athletes in the Cincinnati area. Male HS football players from competitive football programs in the Cincinnati area. None. Scores on knowledge and attitude sections; responses to individual questions. One hundred twenty (100%) athletes were enrolled although not every athlete responded to every question. Thirty (25%) reported history of a concussion; 82 (70%) reported receiving prior concussion education. More than 75% correctly recognized all concussion symptoms that were asked, except "feeling in a fog" [n = 63 (53%)]. One hundred nine (92%) recognized a risk of serious injury if they return to play too quickly. Sixty-four (54%) athletes would report symptoms of a concussion to their coach; 62 (53%) would continue to play with a headache from an injury. There was no association between knowledge score and attitude score (P = 0.08). Despite having knowledge about the symptoms and danger of concussions, many HS football athletes in our sample did not have a positive attitude toward reporting symptoms or abstaining from play after a concussion. Physicians should be aware that young athletes may not report concussion symptoms.

Parent Knowledge and Perceptions of Concussion Related to Youth Football.

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Rieger, Brian; Lewandowski, Lawrence; Potts, Heather; Potter, Kyle; Chin, Lawrence S

2018-03-04

Introduction There is increased concern about concussion in youth athletes, yet there is little research on parent knowledge of concussion. Purpose  The purpose of the current study was to investigate attitudes to and knowledge of concussion among parents of youth football players. Methods We surveyed 180 parents/guardians of youth football players, ages 5-12, regarding their knowledge and beliefs concerning concussion. Results We found that the vast majority of respondents (86%) had confidence in their ability to recognize concussions. Yet, a significant number also held misconceptions about concussions, such as 'too much sleep' (48%) or 'eating certain foods' (26%) make concussion symptoms worse. Most (82%) had not heard of the Zurich guidelines, and less than half (44%) were aware that sustained mental activity could worsen symptoms. Parents were concerned about their child sustaining a concussion, but a substantial minority also reported 'serious concern' about their children losing playing time or their position.  Discussion Results are somewhat positive in terms of parents' general knowledge of concussions; yet, response variability and misconceptions point to a continued need for concussion education for parents. Medical professionals can play an important role in informing families about concussion symptoms, management, and recovery.

Study of functional-performance deficits in athletes with previous ankle sprains

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hamid Babaee

2008-04-01

Full Text Available Abstract Background: Despite the importance of functional-performance deficits in athletes with history of ankle sprain few, studies have been carried out in this area. The aim of this research was to study relationship between previous ankle sprains and functional-performance deficits in athletes. Materials and methods: The subjects were 40 professional athletes selected through random sampling among volunteer participants in soccer, basketball, volleyball and handball teams of Lorestan province. The subjects were divided into 2 groups: Injured group (athletes with previous ankle sprains and healthy group (athletes without previous ankle sprains. In this descriptive study we used Functional-performance tests (figure 8 hop test and side hop test to determine ankle deficits and limitations. They participated in figure 8 hop test including hopping in 8 shape course with the length of 5 meters and side hop test including 10 side hop repetitions in course with the length of 30 centimeters. Time were recorded via stopwatch. Results: After data gathering and assessing information distributions, Pearson correlation was used to assess relationships, and independent T test to assess differences between variables. Finally the results showed that there is a significant relationship between previous ankle sprains and functional-performance deficits in the athletes. Conclusion: The athletes who had previous ankle sprains indicated functional-performance deficits more than healthy athletes in completion of mentioned functional-performance tests. The functional-performance tests (figure 8 hop test and side hop test are sensitive and suitable to assess and detect functional-performance deficits in athletes. Therefore we can use the figure 8 hop and side hop tests for goals such as prevention, assessment and rehabilitation of ankle sprains without spending too much money and time.

The Acute Management of Sport Concussion in Pediatric Athletes.

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Resch, Jacob E; Kutcher, Jeffrey S

2015-10-01

During the past two decades the focus on sport concussion has increased significantly. Young athletes represent the most vulnerable population to sustain a sport concussion yet receive the least amount of attention. Specifically, young athletes who sustain a sport concussion can go unrecognized and continue to participate in sport putting them at an increased risk for a more significant injury. The purpose of this review is to provide a clinical framework for the evaluation and management of sport concussion. In addition, this review provides considerations for health care professionals in regard to clinical measures and follow-up strategies during the acute phase following concussion in young concussed athletes following injury. © The Author(s) 2015.

Concussions and Risk Within Cultural Contexts of Play.

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Torres Colón, Gabriel Alejandro; Smith, Sharia; Fucillo, Jenny

2017-06-01

Concussions are a type of traumatic injury caused by a jolting of the brain that disrupts normal brain function, and multiple concussions can lead to serious long-term health consequences. In this article, we examine the relationship between college students' understanding of concussions and their willingness to continue playing despite the possibility of sustaining multiple head injuries. We use a mixed-methods approach that includes participant observation, cultural domain analysis, and structured interviews. Our research finds that students hold a robust cognitive understanding of concussion yet discursively frame concussions as skeletomuscular injuries. More importantly, students affirm the importance of playing sports for themselves and others, so their decisions to risk multiple concussions must be understood within cultural and biocultural contexts of meaningful social play. We suggest that peoples' decision to risk multiple head injuries should be understood as a desire for meaningful social play rather than an uninformed health risk.

Responses of spinal dorsal horn neurons to foot movements in rats with a sprained ankle

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Kim, Jae Hyo; Kim, Hee Young; Chung, Kyungsoon

2011-01-01

Acute ankle injuries are common problems and often lead to persistent pain. To investigate the underlying mechanism of ankle sprain pain, the response properties of spinal dorsal horn neurons were examined after ankle sprain. Acute ankle sprain was induced manually by overextending the ankle of a rat hindlimb in a direction of plantarflexion and inversion. The weight-bearing ratio (WBR) of the affected foot was used as an indicator of pain. Single unit activities of dorsal horn neurons in response to plantarflexion and inversion of the foot or ankle compression were recorded from the medial part of the deep dorsal horn, laminae IV-VI, in normal and ankle-sprained rats. One day after ankle sprain, rats showed significantly reduced WBRs on the affected foot, and this reduction was partially restored by systemic morphine. The majority of deep dorsal horn neurons responded to a single ankle stimulus modality. After ankle sprain, the mean evoked response rates were significantly increased, and afterdischarges were developed in recorded dorsal horn neurons. The ankle sprain-induced enhanced evoked responses were significantly reduced by morphine, which was reversed by naltrexone. The data indicate that movement-specific dorsal horn neuron responses were enhanced after ankle sprain in a morphine-dependent manner, thus suggesting that hyperactivity of dorsal horn neurons is an underlying mechanism of pain after ankle sprain. PMID:21389306

Reduced brain glutamine in female varsity rugby athletes after concussion and in non-concussed athletes after a season of play.

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Schranz, Amy L; Manning, Kathryn Y; Dekaban, Gregory A; Fischer, Lisa; Jevremovic, Tatiana; Blackney, Kevin; Barreira, Christy; Doherty, Timothy J; Fraser, Douglas D; Brown, Arthur; Holmes, Jeff; Menon, Ravi S; Bartha, Robert

2018-04-01

The purpose of this study was to use non-invasive proton magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) to monitor changes in prefrontal white matter metabolite levels and tissue microstructure in female rugby players with and without concussion (ages 18-23, n = 64). Evaluations including clinical tests and 3 T MRI were performed at the beginning of a season (in-season) and followed up at the end of the season (off-season). Concussed athletes were additionally evaluated 24-72 hr (n = 14), three months (n = 11), and six months (n = 8) post-concussion. Reduced glutamine at 24-72 hr and three months post-concussion, and reduced glutamine/creatine at three months post-concussion were observed. In non-concussed athletes (n = 46) both glutamine and glutamine/creatine were lower in the off-season compared to in-season. Within the MRS voxel, an increase in fractional anisotropy (FA) and decrease in radial diffusivity (RD) were also observed in the non-concussed athletes, and correlated with changes in glutamine and glutamine/creatine. Decreases in glutamine and glutamine/creatine suggest reduced oxidative metabolism. Changes in FA and RD may indicate neuroinflammation or re-myelination. The observed changes did not correlate with clinical test scores suggesting these imaging metrics may be more sensitive to brain injury and could aid in assessing recovery of brain injury from concussion. © 2017 Wiley Periodicals, Inc.

Sports-related Concussion in Children and Adolescents.

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Refakis, Christian A; Turner, Christian D; Cahill, Patrick J

2017-06-01

Concussions are becoming increasingly important to manage properly as sports participation continues to rise. Repeated injuries occurring before the brain has had a chance to recover from an initial insult are particularly dangerous and must be prevented. Although much national media attention has been devoted to concussions in professional sports, it is important to appreciate that athletes in any age group, children and adolescents in particular, are at risk of sports-related concussion. It is crucial to remove an athlete from play any time concussion is suspected. Once removed from play, recovery then begins with a period of cognitive and physical rest, followed by a gradual return to cognitive and athletic activities as symptoms resolve. Children and adolescents pose a unique challenge to the clinician managing their recovery, as the physical and cognitive rest periods required often involve time away from school and sports, which can be academically detrimental and socially isolating. Recently developed sideline assessment tools have greatly aided the urgent sideline assessment of an athlete suspected of having a concussion. In this article, a brief review of current guidelines is presented in tandem with the authors' preferred treatment of concussion.

Strains and Sprains Are a Pain

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... lot of pressure on a muscle or you push it too far, such as when lifting a heavy object. Strains can be more likely to happen if you haven't warmed up first to get blood circulating to the muscles. They're also common for someone returning to a sport after the off-season. That first time playing ...

Neck sprain after motor vehicle accidents in drivers and passengers

NARCIS (Netherlands)

Versteegen, GJ; Kingma, J; Meijler, WJ; ten Duis, HJ

2000-01-01

Neck sprain is a general term denoting a soft tissue injury of the neck, which seldom causes major disability but is considered a modem epidemic. The purpose of the present study was to determine the prevalence of sprain of the neck injury due to motor vehicle accidents (MVAs) in both drivers and

A Practical Concussion Physical Examination Toolbox.

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Matuszak, Jason M; McVige, Jennifer; McPherson, Jacob; Willer, Barry; Leddy, John

With heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical examination has not been standardized or supported by evidence. Important questions remain about the physical examination. Review of ClinicalKey, Cochrane, MEDLINE, and PubMed prior to July 2015 was performed using search terms, including concussion, mTBI, physical examination, mental status, cranial nerves, reflexes, cervical, vestibular, and oculomotor. The references of the pertinent articles were reviewed for other relevant sources. Clinical review. Level 3. The pertinent physical examination elements for concussion include evaluation of cranial nerves, manual muscle testing, and deep tendon reflexes; inspecting the head and neck for trauma or tenderness and cervical range of motion; Spurling maneuver; a static or dynamic balance assessment; screening ocular examination; and a mental status examination that includes orientation, immediate and delayed recall, concentration, mood, affect, insight, and judgment. Other examination elements to consider, based on signs, symptoms, or clinical suspicion, include testing of upper motor neurons, cervical strength and proprioception, coordination, pupillary reactivity, and visual acuity; examination of the jaw, temporomandibular joint, and thoracic spine; fundoscopic evaluation; orthostatic vital signs; assessment of dynamic visual acuity; and screening for depression, anxiety, substance abuse disorders, and preinjury psychiatric difficulties. Various elements of the physical examination, such as screening ocular examination, cervical musculoskeletal examination, static and/or dynamic balance assessment, and mental status examination, appear to have utility for evaluating concussion; however, data on validity are lacking.

Concussion: comparison of humans and rats.

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Parkinson, D; West, M; Pathiraja, T

1978-01-01

Concussion is the most primitive and probably the most simple central nervous system response to an outside agent. Although millions of neurons undergo a very rapid reversal with loss and restoration of function, many physicians argue that every knockout blow leaves some residual damage, i.e., some or all of these neurons stop short of recovery. Clinical experience shows a wide discrepancy in the appearance or persistence of certain signs and symptoms after all types of head injury, but particularly after concussing blows, when third party or grievance cases are involved. Using slow motion filmstrips of boxing ring knockouts, we established a grading system for concussion and duplicated these grades in nonanesthetized rats. When we compared the performance, learning, and memory of concussed rats with their preconcussion performance and with the performance of nonconcussed controls, we were unable to find any differences.

The Impact of Multiple Concussions on Emotional Distress, Post-Concussive Symptoms, and Neurocognitive Functioning in Active Duty United States Marines Independent of Combat Exposure or Emotional Distress

Science.gov (United States)

Lathan, Corinna E.; Bleiberg, Joseph; Tsao, Jack W.

2014-01-01

Abstract Controversy exists as to whether the lingering effects of concussion on emotional, physical, and cognitive symptoms is because of the effects of brain trauma or purely to emotional factors such as post-traumatic stress disorder or depression. This study examines the independent effects of concussion on persistent symptoms. The Defense Automated Neurobehavioral Assessment, a clinical decision support tool, was used to assess neurobehavioral functioning in 646 United States Marines, all of whom were fit for duty. Marines were assessed for concussion history, post-concussive symptoms, emotional distress, neurocognitive functioning, and deployment history. Results showed that a recent concussion or ever having experienced a concussion was associated with an increase in emotional distress, but not with persistent post-concussive symptoms (PPCS) or neurocognitive functioning. Having had multiple lifetime concussions, however, was associated with greater emotional distress, PPCS, and reduced neurocognitive functioning that needs attention and rapid discrimination, but not for memory-based tasks. These results are independent of deployment history, combat exposure, and symptoms of post-traumatic stress disorder and depression. Results supported earlier findings that a previous concussion is not generally associated with post-concussive symptoms independent of covariates. In contrast with other studies that failed to find a unique contribution for concussion to PPCS, however, evidence of recent and multiple concussion was seen across a range of emotional distress, post-concussive symptoms, and neurocognitive functioning in this study population. Results are discussed in terms of implications for assessing concussion on return from combat. PMID:25003552

Misunderstandings of concussion within a youth rugby population.

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Kearney, Philip E; See, James

2017-11-01

The recognition and management of concussion has become a major health concern within rugby union. Identifying misconceptions and attitudes regarding concussion is valuable for informing player education. Therefore, the purpose of this study was to explore the knowledge of, and attitudes towards, concussion in subgroups of youth rugby players. Cross-sectional survey. Information sheets and consent forms were distributed at training sessions for multiple teams at each of three schools and three clubs. Players who returned consent forms completed a custom-designed survey at a subsequent session. Two hundred and fifty-five English players, aged 11-17 years, completed the anonymous survey. Sixty-one participants reported a total of 77 concussions. Self-reported return to play ranged from 0 to 365 days; only seven players (11%) reported a return to play after the Rugby Football Union's recommendation of 23 days. Although the majority of findings relating to players' knowledge of concussion were positive, a number of important misunderstandings were revealed. While the majority of players reported positive attitudes towards concussion, a substantial minority (up to 30%) reported inappropriate attitudes in response to specific questions. Participants who played at multiple venues did report superior knowledge and attitudes relative to their peers who played at a single venue. Despite generally positive results, youth rugby players were found to hold a number of misconceptions regarding concussion which should be the focus for education initiatives. Considering general subgroups of players by concussion history, age, or playing position appears unlikely to enhance the design of concussion education programmes. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Pediatric Issues in Sports Concussions

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Giza, Christopher C.

2014-01-01

Purpose of Review: Sports-related concussions are receiving increasing attention in both the lay press and medical literature. While most media attention has been on high-profile collegiate or professional athletes, the vast majority of individuals participating in contact and collision sports are adolescents and children. This review provides a practical approach toward youth sports-related concussion with a foundation in the recent guidelines, but including specific considerations when applying these management principles to children and adolescents. Recent Findings: Objective measurement of early signs and symptoms is challenging in younger patients, and many commonly used assessment tools await rigorous validation for younger patients. Excellent evidence-based guidelines exist for CT evaluation of mild traumatic brain injury presenting to the emergency department. Evidence suggests that recovery from sports-related concussion takes longer in high school athletes compared with collegiate or professionals; however, rigorous studies below high school age are still lacking. Summary: Proper care for concussion in youth requires a delicate balance of clinical skills, age-appropriate assessment, and individualized management to achieve optimal outcomes. PMID:25470161

Electroacupuncture reduces the evoked responses of the spinal dorsal horn neurons in ankle-sprained rats

Science.gov (United States)

Kim, Jae Hyo; Kim, Hee Young; Chung, Kyungsoon

2011-01-01

Acupuncture is shown to be effective in producing analgesia in ankle sprain pain in humans and animals. To examine the underlying mechanisms of the acupuncture-induced analgesia, the effects of electroacupuncture (EA) on weight-bearing forces (WBR) of the affected foot and dorsal horn neuron activities were examined in a rat model of ankle sprain. Ankle sprain was induced manually by overextending ligaments of the left ankle in the rat. Dorsal horn neuron responses to ankle movements or compression were recorded from the lumbar spinal cord using an in vivo extracellular single unit recording setup 1 day after ankle sprain. EA was applied to the SI-6 acupoint on the right forelimb (contralateral to the sprained ankle) by trains of electrical pulses (10 Hz, 1-ms pulse width, 2-mA intensity) for 30 min. After EA, WBR of the sprained foot significantly recovered and dorsal horn neuron activities were significantly suppressed in ankle-sprained rats. However, EA produced no effect in normal rats. The inhibitory effect of EA on hyperactivities of dorsal horn neurons of ankle-sprained rats was blocked by the α-adrenoceptor antagonist phentolamine (5 mg/kg ip) but not by the opioid receptor antagonist naltrexone (10 mg/kg ip). These data suggest that EA-induced analgesia in ankle sprain pain is mediated mainly by suppressing dorsal horn neuron activities through α-adrenergic descending inhibitory systems at the spinal level. PMID:21389301

Concussion associated with head trauma in athletes

Directory of Open Access Journals (Sweden)

Gabriela Murguía Cánovas

2013-01-01

Full Text Available Recently, there has been increased attention to concussions that occur during sports activities, both at school level or amateur and professional level. Concussion is defined as a sudden and transient alteration of consciousness induced by traumatic biomechanical forces transmitted directly or indirectly to the brain. Such injuries most commonly occur in contact sports such as boxing, football, soccer, wrestling, hockey, among others. Concussion should be suspected in any athlete who suffers a head injury, whether or not it is associated to loss of consciousness. These athletes should not return to their sports activities immediately, and a few days of mental and physical leave are recommended in order to ensure full recovery. Repeat head injuries should be avoided, since there is evidence that in some athletes they can lead to chronic traumatic encephalopathy. The present review focuses on the different definitions of concussion, management and long-term consequences. It also contains the Spanish version of the Sport Concussion Assessment Tool 2 (SCAT2.

Low risk of concussions in top-level karate competition.

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Arriaza, Rafael; Cierna, Dusana; Regueiro, Patricia; Inman, David; Roman, Franco; Abarca, Benjamin; Barrientos, Mercé; Saavedra, Miguel A

2017-02-01

Although it is well known that injuries occur in combat sports, the true incidence of concussions is not clearly defined in the literature for karate competition. To determine the incidence of concussions in top-level (World Karate Federation World Championships) karate competition. Injuries that took place in 4 consecutive World Karate Championships (from 2008 to 2014) were prospectively registered. A total of 4625 fights (2916 in the male category and 1709 in the female category) were scrutinised, and concussions were identified and analysed separately for frequency (rate per fight) and injury risk. A total of 4 concussions were diagnosed by the attending physicians after carrying out athlete examinations. Globally, there was 1 concussion in every 1156 fights, or 0.43/1000 athlete-exposures (AE). In male athletes, the rate of concussion was 1/5832 min of fighting, and in female athletes, it was 1/6836 min. OR for concussion in women is 0.57 (95% CI 0.06 to 5.47; z=0.489; p=0.6249) and risk ratio for concussions in men is RR 1.478 (95% CI 0.271 to 8.072), p=0.528, representing a higher risk of definite concussions in men than in women, but not statistically significant. There is not a significantly higher risk of concussions in team competition (no weight limit) when compared with individual competition (held with strict weight limits for each category). The risk of concussions in top-level karate competition is low, with a tendency for an increased risk for men and for competition without weight limits, but not statistically significant with respect to women or individual competition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Treatment of Ankle Sprain by Intradermal Acupuncture and Magnetic Therapy in 34 Cases

Institute of Scientific and Technical Information of China (English)

WANG Hong-bin; PENG Xiao-ping; XIAO Yuan-chun

2003-01-01

Treatment of 34 cases of Simple ankle sprain mainly by Ashi point and in cooperation with magnetic therapy, and Qiuxu (GB 40), Shenmai (BL 62),Jinmen (BL 63) and Pucan ( BL 61 ) were added in the presence of strephenopodia sprain, Zhaohai (KI 6),Shuiquan (KI 5 ) and Taixi (KI 3 ) were added in the presence of strephexopodia sprain, the effective rate was 91.7%.

Incidence of Concussion in Youth Ice Hockey Players.

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Kontos, Anthony P; Elbin, R J; Sufrinko, Alicia; Dakan, Scott; Bookwalter, Kylie; Price, Ali; Meehan, William P; Collins, Michael W

2016-02-01

Ice hockey is a fast-paced collision sport that entails both intentional (ie, body checking) and incidental contact that may involve the head. The objective of this study was to determine the incidence of concussions in relation to games/practices and age among competition-level youth ice hockey players (ages 12-18 years). Participants included 397 youth ice hockey players from Western Pennsylvania; Boston, Massachusetts; and Birmingham, Alabama, during the 2012-2013 and 2013-2014 youth ice hockey seasons. Incidence rates (IRs) and incidence rate ratios (IRRs) of concussion were calculated for games/practices and age groups. A total of 23 369 (12 784 practice/10 585 game) athletic exposures (AEs) involving 37 medically diagnosed concussions occurred. More than 40% of concussions involved illegal contact. The combined IR for games and practices was 1.58 concussions per 1000 AEs. The IRR was 2.86 times (95% confidence interval 0.68-4.42) higher during games (2.49 per 1000 AEs) than practices (1.04 per 1000 AEs). The overall IR for concussion in youth ice hockey was comparable to those reported in other youth collision sports. The game-to-practice IRR was lower than previously reported in ice hockey and other youth sports, although more concussions per exposure occurred in games compared with practices. Younger players had a higher rate of concussions than older players. Copyright © 2016 by the American Academy of Pediatrics.

Concussion Education for High School Football Players: A Pilot Study

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Manasse-Cohick, Nancy J.; Shapley, Kathy L.

2014-01-01

This survey study compared high school football players' knowledge and attitudes about concussion before and after receiving concussion education. There were no significant changes in the Concussion Attitude Index. Results revealed a statistically significant difference in the athletes' scores for the Concussion Knowledge Index, "t"(244)…

Postural stability and ankle sprain history in athletes compared to uninjured controls.

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Huurnink, Arnold; Fransz, Duncan P; Kingma, Idsart; Verhagen, Evert A L M; van Dieën, Jaap H

2014-02-01

Diminished postural stability is a risk factor for ankle sprain occurrence and ankle sprains result in impaired postural stability. To date, ankle sprain history has not been taken into account as a determinant of postural stability, while it could possibly specify subgroups of interest. Postural stability was compared between 18 field hockey athletes who had recovered from an ankle sprain (mean (SD); 3.6 (1.5) months post-injury), and 16 uninjured controls. Force plate and kinematics parameters were calculated during single-leg standing: mean center of pressure speed, mean absolute horizontal ground reaction force, mean absolute ankle angular velocity, and mean absolute hip angular velocity. Additionally, cluster analysis was applied to the 'injured' participants, and the cluster with diminished postural stability was compared to the other participants with respect to ankle sprain history. MANCOVA showed no significant difference between groups in postural stability (P = 0.68). A self-reported history of an (partial) ankle ligament rupture was typically present in the cluster with diminished postural stability. Subsequently, a 'preceding rupture' was added as a factor in the MANCOVA, which showed a significant association between diminished postural stability and a 'preceding rupture' (P = 0.01), for all four individual parameters (P: 0.001-0.029; Cohen's d: 0.96-2.23). Diminished postural stability is not apparent in all previously injured athletes. However, our analysis suggests that an (mild) ankle sprain with a preceding severe ankle sprain is associated with impaired balance ability. Therefore, sensorimotor training may be emphasized in this particular group and caution is warranted in return to play decisions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Sports concussion: management and predictors of outcome.

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Reddy, Cara Camiolo; Collins, Michael W

2009-01-01

Interest in sports concussion has grown widely in the last two decades among laypersons and medical professionals. Significant contributions of evidence-based research have led to a better understanding of this multifaceted, but still often elusive, injury. This information has transformed all aspects of concussion management, from on-field evaluation through return-to-play guidelines. The aim of this article is to highlight important research regarding predictors of outcome and treatment protocols. This research has been the basis of the paradigm shift from traditional concussion grading scales to individualized care. Today, concussion management requires a patient-centered approach with individualized assessment, including risk factor analysis, neurocognitive testing, and a thorough symptom evaluation.

Neuropsychological Performance and Subjective Symptom Reporting in Military Service Members With a History of Multiple Concussions: Comparison With a Single Concussion, Posttraumatic Stress Disorder, and Orthopedic Trauma.

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Cooper, Douglas B; Curtiss, Glenn; Armistead-Jehle, Patrick; Belanger, Heather G; Tate, David F; Reid, Matthew; Bowles, Amy O; Velez, Carmen S; Kennedy, Jan E; Vanderploeg, Rodney D

To examine differences in objective neurocognitive performance and subjective cognitive symptoms in individuals with a history of a single concussion, multiple concussions, orthopedic injuries, and posttraumatic stress disorder (PTSD). Participants included 116 military service members who sustained a mild traumatic brain injury (mTBI) during combat deployment. Subjects were subdivided into groups based on concussion frequency: a single concussion (n = 42), 2 concussions (n = 21), and 3 or more concussions (n = 53). Eighty-one subjects sustained an orthopedic injury (n = 60) during deployment or were diagnosed with PTSD (n = 21), but had no history of mTBI. Subjects completed a battery of neuropsychological tests and self-report measures of postconcussive symptoms, PTSD symptoms, and psychopathology. No differences were found among the concussion groups on a composite neuropsychological measure. The PTSD group had the highest number of symptom complaints, with the 2-concussion and 3-plus-concussion groups being most similar to the PTSD group. The concussion groups showed a nonsignificant pattern of increasing distress with increasing number of concussions. The current findings are consistent with meta-analytic results showing no differential effect on neuropsychological functioning due to multiple concussions. Results also support the burden of adversity hypothesis suggesting increasing symptom levels with increasing psychological or physically traumatic exposures.

A systematic review and meta-analysis of concussion in rugby union.

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Gardner, Andrew J; Iverson, Grant L; Williams, W Huw; Baker, Stephanie; Stanwell, Peter

2014-12-01

Rugby Union, a popular full-contact sport played throughout the world, has one of the highest rates of concussion of all full-contact sports. The aim of the current review was to systematically evaluate the available evidence on concussion in Rugby Union and to conduct a meta-analysis of findings regarding the incidence of concussion. Articles were retrieved via a number of online databases. The current review examined all articles published in English up to May 2014 pertaining to concussion in Rugby Union players. The key search terms included 'Rugby Union', 'rugby', 'union', and 'football', in combination with the injury terms 'athletic injuries', 'concussion', 'sports concussion', 'sports-related concussion', 'brain concussion', 'brain injury', 'brain injuries', 'mild traumatic brain injury', 'mTBI', 'traumatic brain injury', 'TBI', 'craniocerebral trauma', 'head injury', and 'brain damage'. The final search outcome following the eligibility screening process resulted in the inclusion of 96 articles for this review. The meta-analysis included a total of 37 studies. The results of the meta-analysis revealed an overall incidence of match-play concussion in men's rugby-15s of 4.73 per 1,000 player match hours. The incidence of concussion during training was 0.07 per 1,000 practice hours. The incidence of concussion in women's rugby-15s was 0.55 per 1,000 player match hours. In men's rugby-7s match-play, concussion incidence was 3.01 per 1,000 player match hours. The incidence of concussion varied considerably between levels of play, with elite level play recording a rate of 0.40 concussions per 1,000 player match hours, schoolboy level 0.62 concussions per 1,000 player match hours, and the community or sub-elite level recording a rate of 2.08 concussions per 1,000 player match hours. The incidence of concussion in men's rugby-15s as a function of playing position (forwards vs. backs) was 4.02 and 4.85 concussions per 1,000 player match hours, respectively

Clinical Practices in Collegiate Concussion Management.

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Baugh, Christine M; Kroshus, Emily; Stamm, Julie M; Daneshvar, Daniel H; Pepin, Michael J; Meehan, William P

2016-06-01

In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition. Descriptive epidemiology study. An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information. Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions' practices were in line with NCAA guidelines during the first 24 hours of an athlete's concussion diagnosis, with exact percentages varying

COACH CV: The Seven Clinical Phenotypes of Concussion

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Neil Craton

2017-09-01

Full Text Available Our understanding of the diverse physiological manifestations of concussion is changing rapidly. This has an influence on the clinical assessment of patients who have sustained a concussion. The 2017 Consensus Statement on Concussion in Sport states that numerous post-injury clinical findings, such as cognitive deficits, post-traumatic headaches, dizziness, difficulties with oculomotor function, and depression have all been associated with a poorer prognosis in concussed patients. This demonstrates that there are several potential clinical manifestations after head injury warranting clinical evaluation. We have developed an acronym to guide the office-based assessment of concussed patients to consider each of the potential clinical phenotypes. “COACH CV” prompts the clinician to evaluate for cognitive problems, oculomotor dysfunction, affective disturbances, cervical spine disorders, headaches, and cardiovascular and vestibular anomalies.

The Role of Shoe Design in Ankle Sprain Rates Among Collegiate Basketball Players

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Curtis, Claudia K; Laudner, Kevin G; McLoda, Todd A; McCaw, Steven T

2008-01-01

Context: Much of the recent focus in shoe design and engineering has been on improving athletic performance. Currently, this improvement has been in the form of “cushioned column systems,” which are spring-like in design and located under the heel of the shoe in place of a conventional heel counter. Concerns have been raised about whether this design alteration has increased the incidence of ankle sprains. Objective: To examine the incidence of lateral ankle sprains in collegiate basketball players with regard to shoe design. Design: Prospective cohort study. Setting: Certified athletic trainers at 1014 National Collegiate Athletic Association (NCAA)-affiliated schools sponsoring basketball during the 2005–2006 regular season were notified of an online questionnaire. Athletic trainers at 22 of the 1014 schools participated. Patients or Other Participants: A total of 230 basketball players (141 males, 89 females; age  =  20.2 ± 1.5 years) from NCAA Division I–III basketball programs sustained lateral ankle sprains. Main Outcome Measure(s): Ankle sprain information and type of shoe worn (cushioned column or noncushioned column) were collected via online survey. The incidence of lateral ankle sprains and type of shoes worn were compared using a chi-square analysis. Results: No difference was noted in ankle sprain incidence between groups (χ2  =  2.44, P  =  .20, relative risk  =  1.47, 95% confidence interval [CI]  =  0.32, 6.86). The incidence of ankle sprains was 1.33 per 1000 exposures in the cushioned column group (95% CI  =  0.62, 3.51) and 1.96 per 1000 exposures in the noncushioned column group (95% CI  =  0.51, 4.22). Conclusions: No increased incidence of ankle sprains was associated with shoe design. PMID:18523571

Biomechanical analysis of ankle ligamentous sprain injury cases from televised basketball games: Understanding when, how and why ligament failure occurs.

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Panagiotakis, Emmanouil; Mok, Kam-Ming; Fong, Daniel Tik-Pui; Bull, Anthony M J

2017-12-01

Ankle sprains due to landing on an opponent's foot are common in basketball. There is no analysis to date that provides a quantification of this injury mechanism. The aim of this study was to quantify the kinematics of this specific injury mechanism and relate this to lateral ankle ligament biomechanics. Case series. The model-based image-matching technique was used to quantify calcaneo-fibular-talar kinematics during four ankle inversion sprain injury incidents in televised NBA basketball games. The four incidents follow the same injury pattern in which the players of interest step onto an opponent's foot with significant inversion and a diagnosed ankle injury. A geometric analysis was performed to calculate the in vivo ligament strains and strain rates for the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). Despite the controlled selection of cases, the results show that there are two distinct injury mechanisms: sudden inversion and internal rotation with low levels of plantarflexion; and a similar mechanism without internal rotation. The first of these mechanisms results in high ATFL and CFL strains, whereas the second of these strains the CFL in isolation. The injury mechanism combined with measures of the ligament injury in terms of percentage of strain to failure correlate directly with the severity of the injury quantified by return-to-sport. The opportunity to control excessive internal rotation through proprioceptive training and/or prophylactic footwear or bracing could be utilised to reduce the severity of common ankle injuries in basketball. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Symptom correlates of cerebral blood flow following acute concussion

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Nathan W. Churchill

Full Text Available Concussion is associated with significant symptoms within hours to days post-injury, including disturbances in physical function, cognition, sleep and emotion. However, little is known about how subjective impairments correlate with objective measures of cerebrovascular function following brain injury. This study examined the relationship between symptoms and cerebral blood flow (CBF in individuals following sport-related concussion. Seventy university level athletes had CBF measured using Arterial Spin Labelling (ASL, including 35 with acute concussion and 35 matched controls and their symptoms were assessed using the Sport Concussion Assessment Tool 3 (SCAT3. For concussed athletes, greater total symptom severity was associated with elevated posterior cortical CBF, although mean CBF was not significantly different from matched controls (p=0.46. Examining symptom clusters, athletes reporting greater cognitive symptoms also had lower frontal and subcortical CBF, relative to athletes with greater somatic symptoms. The “cognitive” and “somatic” subgroups also exhibited significant differences in CBF relative to controls (p≤0.026. This study demonstrates objective CBF correlates of symptoms in recently concussed athletes and shows that specific symptom clusters may have distinct patterns of altered CBF, significantly extending our understanding of the neurobiology of concussion and traumatic brain injury. Keywords: Sport concussion, Cerebral blood flow, ASL, Symptoms

A Practical Concussion Physical Examination Toolbox

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Matuszak, Jason M.; McVige, Jennifer; McPherson, Jacob; Willer, Barry; Leddy, John

2016-01-01

Context: With heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical examination has not been standardized or supported by evidence. Important questions remain about the physical examination. Evidence Acquisition: Review of ClinicalKey, Cochrane, MEDLINE, and PubMed prior to July 2015 was performed using search terms, including concussion, mTBI, physical examination, mental status, cranial nerves, reflexes, cervical, vestibular, and oculomotor. The references of the pertinent articles were reviewed for other relevant sources. Study Design: Clinical review. Level of Evidence: Level 3. Results: The pertinent physical examination elements for concussion include evaluation of cranial nerves, manual muscle testing, and deep tendon reflexes; inspecting the head and neck for trauma or tenderness and cervical range of motion; Spurling maneuver; a static or dynamic balance assessment; screening ocular examination; and a mental status examination that includes orientation, immediate and delayed recall, concentration, mood, affect, insight, and judgment. Other examination elements to consider, based on signs, symptoms, or clinical suspicion, include testing of upper motor neurons, cervical strength and proprioception, coordination, pupillary reactivity, and visual acuity; examination of the jaw, temporomandibular joint, and thoracic spine; fundoscopic evaluation; orthostatic vital signs; assessment of dynamic visual acuity; and screening for depression, anxiety, substance abuse disorders, and preinjury psychiatric difficulties. Conclusion: Various elements of the physical examination, such as screening ocular examination, cervical musculoskeletal examination, static and/or dynamic balance assessment, and mental status examination, appear to have utility for evaluating concussion; however, data on validity are lacking. PMID:27022058

Effect of Concussion on Performance of National Football League Players.

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Reams, Nicole; Hayward, Rodney A; Kutcher, Jeffrey S; Burke, James F

2017-09-01

Lingering neurologic injury after concussion may expose athletes to increased risk if return to play is premature. The authors explored whether on-field performance after concussion is a marker of lingering neurologic injury. Retrospective cohort study on 1882 skill-position players who played in the National Football League (NFL) during 2007-2010. Players with concussion based on the weekly injury report were compared with players with other head and neck injuries (controls) on measures of on-field performance using Football Outsiders' calculation of defense-adjusted yards above replacement (DYAR), a measure of a player's contribution controlling for game context. Changes in performance, relative to a player's baseline level of performance, were estimated before and after injury using fixed-effects models. The study included 140 concussed players and 57 controls. Players with concussion performed no better or worse than their baseline on return to play. However, a decline in DYAR relative to their prior performance was noted 2 wk and 1 wk before appearing on the injury report. Concussed players performed slightly better than controls in situations where they returned to play the same week as appearing on the injury report. On return, concussed NFL players performed at their baseline level of performance, suggesting that players have recovered from concussion. Decline in performance noted 2 wk and 1 wk before appearing on the injury report may suggest that concussion diagnosis was delayed or that concussion can be a multihit phenomenon. Athletic performance may be a novel tool for assessing concussion injury and recovery.

Concussion Awareness: Getting School Psychologists into the Game

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Davies, Susan C.

2011-01-01

A concussion is a serious injury--a mild traumatic brain injury (TBI)--that induces physiological disruption of brain function. A concussion is caused by a bump, blow, or jolt to the head or body. The sudden movement causes stretching and tearing of brain cells; cells become damaged and chemical changes occur within the brain. Concussions can lead…

Can a Concussion History Affect the Susceptibility to the Misinformation Effect?

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Geoffrey Genova

2018-04-01

Full Text Available Concussions have been shown to have damaging effects to multiple functions of the brain, including memory. One of the key components of memory is the ability to determine the original source of a memory, a concept called source monitoring. The current study was designed to explore how individuals with a history of concussions would compare with individuals without a concussion history when their source monitoring ability was tested. The researchers investigated the influence a concussion history would have on the susceptibility to the effects of misinformation. Twenty individuals with a concussion history and twenty-two individuals without a concussion history participated in the study. It was expected that individuals without a concussion history would perform better on tests evaluating their ability to correctly monitor the source of information. Statistical analysis revealed that both the concussed and non-concussed group performed similarly in their ability to source monitor. The contradictory results this study exhibits, when compared to previous research, suggests that further exploration into this particular portion of memory may be useful when understanding how concussions affect memory performance. The results of this study suggest that concussions may not always produce negative long- term memory related cognitive effects.

The relationship between concussion and alcohol consumption among university athletes

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Bradey Alcock

2018-06-01

Full Text Available Introduction: This study investigated concussion as a potential risk factor for increased alcohol consumption in university athletes. Methods: Using a cross-sectional design, 41 university students (37% with a history of concussion completed self-report measures, while electrodermal activation (EDA was recorded for each participant to capture baseline physiological arousal. Results: As expected, concussion status significantly predicted alcohol consumption over and above athletic status, b = 0.34, p = 0.034, 95% CI [0.195, 4.832], such that those with a prior concussion history engaged in greater alcohol consumption. Importantly, concussion status also significantly predicted baseline physiological arousal, b = −0.39, p = 0.014, 95% CI [−0.979, −0.120], such that those with a history of concussion exhibited lower EDA. Conclusions: Elevated alcohol consumption among athletes is a pronounced associate of concussion in sports and may be a behavioral reflection of disruption to the orbitofrontal cortex – an area implicated in inhibition. Keywords: Concussion, Arousal, Risk taking, Alcohol consumption, Athletes

Concussions in Community-Level Rugby: Risk, Knowledge, and Attitudes.

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Martin, R Kyle; Hrubeniuk, Travis J; Witiw, Christopher D; MacDonald, Peter; Leiter, Jeff

Rugby is a popular collision sport where participants are at risk of sustaining concussions. Most research focuses on elite-level or youth divisions. Comparatively, little is known about adult community rugby. The aim of this research was to estimate the risk of sustaining a concussion during participation in community-level rugby and summarize the collective knowledge and attitudes toward concussions. Concussion symptoms will be reported frequently among community-level rugby players and a substantial proportion will report a willingness to continue participation despite the risk. Cross-sectional analysis. Level 3. An anonymous, voluntary survey was administered to all 464 senior rugby players registered in the province of Manitoba in 2015. Two primary domains were assessed: (1) concussion history from the preceding season including occurrence, symptomatology, and impact on daily activities and (2) knowledge and attitudes toward concussion risks and management. In total, 284 (61.2%) rugby players responded. Concussive symptoms were reported by 106 (37.3%). Of those, 87% were formally diagnosed with a concussion and 27% missed school and/or work as a result. The danger of playing while symptomatic was recognized by 93.7% of participants, yet 29% indicated they would continue while symptomatic. Furthermore, 39% felt they were letting others down if they stopped playing due to a concussion. Concussive symptoms were common among the study cohort and had a notable impact on daily activities. A high proportion of players were willing to continue while experiencing symptoms despite recognizing the danger. The observed discord between knowledge and attitudes implicates a culture of "playing injured." Understanding the risk of injury may affect an individual's decision to participate in community-level rugby. Moreover, evidence of discord between the knowledge and attitudes of players may direct future research initiatives and league governance.

Possible Lingering Effects of Multiple Past Concussions

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Grant L. Iverson

2012-01-01

Full Text Available Background. The literature on lingering or “cumulative” effects of multiple concussions is mixed. The purpose of this study was to examine whether athletes with a history of three or more concussions perform more poorly on neuropsychological testing or report more subjective symptoms during a baseline, preseason evaluation. Hypothesis. Athletes reporting three or more past concussions would perform more poorly on preseason neurocognitive testing. Study Design. Case-control study. Methods. An archival database including 786 male athletes who underwent preseason testing with a computerized battery (ImPACT was used to select the participants. Twenty-six athletes, between the ages of 17 and 22 with a history of three or more concussions, were identified. Athletes with no history of concussion were matched, in a case-control fashion, on age, education, self-reported ADHD, school, sport, and, when possible, playing position and self-reported academic problems. Results. The two groups were compared on the four neuropsychological composite scores from ImPACT using multivariate analysis of variance followed by univariate ANOVAs. MANOVA revealed no overall significant effect. Exploratory ANOVAs were conducted using Verbal Memory, Visual Memory, Reaction Time, Processing Speed, and Postconcussion Scale composite scores as dependent variables. There was a significant effect for only the Verbal Memory composite. Conclusions. Although inconclusive, the results suggest that some athletes with multiple concussions could have lingering memory deficits.

A Head Start on Concussion Recovery | NIH MedlinePlus the Magazine

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... and Concussions Follow us A Head Start on Concussion Recovery Life lessons after three pediatric concussions "It would have been easier if he had ... Michelle Marchionni says about her son Sam's first concussion. In the fall of 2012, 8-year-old ...

Reliability of concussion history in former professional football players.

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Kerr, Zachary Y; Marshall, Stephen W; Guskiewicz, Kevin M

2012-03-01

The reliability of athletes to recall and self-report a concussion history has never been quantified. This study examined the reliability of the self-report concussion history measure and explored determinants of recall in the number of self-reported concussions in a group of retired professional football players. In 2001, a short questionnaire was administered to a cohort of former professional football players to ascertain the number of self-reported concussions they sustained during their professional playing careers. In 2010, the same instrument was readministered to a subset (n = 899) of the original cohort to assess reliability. Overall reliability was moderate (weighted Cohen κ = 0.48). The majority (62.1%) reported the same number of concussions in both administrations (2001 and 2010); 31.4% reported more concussions in the second administration. Compared with the "same number reported" group, the "greater number reported" group had more deficits in the second administration in their Short Form 36 physical health (composite score combining physical functioning, role physical, bodily pain, general health) and mental health (e.g., composite score combining vitality, social functioning, role emotional) scales. The self-reported concussion history had moderate reliability in former professional football players, on the basis of two administrations of the same instrument, 9 yr apart. However, changes in health status may be differentially associated with recall of concussions.

MRI of ankle sprain

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Nishimura, Gen

1995-01-01

We reviewed MR (magnetic resonance) studies in 54 patients with a sprained ankle. MR examination was able to depict the following injuries: lateral collateral ligamentous injuries, fluid collection in the peroneal tendon sheath, injury to the peroneal tendon, deltoid ligamentous injuries, the extent of subcutaneous soft tissue swelling, and various kinds of osseous injuries. A total of 21 patients underwent repair or reconstructive surgery to the lateral collateral ligaments, the findings of which were correlated with those on MR examination. MR diagnosis of anterior talofibular ligamentous injury was confirmed in 16/21; the discrepancy could be attributed to remodeling and/or reorganization which progressed during the time lapse between the MR examination and surgery in three, while the misdiagnosis resulted from the difficulty in distinguishing the acute tear from the injured scar in two. The calcaneofibular ligamentous injury was confirmed in 10/12; two false negatives were responsible for the difficulty in delineating its entire length on a single image and/or in differentiating between the attenuated star and the normal calcaneofibular ligament. MR imaging is a useful tool to use in deciding the surgical indication and predicting the prognosis of the patients with ankle sprain. (author)

MRI of ankle sprain

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Nishimura, Gen [Dokkyo Univ., Mibu, Tochigi (Japan). School of Medicine

1995-06-01

We reviewed MR (magnetic resonance) studies in 54 patients with a sprained ankle. MR examination was able to depict the following injuries: lateral collateral ligamentous injuries, fluid collection in the peroneal tendon sheath, injury to the peroneal tendon, deltoid ligamentous injuries, the extent of subcutaneous soft tissue swelling, and various kinds of osseous injuries. A total of 21 patients underwent repair or reconstructive surgery to the lateral collateral ligaments, the findings of which were correlated with those on MR examination. MR diagnosis of anterior talofibular ligamentous injury was confirmed in 16/21; the discrepancy could be attributed to remodeling and/or reorganization which progressed during the time lapse between the MR examination and surgery in three, while the misdiagnosis resulted from the difficulty in distinguishing the acute tear from the injured scar in two. The calcaneofibular ligamentous injury was confirmed in 10/12; two false negatives were responsible for the difficulty in delineating its entire length on a single image and/or in differentiating between the attenuated star and the normal calcaneofibular ligament. MR imaging is a useful tool to use in deciding the surgical indication and predicting the prognosis of the patients with ankle sprain. (author)

The Sport Concussion Assessment Tool: a systematic review.

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Yengo-Kahn, Aaron M; Hale, Andrew T; Zalneraitis, Brian H; Zuckerman, Scott L; Sills, Allen K; Solomon, Gary S

2016-04-01

OBJECTIVE Over the last 2 decades, sport-related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004, which is now in its third iteration (SCAT3). In an effort to update our understanding of the most well-known sideline concussion assessment, the authors conducted a systematic review of the SCAT and the evidence supporting its use to date. METHODS English-language titles and abstracts published between 1995 and October 2015 were searched systematically across 4 electronic databases and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines adapted for the review of a heterogeneous collection of study designs. Peer-reviewed journal articles were included if they reported quantitative data on any iteration of the SCAT, Standardized Assessment of Concussion (SAC), or modified Balance Error Scoring System (mBESS) data at baseline or following concussion in an exclusively athlete population with any portion older than 13 years of age. Studies that included nonathletes, only children less than 13 years old, exclusively BESS data, exclusively symptom scale data, or a non-SCAT-related assessment were excluded. RESULTS The database search process yielded 549 abstracts, and 105 full-text articles were reviewed with 36 meeting criteria for inclusion. Nineteen studies were associated with the SAC, 1 was associated with the mBESS exclusively, and 16 studies were associated with a full iteration of the SCAT. The majority of these studies (56%) were prospective cohort studies. Male football players were the most common athletes studied. An analysis of the studies focused on

American Medical Society for Sports Medicine position statement: concussion in sport.

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Harmon, Kimberly G; Drezner, Jonathan A; Gammons, Matthew; Guskiewicz, Kevin M; Halstead, Mark; Herring, Stanley A; Kutcher, Jeffrey S; Pana, Andrea; Putukian, Margot; Roberts, William O

2013-01-01

PURPOSE OF THE STATEMENT: ▸ To provide an evidence-based, best practises summary to assist physicians with the evaluation and management of sports concussion. ▸ To establish the level of evidence, knowledge gaps and areas requiring additional research. ▸ Sports medicine physicians are frequently involved in the care of patients with sports concussion. ▸ Sports medicine physicians are specifically trained to provide care along the continuum of sports concussion from the acute injury to return-to-play (RTP) decisions. ▸ The care of athletes with sports concussion is ideally performed by healthcare professionals with specific training and experience in the assessment and management of concussion. Competence should be determined by training and experience, not dictated by specialty. ▸ While this statement is directed towards sports medicine physicians, it may also assist other physicians and healthcare professionals in the care of patients with sports concussion. ▸ Concussion is defined as a traumatically induced transient disturbance of brain function and involves a complex pathophysiological process. Concussion is a subset of mild traumatic brain injury (MTBI) which is generally self-limited and at the less-severe end of the brain injury spectrum. ▸ Animal and human studies support the concept of postconcussive vulnerability, showing that a second blow before the brain has recovered results in worsening metabolic changes within the cell. ▸ Experimental evidence suggests the concussed brain is less responsive to usual neural activation and when premature cognitive or physical activity occurs before complete recovery the brain may be vulnerable to prolonged dysfunction. ▸ It is estimated that as many as 3.8 million concussions occur in the USA per year during competitive sports and recreational activities; however, as many as 50% of the concussions may go unreported. ▸ Concussions occur in all sports with the highest incidence in football, hockey

Sports-related concussion relevant to the South African football ...

African Journals Online (AJOL)

second injury and potentially leading to longer-lasting deficits. Concussion grading. The historical grading of the severity of concussion is controversial. The concept of traditional mandatory exclusion periods based on the grading of concussive injuries is not helpful and is based on data from motor vehicle accidents.

Dynamic balance deficits in individuals with chronic ankle instability compared to ankle sprain copers 1 year after a first-time lateral ankle sprain injury.

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Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2016-04-01

To quantify the dynamic balance deficits that characterise a group with chronic ankle instability compared to lateral ankle sprain copers and non-injured controls using kinematic and kinetic outcomes. Forty-two participants with chronic ankle instability and twenty-eight lateral ankle sprain copers were initially recruited within 2 weeks of sustaining a first-time, acute lateral ankle sprain and required to attend our laboratory 1 year later to complete the current study protocol. An additional group of non-injured individuals were also recruited to act as a control group. All participants completed the anterior, posterior-lateral and posterior-medial reach directions of the star excursion balance test. Sagittal plane kinematics of the lower extremity and associated fractal dimension of the centre of pressure path were also acquired. Participants with chronic ankle instability displayed poorer performance in the anterior, posterior-medial and posterior-lateral reach directions compared with controls bilaterally, and in the posterior-lateral direction compared with lateral ankle sprain copers on their 'involved' limb only. These performance deficits in the posterior-lateral and posterior-medial directions were associated with reduced flexion and dorsiflexion displacements at the hip, knee and ankle at the point of maximum reach, and coincided with reduced complexity of the centre of pressure path. In comparison with lateral ankle sprain copers and controls, participants with chronic ankle instability were characterised by dynamic balance deficits as measured using the SEBT. This was attested to reduced sagittal plane motions at the hip, knee and ankle joints, and reduced capacity of the stance limb to avail of its supporting base. III.

The history of neurosurgical treatment of sports concussion.

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Stone, James L; Patel, Vimal; Bailes, Julian E

2014-10-01

Concussion has a long and interesting history spanning at least the 5 millennia of written medical record and closely mirrors the development of surgery and neurosurgery. Not surprisingly, much of the past and present experimental head injury and concussion work has been performed within neurosurgically driven laboratories or by several surgically oriented neurologists. This historical review chronicles the key aspects of neurosurgical involvement in sports concussion as related to the diagnosis, treatment, mitigation, and prevention of injury using the example of American football. In addition, we briefly trace the developments that led to our current understanding of the biomechanical and neurophysiological basis of concussion.

The Legal Landscape of Concussion: Implications for Sports Medicine Providers.

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Albano, Andrew W; Senter, Carlin; Adler, Richard H; Herring, Stanley A; Asif, Irfan M

2016-09-01

Concussion legislation has been enacted in all 50 of the United States, aiming to prevent mild traumatic brain injuries and the potential long-term sequelae of these injuries in youth athletics. Sports medicine providers, in addressing this major public health concern, are tasked with adhering to the established standards of medical care while also considering the legal implications. The PubMed (2011-2016) database was searched using the following search terms: concussion, sports concussion, legislation, and concussion legislation. References from consensus statements, review articles, and book chapters were also utilized. Clinical review. Level 4. The Lystedt law and its progeny have increased awareness of the signs and symptoms of sports concussion, but adherence to state legislation can pose some challenges. The presence of concussion legislation places a responsibility on the sports medicine provider to have a firm understanding of the legality of concussion management in the state(s) in which they practice. © 2016 The Author(s).

History of concussion impacts electrophysiological correlates of working memory.

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Hudac, Caitlin M; Cortesa, Cathryn S; Ledwidge, Patrick S; Molfese, Dennis L

2017-10-10

Sports-related concussions occur in approximately 21% of college athletes with implications for long-term cognitive impairments in working memory. Working memory involves the capacity to maintain short-term information and integrate with higher-order cognitive processing for planning and behavior execution, critical skills for optimal cognitive and athletic performance. This study quantified working memory impairments in 36 American football college athletes (18-23years old) using event-related potentials (ERPs). Despite performing similarly in a standard 2-back working memory task, athletes with history of concussion exhibited larger P1 and P3 amplitudes compared to Controls. Concussion History group latencies were slower for the P1 and faster for the N2. Source estimation analyses indicated that previously concussed athletes engaged different brain regions compared to athletes with no concussion history. These findings suggest that ERPs may be a sensitive and objective measure to detect long-term cognitive consequences of concussion. Copyright © 2017 Elsevier B.V. All rights reserved.

Social Norms Theory and Concussion Education

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Kroshus, Emily; Garnett, Bernice R.; Baugh, Christine M.; Calzo, Jerel P.

2015-01-01

Secondary prevention of harm from sport-related concussion is contingent on immediate removal from play post-injury. To date, educational efforts to reduce the prevalent risk behavior of continued play while symptomatic have been largely ineffective. Social norms theory may hold promise as a foundation for more effective concussion education aimed…

Concussion is Treatable: Statements of Agreement from the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting held in Pittsburgh, October 15–16, 2015

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Collins, Michael W.; Kontos, Anthony P.; Okonkwo, David O.; Almquist, Jon; Bailes, Julian; Barisa, Mark; Bazarian, Jeffrey; Bloom, O. Josh; Brody, David; Cantu, Robert; Cardenas, Javier; Clugston, Jay; Cohen, Randall; Echemendia, Ruben; Elbin, R.J.; Ellenbogen, Richard; Fonseca, Janna; Gioia, Gerard; Guskiewicz, Kevin; Heyer, Robert; Hotz, Gillian; Iverson, Grant L.; Jordan, Barry; Manley, Geoffrey; Maroon, Joseph; McAllister, Thomas; McCrea, Michael; Mucha, Anne; Pieroth, Elizabeth; Podell, Kenneth; Pombo, Matthew; Shetty, Teena; Sills, Allen; Solomon, Gary; Thomas, Danny G.; Valovich McLeod, Tamara C.; Yates, Tony; Zafonte, Ross

2016-01-01

Background Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective To describe the current landscape of treatment for concussion and provide summary agreements related to treatment in order to assist clinicians in the treatment of concussion. Methods On October 14–16, 2015, the Targeted Evaluation & Active Management (TEAM) Approaches To Treating Concussion meeting was convened in Pittsburgh, Pennsylvania, USA. 37 concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research, and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. Results A total of 16 statements of agreement were supported covering: 1) Summary of the Current Approach to Treating Concussion, 2) Heterogeneity and Evolving Clinical Profiles of Concussion, 3) Targeted Evaluation and Active Management Approach to Concussion Treatment: Specific Strategies, and 4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97–100%. Conclusion Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies based on modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery following concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments. PMID:27741219

On-field identification and management of concussion in amateur ...

African Journals Online (AJOL)

variety of benefits that the sport offers its participants. [1] However, rugby ... further in the game, concussion has an 'invisible' nature. Therefore ... World Rugby guidelines (online version as at 25 November 2015) for ... suspected concussions in rugby games. ... sustaining a concussion include, but are not limited to: children.

Engaging Teammates in the Promotion of Concussion Help Seeking

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Kroshus, Emily; Garnett, Bernice R.; Baugh, Christine M.; Calzo, Jerel P.

2016-01-01

Concussion underreporting contributes to the substantial public health burden of concussions from sport. Teammates may be able to play an important role in encouraging injury identification and help seeking. This study assessed whether there was an association between beliefs about the consequences of continued play with a concussion and…

The Berlin International Consensus Meeting on Concussion in Sport.

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Davis, Gavin A; Ellenbogen, Richard G; Bailes, Julian; Cantu, Robert C; Johnston, Karen M; Manley, Geoffrey T; Nagahiro, Shinji; Sills, Allen; Tator, Charles H; McCrory, Paul

2018-02-01

The Fifth International Conference on Concussion in Sport was held in Berlin in October 2016. A series of 12 questions and subquestions was developed and the expert panel members were required to perform a systematic review to answer each question. Following presentation at the Berlin meeting of the systematic review, poster abstracts and audience discussion, the summary Consensus Statement was produced. Further, a series of tools for the management of sport-related concussion was developed, including the Sport Concussion Assessment Tool Fifth edition (SCAT5), the Child SCAT5, and the Concussion Recognition Tool Fifth edition. This paper elaborates on this process, the outcomes, and explores the implications for neurosurgeons in the management of sport-related concussion. Copyright © 2017 by the Congress of Neurological Surgeons.

Concussion surveillance: do low concussion rates in the Qatar Professional Football League reflect a true difference or emphasize challenges in knowledge translation?

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Eirale, Cristiano; Tol, Johannes L; Targett, Steve; Holmich, Per; Chalabi, Hakim

2015-01-01

To investigate concussion epidemiology in the first football (soccer) division of Qatar. Prospective cohort study. Professional First Division Football League of Qatar. All first team players were included at the beginning of each season. Daily collection of training and match exposure from August 2008 until April 2012 by club medical staff. Head injuries during training and match play were recorded on standardized injury cards. Injury incidence was calculated as number of injuries per hour exposed to risk and expressed as rate per 1000 hours. The incidence of concussions in professional club football in Qatar is 0.016 (0.000-0.033) per 1000 hours of exposure. The concussion incidence is only 25% of that in the previous European studies using the same time loss injury definition. This raises the possibility that concussions are underreported. Further research is necessary. In the meantime, concussion education of players, club medical, and support staff is warranted, in keeping with the Zurich concussion consensus call for the need for an increase in knowledge translation.

Using video analysis for concussion surveillance in Australian football.

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Makdissi, Michael; Davis, Gavin

2016-12-01

The objectives of the study were to assess the relationship between various player and game factors and risk of concussion; and to assess the reliability of video analysis for mechanistic assessment of concussion in Australian football. Prospective cohort study. All impacts and collisions resulting in concussion were identified during the 2011 Australian Football League season. An extensive list of factors for assessment was created based upon previous analysis of concussion in Australian Football League and expert opinions. The authors independently reviewed the video clips and correlation for each factor was examined. A total of 82 concussions were reported in 194 games (rate: 8.7 concussions per 1000 match hours; 95% confidence interval: 6.9-10.5). Player demographics and game variables such as venue, timing of the game (day, night or twilight), quarter, travel status (home or interstate) or score margin did not demonstrate a significant relationship with risk of concussion; although a higher percentage of concussions occurred in the first 5min of game time of the quarter (36.6%), when compared to the last 5min (20.7%). Variables with good inter-rater agreement included position on the ground, circumstances of the injury and cause of the impact. The remainder of the variables assessed had fair-poor inter-rater agreement. Common problems included insufficient or poor quality video and interpretation issues related to the definitions used. Clear definitions and good quality video from multiple camera angles are required to improve the utility of video analysis for concussion surveillance in Australian football. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Game Schedules and Rate of Concussions in the National Football League.

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Teramoto, Masaru; Cushman, Daniel M; Cross, Chad L; Curtiss, Heather M; Willick, Stuart E

2017-11-01

Concussion prevention in the National Football League (NFL) is an important priority for player safety. The NFL now has modified game schedules, and one concern is that unconventional game schedules, such as a shortened rest period due to playing on a Thursday rather than during the weekend, may lead to an increased risk of injuries. Unconventional game schedules in the NFL are associated with an increased rate of concussion. Descriptive epidemiological study. This study analyzed concussions and game schedules over the NFL regular seasons from 2012 to 2015 (4 years). Documented numbers of concussions, identified by use of the online database PBS Frontline Concussion Watch, were summarized by regular-season weeks. Association of days of rest and game location (home, away, or overseas) with the rate of concussion was examined by use of the χ 2 test. Logistic regression analysis was performed to examine the relationships of days of rest and home/away games to the risk of repeated concussions, with adjustment for player position. A total of 582 concussions were analyzed in this study. A significantly greater number of concussions occurred in the second half of the season ( P game location, or timing of the bye week by the team or the opponent ( P > .05). Game schedules were not significantly associated with the occurrence of repeat concussions ( P > .05). Unconventional game schedules in the NFL, including playing on Thursday and playing overseas, do not seem to put players at increased risk of concussions.

Can Chronic Ankle Instability be Prevented? Rethinking Management of Lateral Ankle Sprains.

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Denegar, Craig R.; Miller, Sayers J., III

2002-01-01

Investigates whether chronic ankle instability can be prevented, discussing: the relationship between mechanical and functional instability; normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics; and tissue healing, joint dysfunction, and acute lateral ankle sprain management. The paper describes a treatment model…

Unrecognised Acute Rupture of the Achilles Tendon in Severe Ankle Sprain

Directory of Open Access Journals (Sweden)

Kin Wai Lam

2015-12-01

Full Text Available Inversion ankle sprain is a common sport injury. It commonly refers to the injury of lateral collateral ligaments of the ankle. Failure to detect the concomitant injuries would lead to inappropriate treatment and suboptimal result. A case of unrecognised rupture of the Achilles tendon in a patient with severe inversion ankle sprain is reported.

Concussive Injuries in Rugby 7s: An American Experience and Current Review.

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Lopez, Victor; Ma, Richard; Weinstein, Meryle G; Cantu, Robert C; Myers, Laurel S D; Nadkar, Nisha S; Victoria, Christian; Allen, Answorth A

2016-07-01

There is a comparative lack of concussion incidence data on the new Olympic sport Rugby 7s. This study aimed to determine the incidence (number of concussions per 1000 playing hours [ph]), mean and median severity (days absence), and cause of concussive injuries. This is a prospective epidemiology study, amateur to elite/national candidate, male (9768) and female (3876) players in USA Rugby sanctioned tournaments, compliant with the international consensus statement for studies in rugby union. Concussions in US Rugby 7s were 7.7/1000 ph (n = 67). Women encountered concussions at 8.1/1000 ph, and men at 7.6/1000 ph (risk ratio [RR] = 1.10, P = 0.593). Elite/national-level players encountered concussions at higher rates (18.3/1000 ph) than lower levels (6.4/1000 ph; RR = 5.48, P Rugby 7s players. US Elite tournament players sustained concussions at much higher rates than international male Rugby 7s counterparts. A substantial portion of US players who sustained a concussion had previous concussion injuries. Given the high rate of concussion, including repetitive concussive injuries, US Rugby 7s may benefit from concussion prevention measures similar to other contact sports such as instruction on proper tackling techniques, in-game and postgame medical assessment, and a standardized return-to-play protocol.

A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program.

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Benson, Brian W; Meeuwisse, Willem H; Rizos, John; Kang, Jian; Burke, Charles J

2011-05-17

In 1997, the National Hockey League (NHL) and NHL Players' Association (NHLPA) launched a concussion program to improve the understanding of this injury. We explored initial postconcussion signs, symptoms, physical examination findings and time loss (i.e., time between the injury and medical clearance by the physician to return to competitive play), experienced by male professional ice-hockey players, and assessed the utility of initial postconcussion clinical manifestations in predicting time loss among hockey players. We conducted a prospective case series of concussions over seven NHL regular seasons (1997-2004) using an inclusive cohort of players. The primary outcome was concussion and the secondary outcome was time loss. NHL team physicians documented post-concussion clinical manifestations and recorded the date when a player was medically cleared to return to play. Team physicians reported 559 concussions during regular season games. The estimated incidence was 1.8 concussions per 1000 player-hours. The most common postconcussion symptom was headache (71%). On average, time loss (in days) increased 2.25 times (95% confidence interval [CI] 1.41-3.62) for every subsequent (i.e., recurrent) concussion sustained during the study period. Controlling for age and position, significant predictors of time loss were postconcussion headache (p < 0.001), low energy or fatigue (p = 0.01), amnesia (p = 0.02) and abnormal neurologic examination (p = 0.01). Using a previously suggested time loss cut-point of 10 days, headache (odds ratio [OR] 2.17, 95% CI 1.33-3.54) and low energy or fatigue (OR 1.72, 95% CI 1.04-2.85) were significant predictors of time loss of more than 10 days. Postconcussion headache, low energy or fatigue, amnesia and abnormal neurologic examination were significant predictors of time loss among professional hockey players.

A heads up on concussions: are there sex-related differences?

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Brook, Emily M; Luo, Xuan; Curry, Emily J; Matzkin, Elizabeth G

2016-01-01

Head injuries are a major concern for physicians in athletes of all ages. Specifically, sports-related concussions are becoming an all-too-common injury among female athletes. The incidence of concussions among female athletes has likely increased over the past few decades because of an increase in sports participation afforded by Title IX. It would be useful for physicians to have general knowledge of concussions and their potential sex-related differences. This review article summarizes the current body of research concerning sex-related differences in concussion epidemiology and outcomes. A literature search was performed using PubMed and included all articles published from 1993 to present, with a predominant focus on research conducted over the past fifteen years. Additional articles were found using the bibliography from articles found through the PubMed search. Several articles have compared incidence, severity of neurological deficit, constellation of symptoms, and length of recovery post-concussion in males and females. However, the literature does not unanimously support a significant sex-related difference in concussions. Lack of consensus in the literature can be attributed to differences between patient populations, different tools used to study concussions, including subjective or objective measures, and differences in mechanisms of injury. We conclude that concussions are a serious injury in both male and female athletes, and physicians should have a very high index of suspicion regardless of sex, because there currently is not sufficient consensus in the literature to institute sex-related changes to concussion management. Current research may suggest a sex-related difference pertaining to sports-related concussions, but further evaluation is needed on this topic.

Clinical outcomes assessment for the management of sport-related concussion.

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Valovich McLeod, Tamara C; Register-Mihalik, Johna K

2011-02-01

PATIENT SCENARIO: An adolescent female youth soccer athlete, with a previous concussion history, suffered a second concussion 4 wk ago. Her postconcussive symptoms are affecting her school performance and social and family life. CLINICAL OUTCOMES ASSESSMENT: Concussion is typically evaluated via symptoms, cognition, and balance. There is no specific patient-oriented outcomes measure for concussion. Clinicians can choose from a variety of generic and specific outcomes instruments aimed at assessing general health-related quality of life or various concussion symptoms and comorbidities such as headache, migraine, fatigue, mood disturbances, depression, anxiety, and concussion-related symptoms. CLINICAL DECISION MAKING: The data obtained from patient self-report instruments may not actively help clinicians make return-to-play decisions; however, these scales may be useful in providing information that may help the athlete return to school, work, and social activities. The instruments may also serve to identify issues that may lead to problems down the road, including depression or anxiety, or serve to further explore the nature of an athlete's symptoms. Concussion results in numerous symptoms that have the potential to linger and has been associated with depression and anxiety. The use of outcomes scales to assess health-related quality of life and the effect of other symptoms that present with a concussion may allow clinicians to better evaluate the effects of concussion on physical, cognitive, emotional, social, school, and family issues, leading to better and more complete management.

CDC's Approach to Educating Coaches about Sports-Related Concussion

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Mitchko, Jane; Huitric, Michele; Sarmiento, Kelly; Hayes, Gail; Pruzan, Marcia; Sawyer, Richard

2007-01-01

Sports-related concussions can happen to any athlete in any sport. Each year in the United States, an estimated 1.6-3.8 million sports and recreation-related traumatic brain injuries (TBIs) occur, most of which can be classified as concussions. To help coaches prevent, recognize, and better manage sports-related concussions, the Centers for…

A neuroscientific approach to the examination of concussions in student-athletes.

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Ketcham, Caroline J; Hall, Eric; Bixby, Walter R; Vallabhajosula, Srikant; Folger, Stephen E; Kostek, Matthew C; Miller, Paul C; Barnes, Kenneth P; Patel, Kirtida

2014-12-08

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually. Concussion as defined by the 2013 Concussion Consensus Statement "may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an 'impulsive' force transmitted to the head." Concussions leave the individual with both short- and long-term effects. The short-term effects of sport related concussions may include changes in playing ability, confusion, memory disturbance, the loss of consciousness, slowing of reaction time, loss of coordination, headaches, dizziness, vomiting, changes in sleep patterns and mood changes. These symptoms typically resolve in a matter of days. However, while some individuals recover from a single concussion rather quickly, many experience lingering effects that can last for weeks or months. The factors related to concussion susceptibility and the subsequent recovery times are not well known or understood at this time. Several factors have been suggested and they include the individual's concussion history, the severity of the initial injury, history of migraines, history of learning disabilities, history of psychiatric comorbidities, and possibly, genetic factors. Many studies have individually investigated certain factors both the short-term and long-term effects of concussions, recovery time course, susceptibility and recovery. What has not been clearly established is an effective multifaceted approach to concussion evaluation that would yield valuable information related to the etiology, functional changes, and recovery. The purpose of this manuscript is to show one such multifaceted approached which examines concussions using computerized neurocognitive testing, event related potentials, somatosensory perceptual responses, balance assessment, gait assessment and genetic testing.

Concussion Management Practice Patterns Among Sports Medicine Physicians.

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Stache, Stephen; Howell, David; Meehan, William P

2016-09-01

The primary purpose of this study was to examine concussion management practice patterns among sports medicine physicians in the United States. Cross-sectional study using a web-based survey. Members of the American Medical Society for Sports Medicine (AMSSM). We distributed a questionnaire to physician members of the AMSSM assessing the current practices for evaluating and managing concussions sustained during sports. Specifically, we asked respondents about their use of management guidelines, medications, balance assessments, neuropsychological tests, and return-to-play strategies. Of the 3591 members emailed, 425 (11.8%) respondents responded. Ninety-seven percent of respondents reported basing current management of sport-related concussion on a published set of criteria, with a majority (91.9%) following the guidelines provided by the Fourth International Conference on Concussion in Sport. Seventy-six percent of respondents reported using medication beyond 48 hours postinjury. Acetaminophen was reported as the most commonly administered medication, although tricyclic antidepressants and amantadine were also commonly administered. Vitamins, minerals, and dietary supplements were also reported as commonly administered. Most respondents reported using a form of neuropsychological testing (87.1%). A majority of respondents (88.6%) reported allowing athletes to return to competition after concussion only once the athlete becomes symptom free and completes a return-to-play protocol. Most sports medicine physicians seem to use recently developed guidelines for concussion management, regularly use medications and neuropsychological testing in management strategies, and follow established return-to-play guidelines. Sports medicine physicians seem to have clinical expertise in the management of sport-related concussion.

Outcomes of a Cross-Disciplinary Concussion Prevention and Diagnosis Workshop Series

Directory of Open Access Journals (Sweden)

Patrick Drane

2018-02-01

Full Text Available This paper reports the outcomes of a series of two Concussion Research Workshops held in Lowell, MA, USA. The workshop examined the state-of-the-art in concussion research, research challenges and the future directions of research within the following three core topic areas: (A Concussion Prevention Techniques & Technology, (B Concussion Diagnosis, and (C Treatment of Concussions. Concussions are a form of traumatic brain injury caused by an impact and are a growing concern among athletes and those who are involved with sports. Recent years have led to increasing awareness and research related to concussions with limited definitive understanding of the specific mechanism and pathology. Technology is beginning to take on an important role in the prevention, diagnosis and treatment of concussions. Currently, sensors provide data about the impact and the athlete. However, sensors and better protective equipment can enable an effective monitoring and thus protection of athletes. Only when a more definitive understanding of the injury mechanism is achieved, can sensors and protective equipment design contribute to effective monitoring and protection of athletes.

Monitoring recovery following syndesmosis sprain: a case report.

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Spaulding, S J

1995-10-01

A sprain to the tibial-fibular syndesmosis often results in prolonged rehabilitation or surgical intervention before recovery occurs. This paper documents gait recovery both before and after surgery for a syndesmosis sprain. Ground reaction force (GRF) data were available before injury and before surgery. Data were also collected every 3 days from 4 days to 4 months after syndesmosis screw removal (8 weeks after surgery). Weightbearing during the stance phase of gait did not approach normal values until approximately 4 months after syndesmosis screw removal. The push-off phase of gait also was slow to recover. When it was possible for the subject to use one or two crutches, differences in GRF were evident, such that walking with one crutch demonstrated increased force production at the ground. Bracing the ankle with a semirigid brace increased GRF, whereas a boot-type lace-up brace resulted in decreased GRF. In this case report of a combined ankle and syndesmosis sprain, results suggest the weightbearing and push-off force were seriously compromised. Decreasing the number of walking assistive devices and wearing a semirigid ankle brace increased the amount of weightbearing through the affected leg and may have merit in encouraging muscle function.

Influence of ankle joint plantarflexion and dorsiflexion on lateral ankle sprain: A computational study.

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Purevsuren, Tserenchimed; Kim, Kyungsoo; Batbaatar, Myagmarbayar; Lee, SuKyoung; Kim, Yoon Hyuk

2018-05-01

Understanding the mechanism of injury involved in lateral ankle sprain is essential to prevent injury, to establish surgical repair and reconstruction, and to plan reliable rehabilitation protocols. Most studies for lateral ankle sprain posit that ankle inversion, internal rotation, and plantarflexion are involved in the mechanism of injury. However, recent studies indicated that ankle dorsiflexion also plays an important role in the lateral ankle sprain mechanism. In this study, the contributions of ankle plantarflexion and dorsiflexion on the ankle joint were evaluated under complex combinations of internal and inversion moments. A multibody ankle joint model including 24 ligaments was developed and validated against two experimental cadaveric studies. The effects of ankle plantarflexion (up to 60°) and dorsiflexion (up to 30°) on the lateral ankle sprain mechanism under ankle inversion moment coupled with internal rotational moment were investigated using the validated model. Lateral ankle sprain injuries can occur during ankle dorsiflexion, in which the calcaneofibular ligament and anterior talofibular ligament tears may occur associated with excessive inversion and internal rotational moment, respectively. Various combinations of inversion and internal moment may lead to anterior talofibular ligament injuries at early ankle plantarflexion, while the inversion moment acts as a primary factor to tear the anterior talofibular ligament in early plantarflexion. It is better to consider inversion and internal rotation as primary factors of the lateral ankle sprain mechanism, while plantarflexion or dorsiflexion can be secondary factor. This information will help to clarify the lateral ankle sprain mechanism of injury.

Ankle sprains: combination of manual therapy and supervised exercise leads to better recovery.

Science.gov (United States)

2013-01-01

Ankle sprains often occur when running, walking on uneven ground, or jumping. Usually, people are told to rest, elevate the foot, apply ice, and use an elastic wrap to reduce swelling. This treatment is typically followed by exercises that can be performed at home. Although the pain and swelling usually improve quickly, more than 70% of people who sprain their ankles continue to have problems with them and up to 80% will sprain their ankles again. This suggests that it is important to better care for ankle sprains. One option is manual therapy, where the therapist moves the ankle and surrounding joints to help restore normal joint movement. A research report published in the July 2013 issue of JOSPT examines and compares the outcomes of a home exercise program with a more involved treatment program that includes manual therapy and supervised exercises.

Content, Delivery, and Effectiveness of Concussion Education for US College Coaches.

Science.gov (United States)

Kroshus, Emily; Baugh, Christine M; Daneshvar, Daniel H

2016-09-01

The primary objective of this study was to examine the proportion of US college coaches who receive annual concussion education from their institution and to describe the content and delivery modalities of this education. This study also tested the hypothesis that coaches receiving concussion education from their institution will have greater knowledge about concussions independent of other individual and institutional characteristics. Cross-sectional online survey. US college sport. College coaches in National Collegiate Athletic Association Division I, II, and III (n = 1818). Self-reported receipt of education from institution, sex, sport coached, division of competition. Concussion identification and management knowledge. Two-thirds of coaches reported receiving informational materials about concussion from their institution. The content of the education most frequently referred to symptoms of a concussion and information about proper management of a concussion. Coaches who received educational materials from their institution were better able to identify symptoms and had more conservative responses to concussion management scenarios. Male coaches of male contact or collision teams less frequently endorsed safe or correct response as compared with female coaches of noncontact or collision teams. Not all US college coaches receive concussion education from their institution. Male Division I coaches of male contact/collision sport are a population for whom targeted educational outreach may be particularly valuable. Education for coaches, delivered by clinicians at many institutions, is an important component of ensuring that coaches are prepared to be informed partners in supporting concussion safety.

Ankle Sprain Injuries: A 2-Year Prospective Cohort Study in Female Greek Professional Basketball Players

Science.gov (United States)

Kofotolis, Nikolaos; Kellis, Eleftherios

2007-01-01

Context: Ankle sprains are a common basketball injury. Therefore, examination of risk factors for injury in female professional basketball players is worthwhile. Objective: To examine rates of ankle sprains, associated time missed from participation, and risk factors for injury during 2 consecutive seasons. Design: Prospective cohort study. Setting: Eighteen professional basketball facilities. Patients or Other Participants: We observed 204 players from 18 female professional basketball teams for 2 consecutive seasons during a 2-year period. Main Outcome Measure(s): Using questionnaires, we recorded the incidence of ankle sprains, participation time missed, and mechanisms of injury in games and practice sessions. Potential risk factors, such as age, body mass, height, training experience, and history of ankle sprain, were examined using multivariate logistic regression. Results: Fifty of the 204 participants sustained ankle injuries; injuries included 32 ankle sprains, which translated to an ankle sprain rate of 1.12 per 1000 hours of exposure to injury. The 32 players missed 224.4 training and game sessions and an average of 7.01 sessions per injury. Most injuries occurred in the key area of the basketball court and were the result of contact. Injury rates during games were higher than injury rates during practice sessions. Centers, followed by guards and forwards, had the highest rate of injury. Players who did not wear an external ankle support had an odds ratio of 2.481 for sustaining an ankle sprain. Conclusions: Female professional basketball athletes who did not wear an external ankle support, who played in the key area, or who functioned as centers had a higher risk for ankle sprain than did other players. PMID:18059995

What is the definition of sports-related concussion

DEFF Research Database (Denmark)

McCrory, Paul; Feddermann-Demont, Nina; Dvořák, Jiří

2017-01-01

OBJECTIVES: Various definitions for concussion have been proposed, each having its strengths and weaknesses. We reviewed and compared current definitions and identified criteria necessary for an operational definition of sports-related concussion (SRC) in preparation of the 5th Concussion Consensus...... Conference (Berlin, Germany). We also assessed the role of biomechanical studies in informing an operational definition of SRC. DESIGN: This is a systematic literature review. DATA SOURCES: Data sources include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central...... (2.2%), 14 reported on criteria for SRC definitions and 22 on biomechanical aspects of concussions. Six different operational definitions focusing on clinical findings and their dynamics were identified. Biomechanical studies were obtained almost exclusively on American football players. Angular...

Acupuncture for ankle sprain: systematic review and meta-analysis.

Science.gov (United States)

Park, Jimin; Hahn, Seokyung; Park, Ji-Yeun; Park, Hi-Joon; Lee, Hyangsook

2013-03-04

Ankle sprain is one of the most frequently encountered musculoskeletal injuries; however, the efficacy of acupuncture in treating ankle sprains remains uncertain. We therefore performed a systematic review to evaluate the evidence regarding acupuncture for ankle sprains. We searched 15 data sources and two trial registries up to February 2012. Randomized controlled trials of acupuncture were included if they involved patients with ankle sprains and reported outcomes of symptom improvement, including pain. A Cochrane risk of bias assessment tool was used. Risk ratio (RR) or mean difference (MD) was calculated with 95% confidence intervals (CIs) in a random effects model. Subgroup analyses were performed based on acupuncture type, grade of sprain, and control type. Sensitivity analyses were also performed with respect to risk of bias, sample size, and outcomes reported. Seventeen trials involving 1820 participants were included. Trial quality was generally poor, with just three reporting adequate methods of randomization and only one a method of allocation concealment. Significantly more participants in acupuncture groups reported global symptom improvement compared with no acupuncture groups (RR of symptoms persisting with acupuncture = 0.56, 95% CI 0.42-0.77). However, this is probably an overestimate due to the heterogeneity (I2 = 51%) and high risk of bias of the included studies. Acupuncture as an add-on treatment also improved global symptoms compared with other treatments only, without significant variability (RR 0.61, 95% CI 0.51-0.73, I2 = 1%). The benefit of acupuncture remained significant when the analysis was limited to two studies with a low risk of bias. Acupuncture was more effective than various controls in relieving pain, facilitating return to normal activity, and promoting quality of life, but these analyses were based on only a small number of studies. Acupuncture did not appear to be associated with adverse events. Given

What You Need to Know About Concussion

Centers for Disease Control (CDC) Podcasts

2010-03-17

This podcast provides the essential facts about concussions and describes symptoms, danger signs, and ways to recover and heal after a concussion.  Created: 3/17/2010 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 3/17/2010.

Game-specific characteristics of sport-related concussions.

Science.gov (United States)

Helmich, Ingo

2018-01-01

Concussions are common incidences in sports. However, game-specific characteristics such as tactics, field positions, etc. might positively/negatively contribute to the occurrence of mild traumatic brain injuries (mTBI) in various sports such as soccer, volleyball, handball, or basketball. Thus, the intention of this study was to analyze game-specific characteristics of concussive incidents in active players from the perspective of different sportive disciplines. Four sport-specific questionnaires for soccer, handball, volleyball and basketball were established using an online survey tool. A total of 3001 participants completed the questionnaires. 18% of the participants answered that they had experienced a concussion which significantly differed depending on the sport practiced (χ2(3)=56.868, Pconcussions on the amateur level, volleyball players experienced most on the professional level and basketball players during leisure play (χ2(9)=112.667, Pconcussions by a collision with another player, volleyball players instead experienced most concussions by hits from the ball (χ2(6)=211.260, Pconcussive incidences (χ2(7)=19.638, Pconcussions (χ2(6)=13.617, Pconcussions are sport-specific and particularly concern amateurs. This indicates that most concussions in ball games appear in situations, where medical care units are not necessarily present. Preventive measures should therefore especially address amateurs in ball sports.

Summary of evidence-based guideline update: Evaluation and management of concussion in sports

Science.gov (United States)

Giza, Christopher C.; Kutcher, Jeffrey S.; Ashwal, Stephen; Barth, Jeffrey; Getchius, Thomas S.D.; Gioia, Gerard A.; Gronseth, Gary S.; Guskiewicz, Kevin; Mandel, Steven; Manley, Geoffrey; McKeag, Douglas B.; Thurman, David J.; Zafonte, Ross

2013-01-01

Objective: To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations. Results: Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of

Influences of Mental Illness, Current Psychological State, and Concussion History on Baseline Concussion Assessment Performance.

Science.gov (United States)

Weber, Michelle L; Dean, John-Henry L; Hoffman, Nicole L; Broglio, Steven P; McCrea, Michael; McAllister, Thomas W; Schmidt, Julianne D; Hoy, April Reed; Hazzard, Joseph B; Kelly, Louise A; Ortega, Justus D; Port, Nicholas; Putukian, Margot; Langford, T Dianne; Tierney, Ryan; Campbell, Darren E; McGinty, Gerald; O'Donnell, Patrick; Svoboda, Steven J; DiFiori, John P; Giza, Christopher C; Benjamin, Holly J; Buckley, Thomas; Kaminski, Thomas W; Clugston, James R; Feigenbaum, Luis A; Eckner, James T; Guskiewicz, Kevin; Mihalik, Jason P; Miles, Jessica Dysart; Anderson, Scott; Master, Christina L; Collins, Micky; Kontos, Anthony P; Bazarian, Jeffrey J; Chrisman, Sara P D; Brooks, Allison; Duma, Stefan; Bullers, Christopher Todd; Miles, Christopher M; Dykhuizen, Brian H

2018-04-01

A student-athlete's mental state, including history of trait anxiety and depression, or current psychological state may affect baseline concussion assessment performance. (1) To determine if mental illness (anxiety, depression, anxiety with depression) influences baseline scores, (2) to determine if psychological state correlates with baseline performance, and (3) to determine if history of concussion affects Brief Symptom Inventory-18 (BSI-18) subscores of state anxiety, depression, and somatization. Cross-sectional study; Level of evidence, 3. A sample of 8652 collegiate student-athletes (54.5% males, 45.5% females) participated in the Concussion Assessment, Research and Education (CARE) Consortium. Baseline assessments included a demographic form, a symptom evaluation, Standardized Assessment of Concussion, Balance Error Scoring System, a psychological state assessment (BSI-18), and Immediate Post-concussion Assessment and Cognitive Test. Baseline scores were compared between individuals with a history of anxiety (n = 59), depression (n = 283), and anxiety with depression (n = 68) and individuals without a history of those conditions (n = 8242). Spearman's rho correlations were conducted to assess the relationship between baseline and psychological state subscores (anxiety, depression, somatization) (α = .05). Psychological state subscores were compared between individuals with a self-reported history of concussions (0, 1, 2, 3, 4+) using Kruskal-Wallis tests (α = .05). Student-athletes with anxiety, depression, and anxiety with depression demonstrated higher scores in number of symptoms reported (anxiety, 4.3 ± 4.2; depression, 5.2 ± 4.8; anxiety with depression, 5.4 ± 3.9; no anxiety/depression, 2.5 ± 3.4), symptom severity (anxiety, 8.1 ± 9.8; depression, 10.4 ± 12.4; anxiety with depression, 12.4 ± 10.7; no anxiety/depression, 4.1 ± 6.9), and psychological distress in state anxiety (anxiety, 3.7 ± 4.7; depression, 2.5 ± 3.6; anxiety with

Gait Biomechanics in Participants, Six Months after First-time Lateral Ankle Sprain.

Science.gov (United States)

Doherty, C; Bleakley, C; Hertel, J; Caulfield, B; Ryan, J; Delahunt, E

2016-06-01

No research currently exists predicating a link between the injury-affiliated sensorimotor deficits of acute ankle sprain and those of chronic ankle instability during gait. This analysis evaluates participants with a 6-month history of ankle sprain injury to affirm this link. 69 participants with a 6-month history of acute first-time lateral ankle sprain were divided into subgroups ('chronic ankle instability' and 'coper') based on their self-reported disability and compared to 20 non-injured participants during a gait task. Lower extremity kinematic and kinetic data were collected from 200 ms pre- to 200 ms post-heel strike (period 1) and from 200 ms pre- to 200 ms post-toe off (period 2). The 'chronic ankle instability' subgroup (who reported greater disability) displayed increased knee flexion during period 1. During period 2, this subgroup exhibited greater total displacement at their ankle joint and greater extensor dominance at their knee. That many of these features are present, both in individuals with acute ankle sprain and those with chronic ankle instability may advocate a link between acute deficits and long-term outcome. Clinicians must be aware that the sensorimotor deficits of ankle sprain may persevere beyond the acute stage of injury and be cognizant of the capacity for impairments to pervade proximally. © Georg Thieme Verlag KG Stuttgart · New York.

Do as I say: contradicting beliefs and attitudes towards sports concussion in Australia.

Science.gov (United States)

Pearce, Alan J; Young, Janet A; Parrington, Lucy; Aimers, Nicole

2017-10-01

The objective of this study was to explore beliefs and attitudes of students studying exercise science in Australia towards sports concussion. A secondary objective explored differences between gender and previous experience of concussion. A total of 312 participants (m = 217; f = 95) responded to a series of statements ranging across a number of areas including personal attitudes and beliefs towards concussion: if they would risk playing with a concussion; their views on elite/professional athletes who continue to play after a concussion; and attitudes towards rehabilitation. Overall, attitudes revealed that it was not safe to play with a concussion, and it was believed that those who have had repeated concussions would be likely to suffer problems later in life. However, responses also indicated that they would risk playing with a concussion, and admired elite athletes who continued to play. When controlling for gender and previous concussions, males and those who sustained a previous concussion/s were more likely to continue playing. Conversely, females were more likely to complete rehabilitation prior to returning to sport. This study demonstrates in an Australian student cohort studying for a career in exercise and sports science, disparity between beliefs and attitudes regarding sports concussion.

Effectiveness of a Seat Pad in Reducing Back Pain in Long-Distance Drivers Deployed to Kuwait, October 2008-May 2009

Science.gov (United States)

2009-12-01

and strains of sacroiliac ligament D 8 3 846.2 Sprains and strains of sacrospinatus (ligament) D 8 3 846.3 Sprains and strains of sacrotuberous...ligament) D 8 3 846.8 Sprains and strains of sacrotuberous (ligament) D 8 3 846.9 Sprains and strains of unspecified site of sacroiliac region D 8...ligament) D 8 3 846.1 Sprains and strains of sacroiliac ligament D 8 846.2 Sprains and strains of sacrospinatus (ligament) 846.3 Sprains and strains of

Sport-Related Concussion Alters Indices of Dynamic Cerebral Autoregulation

Directory of Open Access Journals (Sweden)

Alexander D. Wright

2018-03-01

Full Text Available Sport-related concussion is known to affect a variety of brain functions. However, the impact of this brain injury on cerebral autoregulation (CA is poorly understood. Thus, the goal of the current study was to determine the acute and cumulative effects of sport-related concussion on indices of dynamic CA. Toward this end, 179 elite, junior-level (age 19.6 ± 1.5 years contact sport (ice hockey, American football athletes were recruited for preseason testing, 42 with zero prior concussions and 31 with three or more previous concussions. Eighteen athletes sustained a concussion during that competitive season and completed follow-up testing at 72 h, 2 weeks, and 1 month post injury. Beat-by-beat arterial blood pressure (BP and middle cerebral artery blood velocity (MCAv were recorded using finger photoplethysmography and transcranial Doppler ultrasound, respectively. Five minutes of repetitive squat–stand maneuvers induced BP oscillations at 0.05 and 0.10 Hz (20- and 10-s cycles, respectively. The BP–MCAv relationship was quantified using transfer function analysis to estimate Coherence (correlation, Gain (amplitude ratio, and Phase (timing offset. At a group level, repeated-measures ANOVA indicated that 0.10 Hz Phase was significantly reduced following an acute concussion, compared to preseason, by 23% (−0.136 ± 0.033 rads at 72 h and by 18% (−0.105 ± 0.029 rads at 2 weeks post injury, indicating impaired autoregulatory functioning; recovery to preseason values occurred by 1 month. Athletes were cleared to return to competition after a median of 14 days (range 7–35, implying that physiologic dysfunction persisted beyond clinical recovery in many cases. When comparing dynamic pressure buffering between athletes with zero prior concussions and those with three or more, no differences were observed. Sustaining an acute sport-related concussion induces transient impairments in the capabilities of the cerebrovascular

Sport-Related Concussion Alters Indices of Dynamic Cerebral Autoregulation.

Science.gov (United States)

Wright, Alexander D; Smirl, Jonathan D; Bryk, Kelsey; Fraser, Sarah; Jakovac, Michael; van Donkelaar, Paul

2018-01-01

Sport-related concussion is known to affect a variety of brain functions. However, the impact of this brain injury on cerebral autoregulation (CA) is poorly understood. Thus, the goal of the current study was to determine the acute and cumulative effects of sport-related concussion on indices of dynamic CA. Toward this end, 179 elite, junior-level (age 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes were recruited for preseason testing, 42 with zero prior concussions and 31 with three or more previous concussions. Eighteen athletes sustained a concussion during that competitive season and completed follow-up testing at 72 h, 2 weeks, and 1 month post injury. Beat-by-beat arterial blood pressure (BP) and middle cerebral artery blood velocity (MCAv) were recorded using finger photoplethysmography and transcranial Doppler ultrasound, respectively. Five minutes of repetitive squat-stand maneuvers induced BP oscillations at 0.05 and 0.10 Hz (20- and 10-s cycles, respectively). The BP-MCAv relationship was quantified using transfer function analysis to estimate Coherence (correlation), Gain (amplitude ratio), and Phase (timing offset). At a group level, repeated-measures ANOVA indicated that 0.10 Hz Phase was significantly reduced following an acute concussion, compared to preseason, by 23% (-0.136 ± 0.033 rads) at 72 h and by 18% (-0.105 ± 0.029 rads) at 2 weeks post injury, indicating impaired autoregulatory functioning; recovery to preseason values occurred by 1 month. Athletes were cleared to return to competition after a median of 14 days (range 7-35), implying that physiologic dysfunction persisted beyond clinical recovery in many cases. When comparing dynamic pressure buffering between athletes with zero prior concussions and those with three or more, no differences were observed. Sustaining an acute sport-related concussion induces transient impairments in the capabilities of the cerebrovascular pressure

Predicting functional recovery after acute ankle sprain.

Directory of Open Access Journals (Sweden)

Sean R O'Connor

Full Text Available Ankle sprains are among the most common acute musculoskeletal conditions presenting to primary care. Their clinical course is variable but there are limited recommendations on prognostic factors. Our primary aim was to identify clinical predictors of short and medium term functional recovery after ankle sprain.A secondary analysis of data from adult participants (N = 85 with an acute ankle sprain, enrolled in a randomized controlled trial was undertaken. The predictive value of variables (age, BMI, gender, injury mechanism, previous injury, weight-bearing status, medial joint line pain, pain during weight-bearing dorsiflexion and lateral hop test recorded at baseline and at 4 weeks post injury were investigated for their prognostic ability. Recovery was determined from measures of subjective ankle function at short (4 weeks and medium term (4 months follow ups. Multivariate stepwise linear regression analyses were undertaken to evaluate the association between the aforementioned variables and functional recovery.Greater age, greater injury grade and weight-bearing status at baseline were associated with lower function at 4 weeks post injury (p<0.01; adjusted R square=0.34. Greater age, weight-bearing status at baseline and non-inversion injury mechanisms were associated with lower function at 4 months (p<0.01; adjusted R square=0.20. Pain on medial palpation and pain on dorsiflexion at 4 weeks were the most valuable prognostic indicators of function at 4 months (p< 0.01; adjusted R square=0.49.The results of the present study provide further evidence that ankle sprains have a variable clinical course. Age, injury grade, mechanism and weight-bearing status at baseline provide some prognostic information for short and medium term recovery. Clinical assessment variables at 4 weeks were the strongest predictors of recovery, explaining 50% of the variance in ankle function at 4 months. Further prospective research is required to highlight the factors

Concussion Incidence and Recurrence in Professional Australian Football Match-Play: A 14-Year Analysis

Directory of Open Access Journals (Sweden)

Nathan Gibbs

2017-01-01

Full Text Available Background. Concussion incidence rates in professional Australian football may be underreported due to the injury classification definition. A myriad of factors contribute to concussion risk; however, there is limited long-term surveillance in Australian football. This study analysed concussion in one Australian football team over an extended period. Method. Match-play concussion injuries in one team (n=116 participants were diagnosed and treated by the team physician over 14 years. Analysis of factors related to concussion including matches played, time of day and season, and return to play provided an insight into occurrence and recurrence rates. Results. 140 concussions were recorded (17.6 per 1000 player match hours. A strong relationship was evident between matches played and concussion incidence (r=0.70 and match conditions did not negatively affect the concussion rate. Whether an athlete returned to play in the same match or suffered a loss-of-consciousness concussion (p=0.84, their ensuing rate of concussion was not affected. Conclusion. Concussion in professional Australian football was related to the number of matches played. Further, neither previous incidence nor loss of consciousness affected future concussion risk. This study provides ecologically valid evidence of the concussion incidence rate in professional Australian football and has implications for the management of athletes sustaining concussion injuries.

Increased Symptom Reporting in Young Athletes Based on History of Previous Concussions.

Science.gov (United States)

Moser, Rosemarie Scolaro; Schatz, Philip

2017-01-01

Research documents increased symptoms in adolescents with a history of two or more concussions. This study examined baseline evaluations of 2,526 younger athletes, ages 10 to 14. Between-groups analyses examined Post Concussion Symptom Scale symptoms by concussion history group (None, One, Two+) and clusters of Physical, Cognitive, Emotional, and Sleep symptoms. Healthy younger athletes with a concussion history reported greater physical, emotional, and sleep-related symptoms than those with no history of concussion, with a greater endorsement in physical/sleep symptom clusters. Findings suggest younger athletes with a history of multiple concussions may experience residual symptoms.

Remembering your past: The effects of concussion on autobiographical memory recall.

Science.gov (United States)

Barry, Nicole C; Tomes, Jennifer L

2015-01-01

To date, research focusing on long-term memory functioning post concussion is limited. The purpose of the current study was to investigate the effects of concussion on long-term episodic autobiographical memory, once acute postconcussive symptoms have abated. Individuals with and without a history of concussion were asked to recall autobiographical memories from different life periods. The details, self-reported vividness, ease of recall, and completeness of these memories were assessed. Results indicated that although both control and previously concussed participants were equally able to recall autobiographical memories from all life periods, the transcribed memories of previously concussed participants were less detailed, were less complex, and revealed less active involvement in recollection. Specifically, memories of control participants contained more words and a higher proportion of pronouns, personal pronouns, cognitive process words, perceptual process words, and past-tense words. Deficits were found regardless of the frequency or recency of concussion. Concussion information, limitations, and implications of the current findings are discussed.

Sleep Disturbance Following Concussion Is a Risk Factor for a Prolonged Recovery.

Science.gov (United States)

Bramley, Harry; Henson, Alyssa; Lewis, Mechelle M; Kong, Lan; Stetter, Christy; Silvis, Matthew

2017-12-01

Sleep disturbance is a common problem following concussion. A retrospective chart review was conducted at a regional concussion clinic on patients 13 to 18 years of age between 2005 and 2011. Statistical analysis evaluated sleep disturbance and duration of concussion, as well as the use and effectiveness of melatonin. A total of 417 patients met inclusion criteria. One hundred twenty-three (34%) reported disturbance in sleep. There was no difference in sleep disturbance based on age, gender, or past number of concussions. Sleep disturbance was associated with a 3- to 4-fold increase in recovery time. Non-sport-related concussions were more likely to be associated with sleep disturbance compared to sport-related concussions (45% vs 29%, P = .01). Melatonin improved sleep disturbance in 67% of the patients. Evaluating sleep disorders following concussion is an important part of the assessment. These findings will help clinicians provide anticipatory guidance and treatment for adolescents recovering from concussion.

Potential savings of a program to prevent ankle sprain recurrence: Economic evaluation of a randomized controlled trial

NARCIS (Netherlands)

Hupperets, M.D.W.; Verhagen, E.A.L.M.; Heymans, M.W.; Bosmans, J.E.; Tulder, M.W. van; Mechelen, W. van

2010-01-01

Background: The most common ankle injury is the lateral ankle sprain. Dutch annual sports-related ankle sprain costs can roughly be estimated at 187,200,000. Research has shown that proprioceptive training accounts for an approximated overall 50% reduction in ankle sprain recurrence rate.

Mechanisms of injury for concussions in university football, ice hockey, and soccer.

Science.gov (United States)

Delaney, J Scott; Al-Kashmiri, Ammar; Correa, José A

2014-05-01

To examine the mechanisms of injury for concussions in university football, ice hockey, and soccer. Prospective cohort design. McGill University Sport Medicine Clinic. Male and female athletes participating in varsity football, ice hockey, and soccer. Athletes were followed prospectively over a 10-year period to determine the mechanisms of injury for concussions and whether contact with certain areas of the body or individual variables predisposed to longer recovery from concussions. For soccer, data were collected on whether concussions occurred while attempting to head the ball. There were 226 concussions in 170 athletes over the study period. The side/temporal area of the head or helmet was the most common area to be struck resulting in concussion in all 3 sports. Contact from another player's head or helmet was the most probable mechanism in football and soccer. In hockey, concussion impacts were more likely to occur from contact with another body part or object rather than another head/helmet. Differences in mechanisms of injuries were found between males and females in soccer and ice hockey. Athletes with multiple concussions took longer to return to play with each subsequent concussion. Half of the concussions in soccer were related to attempting to head the soccer ball. The side of the head or helmet was the most common area to be struck resulting in concussion in all 3 sports. In ice hockey and soccer, there are differences in the mechanisms of injury for males and females within the same sport.

An Evidence-Based Discussion of Heading the Ball and Concussions in High School Soccer.

Science.gov (United States)

Comstock, R Dawn; Currie, Dustin W; Pierpoint, Lauren A; Grubenhoff, Joseph A; Fields, Sarah K

2015-09-01

Soccer, originally introduced as a safer sport for children and adolescents, has seen a rapid increase in popularity in the United States over the past 3 decades. Recently, concerns have been raised regarding the safety of soccer ball heading (when an athlete attempts to play the ball in the air with his or her head) given the rise in concussion rates, with some calling for a ban on heading among soccer players younger than 14 years. To evaluate trends over time in boys' and girls' soccer concussions, to identify injury mechanisms commonly leading to concussions, to delineate soccer-specific activities during which most concussions occur, to detail heading-related soccer concussion mechanisms, and to compare concussion symptom patterns by injury mechanism. Retrospective analysis of longitudinal surveillance data collected from 2005-2006 through 2013-2014 in a large, nationally representative sample of US high schools. Participants were boys and girls who were high school soccer players. Concussions sustained during high school-sanctioned soccer games and practices. Mechanism and sport-specific activity of concussion. Overall, 627 concussions were sustained during 1,393,753 athlete exposures (AEs) among girls (4.50 concussions per 10,000 AEs), and 442 concussions were sustained during 1,592,238 AEs among boys (2.78 concussions per 10,000 AEs). For boys (68.8%) and girls (51.3%), contact with another player was the most common concussion mechanism. Heading was the most common soccer-specific activity, responsible for 30.6% of boys' concussions and 25.3% of girls' concussions. Contact with another player was the most common mechanism of injury in heading-related concussions among boys (78.1%) and girls (61.9%). There were few differences in concussion symptom patterns by injury mechanism. Although heading is the most common activity associated with concussions, the most frequent mechanism was athlete-athlete contact. Such information is needed to drive evidence

Concussion: Doug Flutie: "Be on the Safe Side."

Science.gov (United States)

... of this page please turn JavaScript on. Feature: Concussion Doug Flutie: "Be on the Safe Side." Past ... for NBC Sports. Flutie is often asked about concussions and brain trauma associated with sports like football, ...

Exercise and ankle sprain injuries: a comprehensive review.

Science.gov (United States)

Calatayud, Joaquin; Borreani, Sebastien; Colado, Juan Carlos; Flandez, Jorge; Page, Phil; Andersen, Lars L

2014-02-01

Ankle sprains are common in team sports and sports played on courts, and often result in structural and functional alterations that lead to a greater reinjury risk. Specific exercises are often used to promote neuromuscular improvements in the prevention and rehabilitation of ankle injuries. This literature review summarizes the neuromuscular characteristics of common ankle sprains and the effectiveness of exercise as an intervention for improving neuromuscular function and preventing reinjury. Our review found that appropriate exercise prescription can increase static and dynamic balance and decrease injury recurrence. In particular, the addition of dynamic activities in the exercise program can be beneficial because of the anticipatory postural adjustments identified as a key factor in the injury mechanism.

Return to Learning: Going Back to School Following a Concussion

Science.gov (United States)

McAvoy, Karen

2012-01-01

A concussion is a brain injury that affects cognitive, emotional, behavioral, physical, and sleep/energy patterns. The Centers for Disease Control and Prevention (CDC) estimate that approximately 1.6 to 3.8 million sports and recreational concussions occur each year. Countless more children sustain concussions from nonsports activities such as…

Prevalence of and attitudes about concussion in Irish schools' rugby union players.

Science.gov (United States)

Delahunty, Sinéad E; Delahunt, Eamonn; Condon, Brian; Toomey, David; Blake, Catherine

2015-01-01

Youth rugby players represent 45.2% (N = 69,472) of the Irish rugby union playing population. The risk and consequences of concussion injury are of particular concern in these young athletes, but limited epidemiological data exists. This study investigated annual and lifetime prevalence of concussion in an Irish schoolboy rugby union cohort. An anonymous cross-sectional survey of youth rugby players was conducted. Diagnosed concussion was defined as an incident where diagnosis was confirmed by a health professional or coach. Demographics, prevalence, and attitudes to concussion were collated. Data were analyzed with descriptive statistics, chi-square test, t-tests, Mann-Whitney tests, and logistic regression. Overall, 304 youth (aged 12-18 years) responded. Lifetime prevalence of diagnosed concussion was 19.4%, with annual (2010) prevalence 6.6%. Approximately 25.4% of players with diagnosed concussions returned to play without medical advice. Internal motivation (11.8%) was the predominant factor in feeling pressure to play while concussed. A desire for further concussion education was expressed by 89.5% of participants. Reform is required to prevent and manage concussion injuries among youth players in the rugby union, including mandatory education specific to concussion and implementation of return-to-play protocols. These findings have relevance for governing bodies, coaches, clinicians, schools, parents, and rugby union players. © 2014, American School Health Association.

Experience with Canada's First Policy on Concussion Education and Management in Schools.

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Hachem, Laureen D; Kourtis, George; Mylabathula, Swapna; Tator, Charles H

2016-07-01

In response to the rising incidence of concussions among children and adolescents, the province of Ontario recently introduced the Ontario Policy/Program Memorandum on Concussions (PPM No. 158) requiring school boards to develop a concussion protocol. As this is the first policy of its kind in Canada, the impact of the PPM is not yet known. An electronic survey was sent to all high school principals in the Toronto District School Board 1 year after announcement of the PPM. Questions covered extent of student, parent, and staff concussion education along with concussion management protocols. Of 109 high school principals contacted, 39 responded (36%). Almost all schools provided concussion education to students (92%), with most education delivered through physical education classes. Nearly all schools had return to play (92%) and return to learn (77%) protocols. Although 85% of schools educated staff on concussions, training was aimed at individuals involved in sports/physical education. Only 43.6% of schools delivered concussion education to parents, and many principals requested additional resources in this area. One year after announcement of the PPM, high schools in the Toronto District School Board implemented significant student concussion education programs and management protocols. Staff training and parent education required further development. A series of recommendations are provided to aid in future concussion policy development.

Pediatric volleyball-related injuries treated in US emergency departments, 1990-2009.

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Pollard, Katherine A; Shields, Brenda J; Smith, Gary A

2011-09-01

This study describes the epidemiology of pediatric volleyball-related injuries treated in US hospital emergency departments. Data for children younger than 18 years obtained from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission from 1990 through 2009 were analyzed. An estimated 692 024 volleyball-related injuries to children younger than 18 years occurred during the study period. The annual number of injuries declined significantly by 23% during the study period; however, the annual injury rate remained unchanged, and the number of volleyball-related concussions/closed head injuries increased significantly. Upper (48%) and lower (39%) extremity injuries occurred most frequently, as did strains/sprains (54%). Contact with the net/pole was associated with concussions/closed head injury our findings indicate opportunities for making volleyball an even safer sport for children. Protective padding, complying with US volleyball standards, should cover all volleyball poles and protruding hardware to prevent impact-related injuries.

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.

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Doherty, Cailbhe; Bleakley, Chris; Delahunt, Eamonn; Holden, Sinead

2017-01-01

Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. Overview of intervention systematic reviews. Individuals with acute ankle sprain/CAI. The primary outcomes were injury/reinjury incidence and function. 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Performance following a first professional concussion among National Basketball Association players.

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Yengo-Kahn, Aaron M; Zuckerman, Scott L; Stotts, Jeff; Zalneraitis, Brian H; Gardner, Ryan M; Kerr, Zachary Y; Solomon, Gary S

2016-09-01

Basketball is a physical game played on a hardwood floor among high-jumping athletes at risk for injury. It is currently unknown how sport-related concussion (SRC) affects player performance after injury among professional basketball players. The objective of this study was to explore the impact of SRC on basketball performance among National Basketball Association (NBA) players. A retrospective, archival cohort study was performed that compared NBA player performance following concussion to pre-concussive performance. A comprehensive NBA injury database, compiled from publically available sources, was queried for NBA players who suffered concussion from 2005-06 to 2014-15 (10 seasons). Intra-and inter-player analyses were performed against a matched control group of players who missed playing time for personal reasons. Following application of inclusion/exclusion criteria and a matching process, 51 concussed players and 51 control players were included in analysis. There were no statistically significant decrements in baseline to post-concussion performance metrics in intra-player or player vs. controls after 5 return games. Our findings suggest that at the NBA level, an athlete's performance in the initial 5 games following injury does not suffer from the after-effects of concussive injury. These results may be useful in counseling professional athletes following a concussion.

Heart rate variability interventions for concussion and rehabilitation.

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Conder, Robert L; Conder, Alanna A

2014-01-01

The study of heart rate variability (HRV) has emerged as an essential component of cardiovascular health, as well as a physiological mechanism by which one can increase the interactive communication between the cardiac and the neurocognitive systems (i.e., the body and the brain). It is well-established that lack of HRV implies cardiopathology, morbidity, reduced quality-of-life, and precipitous mortality. On the positive, optimal HRV has been associated with good cardiovascular health, autonomic nervous system (ANS) control, emotional regulation, and enhanced neurocognitive processing. In addition to health benefits, optimal HRV has been shown to improve neurocognitive performance by enhancing focus, visual acuity and readiness, and by promoting emotional regulation needed for peak performance. In concussed athletes and soldiers, concussions not only alter brain connectivity, but also alter cardiac functioning and impair cardiovascular performance upon exertion. Altered sympathetic and parasympathetic balance in the ANS has been postulated as a critical factor in refractory post concussive syndrome (PCS). This article will review both the pathological aspects of reduced HRV on athletic performance, as well as the cardiovascular and cerebrovascular components of concussion and PCS. Additionally, this article will review interventions with HRV biofeedback (HRV BFB) training as a promising and underutilized treatment for sports and military-related concussion. Finally, this article will review research and promising case studies pertaining to use of HRV BFB for enhancement of cognition and performance, with applicability to concussion rehabilitation.

Heart Rate Variability Interventions for Concussion and Rehabilitation

Directory of Open Access Journals (Sweden)

Robert Lake Conder

2014-08-01

Full Text Available The study of Heart Rate Variability (HRV has emerged as an essential component of cardiovascular health, as well as a physiological mechanism by which one can increase the interactive communication between the cardiac and the neurocognitive systems (i.e., the body and the brain. It is well-established that lack of heart rate variability implies cardiopathology, morbidity, reduced quality-of-life, and precipitous mortality. On the positive, optimal heart rate variability has been associated with good cardiovascular health, autonomic nervous system (ANS control, emotional regulation, and enhanced neurocognitive processing. In addition to health benefits, optimal HRV has been shown to improve neurocognitive performance by enhancing focus, visual acuity and readiness, and by promoting emotional regulation needed for peak performance. In concussed athletes and soldiers, concussions not only alter brain connectivity, but also alter cardiac functioning and impair cardiovascular performance upon exertion. Altered sympathetic and parasympathetic balance in the ANS has been postulated as a critical factor in refractory Post Concussive Syndrome (PCS. This article will review both the pathological aspects of reduced heart rate variability on athletic performance, as well as the cardiovascular and cerebrovascular components of concussion and PCS. Additionally, this article will review interventions with HRV biofeedback (HRV BFB training as a promising and underutilized treatment for sports and military-related concussion. Finally, this article will review research and promising case studies pertaining to use of HRV BFB for enhancement of cognition and performance, with applicability to concussion rehabilitation.

Post-concussion driving behaviors and opinions: A survey of collegiate student-athletes.

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Schmidt, Julianne D; Lynall, Robert C; Lempke, Landon Bryce; Weber, Michelle L; Devos, Hannes

2018-05-08

Post-concussion driving restrictions are eminent, but we lack understanding of current behaviors and opinions about driving following concussion among populations at risk of concussion. We aimed to describe post-concussion driving behaviors and opinions among collegiate student-athletes. Student-athletes completed a survey (response rate=45.3%, 223/492) regarding their post-concussion driving behaviors and opinions. Response frequencies and percentages are presented. Student-athletes self-reported a total of 169 lifetime concussions (0.76±1.02 each). Of the 169 concussions, 52.1% (88/169) were diagnosed and 52.7% (89/169) occurred while the student-athlete possessed a valid driver's license. Student-athletes refrained from driving following 43.8% (39/89) of the concussive events. Student-athletes that refrained most commonly did so for only 24-48 hours (20.5%, 8/39) and because a health care provider advised them to (33.3%: 13/39). Student-athletes most commonly reported that they would feel "very unsafe" driving a car immediately following injury (38.4%, 84/219). When asked whether driving restrictions would influence your decision to report the injury to a health care provider, 7.9% reported that it "definitely would" (17/214), 26.6% "probably would" (57/214), 17.8% "neutral" (38/214), 24.8% "probably would not" (53/214), and 22.9% "definitely would not" (49/214). Despite generally believing that driving immediately following a concussion is unsafe, a majority of student-athletes did not refrain from driving at any point following their previous concussions. Post-concussion driving restrictions may have some influence on student-athletes' decisions to report the injury to a health care provider. Health care providers play a critical role in post-concussion driving restriction, but lack standardized recommendations to guide their care.

Anatomical predisposition of the ankle joint for lateral sprain or lateral malleolar fracture evaluated by radiographic measurements.

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Lee, Kyoung Min; Chung, Chin Youb; Sung, Ki Hyuk; Lee, SeungYeol; Kim, Tae Gyun; Choi, Young; Jung, Ki Jin; Kim, Yeon Ho; Koo, Seung Bum; Park, Moon Seok

2015-01-01

Injury mechanism and the amount of force are important factors determining whether a fracture or sprain occurs at the time of an ankle inversion injury. However, the anatomical differences between the ankle fracture and sprain have not been investigated sufficiently. This study was performed to investigate whether an anatomical predisposition of the ankle joint results in a lateral malleolar fracture or lateral ankle sprain. Two groups of consecutive patients, one with lateral malleolar fracture (274 patients, mean age 49.0 years) and the other with lateral ankle sprain (400 patients, mean age 38.4 years), were evaluated. Ankle radiographs were examined for 7 measures: distal tibial articular surface (DTAS) angle, bimalleolar tilt (BT), medial malleolar relative length (MMRL), lateral malleolar relative length (LMRL), medial malleolar slip angle (MMSA), anterior inclination of tibia (AI), and fibular position (FP). After an interobserver reliability test, the radiographic measurements were compared between the 2 groups. Linear regression analysis was performed to correct for age and sex effects between the groups. The fracture group and the sprain group showed significant differences in BT (P = .001), MMSA (P sprain groups showed a significant difference in BT (P = .001), MMRL (P ankle sprain group. Further 3-dimensional assessment of the bony structure and subsequent biomechanical studies are needed to elucidate the mechanism of injury according to the various types of ankle fractures and ankle sprain. Level III, retrospective comparative study. © The Author(s) 2014.

The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.

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Doherty, Cailbhe; Delahunt, Eamonn; Caulfield, Brian; Hertel, Jay; Ryan, John; Bleakley, Chris

2014-01-01

Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist. Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity. We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields. One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with

Inadequate Helmet Fit Increases Concussion Severity in American High School Football Players.

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Greenhill, Dustin A; Navo, Paul; Zhao, Huaqing; Torg, Joseph; Comstock, R Dawn; Boden, Barry P

2016-05-01

There is limited information on the relationship between football helmet fit and concussion severity. Poor helmet fit may predispose football players to a more severe concussion. Descriptive epidemiology study. Level 3. Data from concussion injury reports were obtained from the National High School Sports-Related Injury Surveillance System over a 9-year period. Symptoms, duration, and helmet parameters (fit, interior padding) were analyzed for all first-time concussions. Data from 4580 concussions were analyzed. Patients who suffered concussions with a helmet that did not fit properly (3.22%), as determined by an athletic trainer, had higher rates of drowsiness (RR, 1.46; P = 0.005), hyperexcitability (RR, 2.38; P = 0.047), and sensitivity to noise (RR, 1.88; P football helmet is a risk factor for a concussion with more symptoms and of longer duration. Concussions of longer duration are also more common in players with an air bladder-lined helmet. Current high school football rules should mandate supervision and maintenance of helmet fit throughout the season, prior to impact. Team physicians, athletic trainers, coaches, and high school officials should ensure proper oversight of helmet fit in high school athletes to decrease concussion severity and duration. © 2016 The Author(s).

Concussion knowledge and experience among Welsh amateur rugby union coaches and referees

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Griffin, Steffan Arthur; Ranson, Craig; Moore, Isabel; Mathema, Prabhat

2017-01-01

Background Rugby union is a collision sport where participants are at high risk of sustaining a concussion. In settings where there is little qualified medical supervision, certain stakeholders (eg, coaches and officials) should possess sufficient knowledge in regard to the recognition and management of concussion. Aim The aim of this study was to assess the knowledge and experience of various aspects of concussion among coaches and referees involved in Welsh amateur rugby union. Methods A questionnaire was distributed to 1843 coaches and 420 referees. Results A total of 333 coaches and 283 referees completed the questionnaire (18% and 68% response rates, respectively). Participants exhibited greater knowledge of concussion symptom recognition relative to knowledge of both the consequences of concussion and associated return-to-play protocols, both of which could be considered poor. There were no differences in knowledge levels between coaches and referees or between participants with or without a history of concussion. Two-thirds of participants incorrectly believed that headgear could prevent concussion, and nearly 30% of coaches reported having witnessed other coaches allowing a potentially concussed player to continue playing. Conclusions Identification of several misconceptions indicates that concussion management within Welsh amateur rugby union needs to be improved, warranting a multi-faceted educational intervention. PMID:29259806

Lower Limb Interjoint Postural Coordination One Year after First-Time Lateral Ankle Sprain.

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Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Patterson, Matthew R; Delahunt, Eamonn

2015-11-01

Longitudinal analyses of participants with a history of lateral ankle sprain are lacking. This investigation combined measures of lower limb interjoint coordination and stabilometry to evaluate static unipedal stance with the eyes open (condition 1) and closed (condition 2) in a group of participants with chronic ankle instability (CAI) compared to lateral ankle sprain "copers" (both recruited 12 months after sustaining an acute first-time lateral ankle sprain) and a group of noninjured controls. Twenty-eight participants with CAI, 42 lateral ankle sprain "copers," and 20 noninjured controls completed three 20-s single-limb stance trials in conditions 1 and 2. An adjusted coefficient of multiple determination statistic was used to compare stance limb three-dimensional kinematic data for similarity to establish patterns of interjoint coordination. The fractal dimension of the stance limb center of pressure path was also calculated. Between-group analyses revealed that participants with CAI displayed notable increases in ankle-hip linked coordination compared with both lateral ankle sprain "copers" (-0.52 (1.05) vs 0.28 (0.9), P = 0.007) and controls (-0.52 (1.05) vs 0.63 (0.64), P = 0.006) in condition 1 and compared with controls only (0.62 (1.92) vs 0.1 (1.0) P = 0.002) in condition 2. Participants with CAI also exhibited a decrease in the fractal dimension of the center-of-pressure path during condition 2 compared with both controls and lateral ankle sprain "copers." Participants with CAI present with a hip-dominant strategy of eyes-open and eyes-closed static unipedal stance. This coincided with reduced complexity of the stance limb center of pressure path in the eyes-closed condition.

Epidemiology of concussions among United States high school athletes in 20 sports.

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Marar, Mallika; McIlvain, Natalie M; Fields, Sarah K; Comstock, R Dawn

2012-04-01

In the United States (US), an estimated 300,000 sports-related concussions occur annually. Among individuals 15 to 24 years of age, sports are second only to motor vehicle crashes as the leading cause of concussions. To investigate the epidemiology of concussions in high school athletes by comparing rates and patterns of concussion among 20 sports. Descriptive epidemiology study. Using an Internet-based data collection tool, RIO, certified athletic trainers from a large, nationally disperse sample of US high schools reported athlete exposure and injury data for 20 sports during the 2008-2010 academic years. During the study period, 1936 concussions were reported during 7,780,064 athlete-exposures (AEs) for an overall injury rate of 2.5 per 10,000 AEs. The injury rate was higher in competition (6.4) than practice (1.1) (rate ratio [RR], 5.7; 95% confidence interval [CI], 5.2-6.3). The majority of concussions resulted from participation in football (47.1%, n = 912), followed by girls' soccer (8.2%, n = 159), boys' wrestling (5.8%, n = 112), and girls' basketball (5.5%, n = 107). Football had the highest concussion rate (6.4), followed by boys' ice hockey (5.4) and boys' lacrosse (4.0). Concussions represented a greater proportion of total injuries among boys' ice hockey (22.2%) than all other sports studied (13.0%) (injury proportion ratio [IPR], 1.7; 95% CI, 1.4-2.1; P sports, girls had a higher concussion rate (1.7) than boys (1.0) (RR, 1.7; 95% CI, 1.4-2.0). The most common mechanisms of injury were player-player contact (70.3%) and player-playing surface contact (17.2%). In more than 40% of athletes in sports other than girls' swimming and girls' track, concussion symptoms resolved in 3 days or less. Athletes most commonly returned to play in 1 to 3 weeks (55.3%), with 22.8% returning in less than 1 week and 2.0% returning in less than 1 day. Although interest in sports-related concussions is usually focused on full-contact sports like football and ice hockey

Educating Coaches about Concussion in Sports: Evaluation of the CDC's "Heads Up: Concussion in Youth Sports" Initiative

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Covassin, Tracey; Elbin, R. J.; Sarmiento, Kelly

2012-01-01

Background: Concussions remain a serious public health concern. It is important that persons involved in youth sports, particularly coaches, be made aware and educated on the signs and symptoms of concussion. This study assessed the perceptions of youth sport coaches who have received the Centers for Disease Control and Prevention's…

Subjective, but not objective, lingering effects of multiple past concussions in adolescents.

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Brooks, Brian L; McKay, Carly D; Mrazik, Martin; Barlow, Karen M; Meeuwisse, Willem H; Emery, Carolyn A

2013-09-01

The existing literature on lingering effects from concussions in children and adolescents is limited and mixed, and there are no clear answers for patients, clinicians, researchers, or policy makers. The purpose of this study was to examine whether there are lingering effects of past concussions in adolescent athletes. Participants in this study included 643 competitive Bantam and Midget hockey players (most elite 20% by division of play) between 13 and 17 years of age (mean age=15.5, SD=1.2). Concussion history at baseline assessment was retrospectively documented using a pre-season questionnaire (PSQ), which was completed at home by parents and players in advance of baseline testing. Players with English as a second language, self-reported attention or learning disorders, a concussion within 6 months of baseline, or suspected invalid test profiles were excluded from these analyses. Demographically adjusted standard scores for the five composites/domains and raw symptom ratings from the brief Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized battery were analyzed. Adolescent athletes with one or two or more prior concussions did not have significantly worse neurocognitive functioning on ImPACT than did those with no previous concussions. There were significantly more symptoms reported in those with two or more prior concussions than in those with no or one prior concussion. Adolescents with multiple previous concussions had higher levels of baseline symptoms, but there were not group differences in neurocognitive functioning using this brief computerized battery.

Caring for Student-Athletes following a Concussion

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Piebes, Sarah K.; Gourley, Meganne; Valovich McLeod, Tamara C.

2009-01-01

The school nurse plays a dynamic role in the care and treatment of a concussed athlete. Concussions in the adolescent populations are of special concern due to their potential impact on mental development and cognitive function, as well as an increased risk of serious complications including second impact syndrome. The complexity of a concussion…

Common data elements collected among universities for sport-related concussion studies.

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Yang, Jingzhen; Peek-Asa, Corinne; Noble, James M; Torner, James; Schmidt, Paul; Cooper, Martha L

2018-02-12

Universities are increasingly implementing programs to effectively respond to and manage sport-related concussions (SRCs). One such effort is to develop common data elements (CDEs) and standardize data collection methods. The objectives of this study were to describe CDEs currently collected by Big Ten and Ivy League universities for SRC studies, and to compare the data collected with the core CDEs recommended by the National Institute of Neurological Disorders and Stroke (NINDS). We conducted an anonymous cross-sectional online survey among medical staff at the 14 Big Ten and 8 Ivy League universities (one per university) between September and October 2015. The survey instrument, including 9 questions corresponding to the concussion data collected before, during, and after a concussion, was developed and pilot-tested before field use. We analyzed patterns of the concussion CDEs being collected, including when, what, and how the data were collected and stored, and compared them with the NINDS' recommended core CDEs. A total of 19 out of 22 universities were included, with 13 from Big Ten and 6 from Ivy-League universities. All 19 participating universities currently collected concussion data with athletes before, during, and after a concussion. Great similarities in data collection were observed at baseline and acutely post-concussion across participating universities. All 19 universities collected at least one of the ten recommended acute symptoms checklists, and 18 universities collected one of the four recommended core neuropsychological function cognitive measures. However, CDEs in the sub-acute and chronic timeframes were limited, with only 9 (47%) universities collecting post-concussion short to long term outcome data. While over 60% of universities collected and stored concussion data electronically, only 17% to 42% of data collected were readily available for research. Significant inter-institutional similarities in acute concussion CDEs were found. Further

Concussion in youth rugby union and rugby league: a systematic review.

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Kirkwood, Graham; Parekh, Nikesh; Ofori-Asenso, Richard; Pollock, Allyson M

2015-04-01

Children and adolescents who play rugby are at increased risk of concussion and its effects. Competitive rugby union and rugby league feature as major sports in the school sport curriculum in the UK. There is a need for a thorough understanding of the epidemiology of concussion in youth rugby, the mechanisms involved in injuries and predisposing risk factors. The publication databases Pubmed, Embase and SportDISCUS were searched in April 2014 for primary research studies of child and adolescent rugby union and rugby league (under 20 years) in English language with data on concussion injuries. The review was conducted within a larger all injury systematic review on rugby union and rugby league where key words used in the search included rugby, injury and concussion with child, adolescent, paediatric and youth. There were 25 studies retrieved with data on child or adolescent rugby and concussion, 20 were on rugby union, three on rugby league and in two the code of rugby was unspecified. There was significant heterogeneity in the definitions of injuries and of concussion. The incidence of child and adolescent match concussion ranged from 0.2 to 6.9 concussions per 1000 player-hours for rugby union and was 4.6 and 14.7 concussions per 1000 player-hours for rugby league, equivalent to a probability of between 0.3% and 11.4% for rugby union and of 7.7% and 22.7% for rugby league. There is a significant risk of concussion in children and adolescents playing rugby union and rugby league evident from the studies included in this systematic review. There is a need for reliable data through routine monitoring and reporting in schools and clubs and in hospital emergency departments in order to inform prevention. Concussion protocols should be implemented and tested. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Myoelectric stimulation on peroneal muscles resists simulated ankle sprain motion.

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Fong, Daniel Tik-Pui; Chu, Vikki Wing-Shan; Chan, Kai-Ming

2012-07-26

The inadequate reaction time of the peroneal muscles in response to an incorrect foot contact event has been proposed as one of the etiological factors contributing to ankle joint inversion injury. Thus, the current study aimed to investigate the efficacy of a myoelectric stimulation applied to the peroneal muscles in the prevention of a simulated ankle inversion trauma. Ten healthy male subjects performed simulated inversion and supination tests on a pair of mechanical sprain simulators. An electrical signal was delivered to the peroneal muscles of the subjects through a pair of electrode pads. The start of the stimulus was synchronized with the drop of the sprain simulator's platform. In order to determine the maximum delay time which the stimulus could still resist the simulated ankle sprain motion, different delay time were test (0, 5, 10, and 15ms). Together with the control trial (no stimulus), there were 5 testing conditions for both simulated inversion and supination test. The effect was quantified by the drop in maximum ankle tilting angle and angular velocity, as determined by a motion analysis system with a standard laboratory procedure. Results showed that the myoelectric stimulation was effective in all conditions except the one with myoelectric stimulus delayed for 15ms in simulated supination test. It is concluded that myoelectric stimulation on peroneal muscles could resist an ankle spraining motion. Copyright © 2012 Elsevier Ltd. All rights reserved.

A resting state functional magnetic resonance imaging study of concussion in collegiate athletes.

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Czerniak, Suzanne M; Sikoglu, Elif M; Liso Navarro, Ana A; McCafferty, Joseph; Eisenstock, Jordan; Stevenson, J Herbert; King, Jean A; Moore, Constance M

2015-06-01

Sports-related concussions are currently diagnosed through multi-domain assessment by a medical professional and may utilize neurocognitive testing as an aid. However, these tests have only been able to detect differences in the days to week post-concussion. Here, we investigate a measure of brain function, namely resting state functional connectivity, which may detect residual brain differences in the weeks to months after concussion. Twenty-one student athletes (9 concussed within 6 months of enrollment; 12 non-concussed; between ages 18 and 22 years) were recruited for this study. All participants completed the Wisconsin Card Sorting Task and the Color-Word Interference Test. Neuroimaging data, specifically resting state functional Magnetic Resonance Imaging data, were acquired to examine resting state functional connectivity. Two sample t-tests were used to compare the neurocognitive scores and resting state functional connectivity patterns among concussed and non-concussed participants. Correlations between neurocognitive scores and resting state functional connectivity measures were also determined across all subjects. There were no significant differences in neurocognitive performance between concussed and non-concussed groups. Concussed subjects had significantly increased connections between areas of the brain that underlie executive function. Across all subjects, better neurocognitive performance corresponded to stronger brain connectivity. Even at rest, brains of concussed athletes may have to 'work harder' than their healthy peers to achieve similar neurocognitive results. Resting state brain connectivity may be able to detect prolonged brain differences in concussed athletes in a more quantitative manner than neurocognitive test scores.

Do self-reported concussions have cumulative or enduring effects on drivers' anticipation of traffic hazards?

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Preece, Megan H W; Horswill, Mark S; Ownsworth, Tamara

2016-01-01

To investigate the cumulative effect of multiple self-reported concussions and the enduring effect of concussion on drivers' hazard perception ability. It was hypothesized: (1) that individuals reporting multiple previous concussions would be slower to anticipate traffic hazards than individuals reporting either one previous concussion or none; and (2) that individuals reporting a concussion within the past 3 months would be slower to anticipate traffic hazards than individuals reporting either an earlier concussion or no prior concussion. Two hundred and eighty-two predominantly young drivers (nconcussed = 68, Mage = 21.57 years, SDage = 6.99 years, 66% female) completed a validated hazard perception test (HPT) and measures of emotional, cognitive, health and driving status. A one-way analysis of variance showed that there was no significant effect of concussion number on HPT response times. Similarly, pairwise comparisons showed no significant differences between the HPT response times of individuals reporting a concussion within the previous 3 months, individuals reporting an earlier concussion and the never concussed group. The findings suggest that previous concussions do not adversely affect young drivers' ability to anticipate traffic hazards; however, due to reliance on self-reports of concussion history, further prospective longitudinal research is needed.

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

Science.gov (United States)

Kaminski, Thomas W.; Hertel, Jay; Amendola, Ned; Docherty, Carrie L.; Dolan, Michael G.; Hopkins, J. Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

2013-01-01

Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available. PMID:23855363

Acupuncture for ankle sprain: systematic review and meta-analysis

Science.gov (United States)

2013-01-01

Background Ankle sprain is one of the most frequently encountered musculoskeletal injuries; however, the efficacy of acupuncture in treating ankle sprains remains uncertain. We therefore performed a systematic review to evaluate the evidence regarding acupuncture for ankle sprains. Methods We searched 15 data sources and two trial registries up to February 2012. Randomized controlled trials of acupuncture were included if they involved patients with ankle sprains and reported outcomes of symptom improvement, including pain. A Cochrane risk of bias assessment tool was used. Risk ratio (RR) or mean difference (MD) was calculated with 95% confidence intervals (CIs) in a random effects model. Subgroup analyses were performed based on acupuncture type, grade of sprain, and control type. Sensitivity analyses were also performed with respect to risk of bias, sample size, and outcomes reported. Results Seventeen trials involving 1820 participants were included. Trial quality was generally poor, with just three reporting adequate methods of randomization and only one a method of allocation concealment. Significantly more participants in acupuncture groups reported global symptom improvement compared with no acupuncture groups (RR of symptoms persisting with acupuncture = 0.56, 95% CI 0.42–0.77). However, this is probably an overestimate due to the heterogeneity (I2 = 51%) and high risk of bias of the included studies. Acupuncture as an add-on treatment also improved global symptoms compared with other treatments only, without significant variability (RR 0.61, 95% CI 0.51–0.73, I2 = 1%). The benefit of acupuncture remained significant when the analysis was limited to two studies with a low risk of bias. Acupuncture was more effective than various controls in relieving pain, facilitating return to normal activity, and promoting quality of life, but these analyses were based on only a small number of studies. Acupuncture did not appear to be associated with

The efficacy of manual joint mobilisation/manipulation in treatment of lateral ankle sprains: a systematic review.

Science.gov (United States)

Loudon, Janice K; Reiman, Michael P; Sylvain, Jonathan

2014-03-01

Lateral ankle sprains are common and can have detrimental consequences to the athlete. Joint mobilisation/manipulation may limit these outcomes. Systematically summarise the effectiveness of manual joint techniques in treatment of lateral ankle sprains. This review employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer-assisted literature search of MEDLINE, CINHAL, EMBASE, OVID and Physiotherapy Evidence Database (PEDro) (January 1966 to March 2013) was used with the following keywords alone and in combination 'ankle', 'sprain', 'injuries', 'lateral', 'manual therapy', and 'joint mobilisation'. The methodological quality of individual studies was assessed using the PEDro scale. After screening of titles, abstracts and full articles, eight articles were kept for examination. Three articles achieved a score of 10 of 11 total points; one achieved a score of 9; two articles scored 8; one article scored a 7 and the remaining article scored a 5. Three articles examined joint techniques for acute sprains and the remainder examined subacute/chronic ankle sprains. Outcome measures included were pain level, ankle range of motion, swelling, functional score, stabilometry and gait parameters. The majority of the articles only assessed these outcome measures immediately after treatment. No detrimental effects from the joint techniques were revealed in any of the studies reviewed. For acute ankle sprains, manual joint mobilisation diminished pain and increased dorsiflexion range of motion. For treatment of subacute/chronic lateral ankle sprains, these techniques improved ankle range-of-motion, decreased pain and improved function.

Effects of ankle eversion taping using kinesiology tape in a patient with ankle inversion sprain

OpenAIRE

Lee, Sun-Min; Lee, Jung-Hoon

2016-01-01

[Purpose] The aim of this study was to report the effects of ankle eversion taping using kinesiology tape on ankle inversion sprain. [Subject] The subject was a 21-year-old woman with Grade 2 ankle inversion sprain. [Methods] Ankle eversion taping was applied to the sprained left ankle using kinesiology tape for 4 weeks (average, 15?h/day). [Results] Ankle instability and pain were reduced, and functional dynamic balance was improved after ankle eversion taping for 4 weeks. The Cumberland Ank...

Responses of spinal dorsal horn neurons to foot movements in rats with a sprained ankle

OpenAIRE

Kim, Jae Hyo; Kim, Hee Young; Chung, Kyungsoon; Chung, Jin Mo

2011-01-01

Acute ankle injuries are common problems and often lead to persistent pain. To investigate the underlying mechanism of ankle sprain pain, the response properties of spinal dorsal horn neurons were examined after ankle sprain. Acute ankle sprain was induced manually by overextending the ankle of a rat hindlimb in a direction of plantarflexion and inversion. The weight-bearing ratio (WBR) of the affected foot was used as an indicator of pain. Single unit activities of dorsal horn neurons in res...

Intrinsic risk factors of noncontact ankle sprains in soccer: a prospective study on 100 professional players.

Science.gov (United States)

Fousekis, Konstantinos; Tsepis, Elias; Vagenas, George

2012-08-01

Ankle sprain is an extremely common injury in soccer players. Despite extensive research, the intrinsic cause of this injury under noncontact conditions remains unclear. To identify intrinsic risk factors for noncontact ankle sprains in professional soccer players. Cohort study; Level of evidence, 2 One hundred professional soccer players were assessed in the preseason for potential risk factors of noncontact ankle sprains. The assessment included (A) ankle joint asymmetries (right-left) in isokinetic muscle strength, flexibility, proprioception, and stability; (B) somatometric asymmetries; (C) previous injuries; and (D) lateral dominance traits. Noncontact ankle sprains were prospectively recorded and diagnosed for a full competition period (10 months). Seventeen of the players sustained at least 1 noncontact ankle sprain. Logistic regression revealed that players with (A) eccentric isokinetic ankle flexion strength asymmetries (odds ratio [OR] = 8.88; 95% confidence interval [CI], 1.95-40.36, P = .005), (B) increased body mass index (OR = 8.16; 95% CI, 1.42-46.63, P = .018), and (C) increased body weight (OR = 5.72; 95% CI, 1.37-23.95, P = .017 ) each had a significantly higher risk of a noncontact ankle sprain. A trend for younger players (OR = 0.28; 95% CI, 0.061-1.24, P = .092) and for players with ankle laxity asymmetries (OR = 3.38; 95% CI, 0.82-14.00, P = .093) to be at greater risk for ankle sprain was also apparent to the limit of statistical significance (.05 ankle flexors and increased body mass index and body weight raise the propensity for ankle sprains in professional soccer players. Age and asymmetries in ankle laxity are potential factors worth revisiting, as there was an indication for younger players and players with ankle instability to be at higher risk for ankle injury. Proper preseason evaluation may improve prevention strategies for this type of injury in soccer.

Does a not-so-recent ankle sprain influence interjoint coordination during walking?

Science.gov (United States)

Dedieu, Philippe; Chamoun, Rima; Lacaud, Guilhaume; Moulinat, Thibault; Queron, Maxime; Zanone, Pier-Giorgio

2017-12-01

Ankle sprains are common joint injuries in daily and sports activities, whose underlying mechanisms have been amply studied. If joint structures are directly damaged, neuromuscular activity can be affected, particularly in the time domain. This study aims to establish whether previous ankle injury correlates with changes in the inter-joint synergy of the entire lower limb and in the muscle activity pattern during walking. Three-dimensional walking-gait analysis was conducted on twenty-four adults. Ten of them had never suffered from ankle sprain; fourteen had suffered from ankle sprain at least once during the three preceding years. Continuous Relative Phase (CRP) between the moving limbs assessed inter-joint coordination, and muscular activity was recorded by EMG. CRP between ankle and knee and between ankle and hip indicates that both joints moved in tight synchronization in the same direction on the injured side, whereas there was a time lag between joints on the healthy side for each sprained participants or on both side for the control group. Start-time and/or duration of muscular activity of tibialis anterior, soleus and peroneus longus occurred earlier and were longer on the injured side, respectively. Our findings suggest that ankle sprain modifies inter-joint coordination and muscular activity of the injured limb, inducing not an entirely new pattern of coordination but an alteration of the existing pattern. CRP revealed slight modifications in the extant inter-joint coordination which may not be captured by other kinematic variables, which opens perspectives on therapy and relapse prevention. Copyright © 2017 Elsevier Ltd. All rights reserved.

Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review.

Science.gov (United States)

Terada, Masafumi; Pietrosimone, Brian G; Gribble, Phillip A

2013-01-01

Clinicians perform therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, authors of previous studies have not determined which intervention or combination of interventions is most effective. To determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain. We performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles. Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental-relaxation interventions. We extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale. In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39). Static-stretching intervention as a part of standardized care yielded the strongest effects on dorsiflexion after acute ankle sprains. The existing evidence suggests that clinicians need to consider what may be the limiting factor of

Rugby headgear and concussion prevention: misconceptions could increase aggressive play.

Science.gov (United States)

Menger, Richard; Menger, Austin; Nanda, Anil

2016-04-01

OBJECTIVE Multiple studies have illustrated that rugby headgear offers no statistically significant protection against concussions. However, there remains concern that many players believe rugby headgear in fact does prevent concussions. Further investigation was undertaken to illustrate that misconceptions about concussion prevention and rugby headgear may lead to an increase in aggressive play. METHODS Data were constructed by Internet survey solicitation among United States collegiate rugby players across 19 teams. Initial information given was related to club, age, experience, use of headgear, playing time, whether the rugger played football or wrestling in high school, and whether the player believed headgear prevented concussion. Data were then constructed as to whether wearing headgear would increase aggressive playing style secondary to a false sense of protection. RESULTS A total of 122 players responded. All players were male. The average player was 19.5 years old and had 2.7 years of experience. Twenty-three of 122 players (18.9%) wore protective headgear; 55.4% of players listed forward as their primary position. Overall, 45.8% (55/120) of players played 70-80 minutes per game, 44.6% (54/121) played football or wrestled in high school, 38.1% (45/118) believed headgear prevented concussions, and 42.2% (51/121) stated that if they were using headgear they would be more aggressive with their play in terms of running or tackling. Regression analysis illustrated that those who believed headgear prevented concussions were or would be more likely to engage in aggressive play (p = 0.001). CONCLUSIONS Nearly 40% of collegiate rugby players surveyed believed headgear helped to prevent concussions despite no scientific evidence that it does. This misconception about rugby headgear could increase aggressive play. Those who believed headgear prevented concussion were, on average, 4 times more likely to play with increased aggressive form than those who believed

Dynamic postural stability differences between male and female players with and without ankle sprain

NARCIS (Netherlands)

Dallinga, Joan M.; Does, van der Henrike T. D.; Benjaminse, Anne; Lemmink, Koen A. P. M.

Objectives: To evaluate dynamic stability index (DSI) differences between males and females for different jump directions. To examine both preseason DSI differences between players with and without a history of ankle sprain, and between players with and without an ankle sprain during the subsequent

The use of Bioptron light (polarized, polychromatic, non-coherent) therapy for the treatment of acute ankle sprains.

Science.gov (United States)

Stasinopoulos, Dimitrios; Papadopoulos, Costas; Lamnisos, Dimitrios; Stasinopoulos, Ioannis

2017-03-01

Purpose The purpose of this study was to investigate the efficacy of Bioptron light therapy for the treatment of acute ankle sprains. Method A parallel group, single-blind, controlled study was carried out in patients with grade II acute ankle sprains. Patients were randomly allocated into two treatment groups (n = 25 for each). Both groups received cryotherapy, and the test group also received Bioptron light therapy. All treatments were performed daily for 5 d. Evaluations included self-reported pain via a visual analogue scale, degree of ankle edema, and ankle range of motion via goniometry carried out before the treatment and at the end of the treatment. Results The test group showed the largest magnitude of improvement for all evaluations at treatment five, and the between-group differences observed were statistically significant (p Bioptron light therapy supplemented with cryotherapy for the treatment of acute ankle sprains; however, larger studies are required to confirm these results. Implications for Rehabilitation Ankle sprains are common acute injuries among professional and recreational sports players but also among people in general. Cryotherapy is the first-standard treatment of acute ankle sprains. Phototherapy such as Bioptron light has been recommended supplement to cryotherapy to reduce the symptoms of ankle sprains. The results of the present trial showed that using BIOPTRON LIGHT and cryotherapy the rehabilitation period of acute ankle sprains can be reduced.

Decreased microvascular cerebral blood flow assessed by diffuse correlation spectroscopy after repetitive concussions in mice.

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Buckley, Erin M; Miller, Benjamin F; Golinski, Julianne M; Sadeghian, Homa; McAllister, Lauren M; Vangel, Mark; Ayata, Cenk; Meehan, William P; Franceschini, Maria Angela; Whalen, Michael J

2015-12-01

Repetitive concussions are associated with long-term cognitive dysfunction that can be attenuated by increasing the time intervals between concussions; however, biomarkers of the safest rest interval between injuries remain undefined. We hypothesize that deranged cerebral blood flow (CBF) is a candidate biomarker for vulnerability to repetitive concussions. Using a mouse model of human concussion, we examined the effect of single and repetitive concussions on cognition and on an index of CBF (CBFi) measured with diffuse correlation spectroscopy. After a single mild concussion, CBFi was reduced by 35±4% at 4 hours (Pconcussions spaced 1 day apart, CBFi was also reduced from preinjury levels 4 hours after each concussion but had returned to preinjury levels by 72 hours after the final concussion. Interestingly, in this repetitive concussion model, lower CBFi values measured both preinjury and 4 hours after the third concussion were associated with worse performance on the Morris water maze assessed 72 hours after the final concussion. We conclude that low CBFi measured either before or early on in the evolution of injury caused by repetitive concussions could be a useful predictor of cognitive outcome.

Ankle sprain: pathophysiology, predisposing factors, and management strategies

Directory of Open Access Journals (Sweden)

Tricia J Hubbard

2010-07-01

Full Text Available Tricia J Hubbard, Erik A WikstromUNC Charlotte, Department of Kinesiology, CharlotteAbstract: With the high percentage (up to 75% of initial lateral ankle sprains (LAS leading to repetitive sprains and chronic symptoms, it is imperative to better understand how best to treat and rehabilitate LAS events. The purpose of this paper is to review LAS pathophysiology, predisposing factors, and the current evidence regarding therapeutic modalities and exercises used in the treatment of LAS. Functional rehabilitation, early mobilization with support, is the current standard of care for LAS. However, the high percentage of reinjury occurrence and development of chronic symptoms (up to 75% after a LAS, suggests the current standard of care may not be effective. Recent evidence has shown the need for more stringent immobilization to facilitate ligament healing and restoration of joint stability and function after a LAS. Additionally, the importance of adding adjunctive therapies, specifically joint mobilizations and balance training have been shown to improve function and decrease the incidence of reinjury after a LAS. Modifying current rehabilitation protocols to include protecting the ankle joint with stringent immobilization, and including joint mobilizations and balance training may be the first step to decreasing the incidence of short and long term ankle joint dysfunction.Keywords: rehabilitation, recurrent sprains, chronic ankle instability (CAI

Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children.

Science.gov (United States)

Master, Christina L; Master, Stephen R; Wiebe, Douglas J; Storey, Eileen P; Lockyer, Julia E; Podolak, Olivia E; Grady, Matthew F

2018-03-01

Up to one-third of children with concussion have prolonged symptoms lasting beyond 4 weeks. Vision and vestibular dysfunction is common after concussion. It is unknown whether such dysfunction predicts prolonged recovery. We sought to determine which vision or vestibular problems predict prolonged recovery in children. A retrospective cohort of pediatric patients with concussion. A subspecialty pediatric concussion program. Four hundred thirty-two patient records were abstracted. Presence of vision or vestibular dysfunction upon presentation to the subspecialty concussion program. The main outcome of interest was time to clinical recovery, defined by discharge from clinical follow-up, including resolution of acute symptoms, resumption of normal physical and cognitive activity, and normalization of physical examination findings to functional levels. Study subjects were 5 to 18 years (median = 14). A total of 378 of 432 subjects (88%) presented with vision or vestibular problems. A history of motion sickness was associated with vestibular dysfunction. Younger age, public insurance, and presence of headache were associated with later presentation for subspecialty concussion care. Vision and vestibular problems were associated within distinct clusters. Provocable symptoms with vestibulo-ocular reflex (VOR) and smooth pursuits and abnormal balance and accommodative amplitude (AA) predicted prolonged recovery time. Vision and vestibular problems predict prolonged concussion recovery in children. A history of motion sickness may be an important premorbid factor. Public insurance status may represent problems with disparities in access to concussion care. Vision assessments in concussion must include smooth pursuits, saccades, near point of convergence (NPC), and accommodative amplitude (AA). A comprehensive, multidomain assessment is essential to predict prolonged recovery time and enable active intervention with specific school accommodations and targeted rehabilitation.

Concussion knowledge and attitudes among amateur South African ...

African Journals Online (AJOL)

Kathryn van Boom

3 Section Sports Medicine, Faculty of Health Sciences, University of. Pretoria, and Department of ... Currently, no rugby safety management programme focuses on concussion .... symptoms of concussion correctly 66% of the time compared to 63% by SAC ..... References. 1. Carter M. The unknown risks of youth rugby. BMJ.

Management of sport-related concussion in young athletes.

Science.gov (United States)

Patel, Dilip R; Shivdasani, Vandana; Baker, Robert J

2005-01-01

Sport-related head injuries are a common clinical problem. Most head injuries in young athletes are mild traumatic brain injuries or concussions. The highest number of sport-related concussions has been reported in American football. In addition to the well described physical and psychosocial growth, there is ongoing neurocognitive development of the brain during childhood and through adolescence. This developmental process has direct implications in the assessment and management of head injuries in young athletes. Research on the management and long-term outcome following brain injuries in young athletes is limited. Traditionally, the assessment of concussion has been based on clinical history and physical and neurological examination. Increasingly, neuropsychological testing, especially computerised testing, is providing objective measures for the initial assessment and follow-up of young athletes following brain injuries. Numerous guidelines have been published for grading and return to play criteria following concussion; however, none of these have been prospectively validated by research and none are specifically applicable to children and adolescents.

Concussions in the National Football League: A Current Concepts Review.

Science.gov (United States)

Yengo-Kahn, Aaron M; Johnson, Daniel J; Zuckerman, Scott L; Solomon, Gary S

2016-03-01

Significant attention has been directed toward the immediate and long-term effects of sport-related concussions on athletes participating in contact sports, particularly football. The highest level of football, the National Football League (NFL), has received significant attention and criticism regarding player management and safety after mild traumatic brain injury (mTBI). Several review articles have reported data related to concussion in the NFL, but a succinct review and synthesis of data regarding NFL concussions is currently lacking. To (1) review systematically the published data regarding concussion in the NFL and assess limitations of the studies, (2) elucidate areas where further research is needed, and (3) identify methods to improve future investigations of concussion in the NFL. Systematic review of literature. English-language titles and abstracts published between 1900 and September 2014 were searched systematically across electronic databases, and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed journal articles were included if they contained NFL concussion data with or without additional associated long-term effects. Reviews, editorials, letters to the editor, and comments were not included. Of the 344 records screened for review, 88 articles were assessed for eligibility. There were 31 studies that met the inclusion criteria and formed the basis of the evidence synthesis. Included in the current review were 8 case-control studies (Oxford Centre for Evidence-Based Medicine evidence level 3b), 6 descriptive epidemiological studies (level 4), 6 cross-sectional studies (level 4), 6 cohort studies (level 2b), and 5 case series (level 4). The study of concussions in the NFL has been limited by lack of recent empirical data, reliance on self-reported concussion history, and ascertainment bias of brains donated for autopsy studies. The scientific community

Australian Institute of Sport and Australian Medical Association position statement on concussion in sport.

Science.gov (United States)

Elkington, Lisa J; Hughes, David C

2017-01-16

Sport-related concussion is a growing health concern in Australia. Public concern is focused on the incidence and potential long term consequences of concussion. Children may be more prone to concussion and take longer to recover. The Australian Institute of Sport and the Australian Medical Association have collaborated to present the most contemporary evidence-based information in a format appropriate for all stakeholders. This position statement aims to ensure that participant safety and welfare is paramount when dealing with concussion in sport.First aid principles apply in the management of the athlete with suspected concussion, including protection of the cervical spine. Tools exist for use by members of the community, allowing identification of key symptoms and signs that raise the suspicion of concussion. Medical professionals should use the Sport Concussion Assessment Tool 3, in conjunction with clinical assessment for the diagnosis of concussion. Clinical assessment includes mechanism of injury, symptoms and signs, cognitive functioning, and neurological assessment including balance testing. In any situation where concussion is suspected, the athlete must be immediately removed from sport and not be allowed to return to activity until they have been assessed by a medical practitioner. "If in doubt, sit them out."A diagnosis of concussion requires immediate physical and cognitive rest, followed by a structured, graduated return to physical activity. Children require a longer period of recovery from concussion. Algorithms are provided for use by medical and non-medically trained stakeholders in the recognition and management of concussion.

Concussion: the history of clinical and pathophysiological concepts and misconceptions.

Science.gov (United States)

McCrory, P R; Berkovic, S F

2001-12-26

Concussion is a well-recognized clinical entity; however, its pathophysiologic basis remains a mystery. One unresolved issue is whether concussion is associated with lesser degrees of diffuse structural change seen in severe traumatic brain injury, or is the mechanism entirely caused by reversible functional changes. This issue is clouded not only by the lack of critical data, but also by confusion in terminology, even in contemporary literature. This confusion began in ancient times when no distinction was made between the transient effects of concussion and severe traumatic brain injury. The first clear separate recognition of concussion was made by the Persian physician, Rhazes, in the 10th century. Lanfrancus subsequently expanded this concept as brain "commotion" in the 13th century, although other Renaissance physicians continued to obscure this concept. By the 18th century, a variety of hypotheses for concussion had emerged. The 19th century discovery of petechial hemorrhagic lesions in severe traumatic brain injury led to these being posited as the basis of concussion, and a similar logic was used later to suggest diffuse axonal injury was responsible. The neuropathology and pathophysiology of concussion has important implications in neurology, sports medicine, medicolegal medicine, and in the understanding of consciousness. Fresh approaches to these questions are needed and modern research tools, including functional imaging and experimental studies of ion-channel function, could help elucidate this puzzle that has evolved over the past 3,000 years.

K-12 Students with Concussions: A Legal Perspective

Science.gov (United States)

Zirkel, Perry A.; Brown, Brenda Eagan

2015-01-01

This article provides a multipart analysis of the public schools' responsibility for students with concussions. The first part provides the prevailing diagnostic definitions of concussions and postconcussive syndrome. The second and central part provides (a) the legal framework of the two overlapping federal laws--the Individuals with Disabilities…

Rapid sideline performance meets outpatient clinic: Results from a multidisciplinary concussion center registry.

Science.gov (United States)

Kyle Harrold, G; Hasanaj, Lisena; Moehringer, Nicholas; Zhang, Isis; Nolan, Rachel; Serrano, Liliana; Raynowska, Jenelle; Rucker, Janet C; Flanagan, Steven R; Cardone, Dennis; Galetta, Steven L; Balcer, Laura J

2017-08-15

This study investigated the utility of sideline concussion tests, including components of the Sports Concussion Assessment Tool, 3rd Edition (SCAT3) and the King-Devick (K-D), a vision-based test of rapid number naming, in an outpatient, multidisciplinary concussion center treating patients with both sports-related and non-sports related concussions. The ability of these tests to predict clinical outcomes based on the scores at the initial visit was evaluated. Scores for components of the SCAT3 and the K-D were fit into regression models accounting for age, gender, and sport/non-sport etiology in order to predict clinical outcome measures including total number of visits to the concussion center, whether the patient reached a SCAT3 symptom severity score≤7, and the total types of referrals each patient received over their course. Patient characteristics, differences between those with sport and non-sport etiologies, and correlations between the tests were also analyzed. Among 426 patients with concussion, SCAT3 total symptom score and symptom severity score at the initial visit predicted each of the clinical outcome variables. K-D score at the initial visit predicted the total number of visits and the total number of referrals. Those with sports-related concussions were younger, had less severely-affected test scores, had fewer visits and types of referrals, and were more likely to have clinical resolution of their concussion and to reach a symptom severity score≤7. This large-scale study of concussion patients supports the use of sideline concussion tests as part of outpatient concussion assessment, especially the total symptom and symptom severity score portions of the SCAT3 and the K-D. Women in this cohort had higher total symptom and symptom severity scores compared to men. Our data also suggest that those with non-sports-related concussions have longer lasting symptoms than those with sports-related concussions, and that these two groups should perhaps be

A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions

Science.gov (United States)

Mucha, Anne; Collins, Michael W.; Elbin, R.J.; Furman, Joseph M.; Troutman-Enseki, Cara; DeWolf, Ryan M.; Marchetti, Greg; Kontos, Anthony P.

2014-01-01

Background Vestibular and ocular motor impairments and symptoms have been documented in patients with sport-related concussions. However, there is no current brief clinical screen to assess and monitor these issues. Purpose To describe and provide initial data for the internal consistency and validity of a brief clinical screening tool for vestibular and ocular motor impairments and symptoms after sport-related concussions. Study Design Cross-sectional study; Level of evidence, 2. Methods Sixty-four patients, aged 13.9 ± 2.5 years and seen approximately 5.5 ± 4.0 days after a sport-related concussion, and 78 controls were administered the Vestibular/Ocular Motor Screening (VOMS) assessment, which included 5 domains: (1) smooth pursuit, (2) horizontal and vertical saccades, (3) near point of convergence (NPC) distance, (4) horizontal vestibular ocular reflex (VOR), and (5) visual motion sensitivity (VMS). Participants were also administered the Post-Concussion Symptom Scale (PCSS). Results Sixty-one percent of patients reported symptom provocation after at least 1 VOMS item. All VOMS items were positively correlated to the PCSS total symptom score. The VOR (odds ratio [OR], 3.89; P concussed group. An NPC distance ≥5 cm and any VOMS item symptom score ≥2 resulted in an increase in the probability of correctly identifying concussed patients of 38% and 50%, respectively. Receiver operating characteristic curves supported a model including the VOR, VMS, NPC distance, and ln(age) that resulted in a high predicted probability (area under the curve = 0.89) for identifying concussed patients. Conclusion The VOMS demonstrated internal consistency as well as sensitivity in identifying patients with concussions. The current findings provide preliminary support for the utility of the VOMS as a brief vestibular/ocular motor screen after sport-related concussions. The VOMS may augment current assessment tools and may serve as a single component of a comprehensive approach

NIH Research on Concussion and the Brain | NIH MedlinePlus the Magazine

Science.gov (United States)

... of this page please turn JavaScript on. Feature: Concussion NIH Research on Concussion and the Brain Past Issues / Summer 2015 Table ... on injuries affecting athletes—with brain trauma, including concussions, being the primary area of focus. The National ...

Heads Up! Play it Safe When it Comes to Concussions

Centers for Disease Control (CDC) Podcasts

As many as 3.8 million sports- and recreation-related concussions are estimated to occur in the United States each year. This podcast is a radio interview with CDC's Dr. Julie Gilchrist on the newly available “Heads Up: Concussion in Youth Sports" tool kit, which was developed to provide information to coaches, parents, and athletes involved in youth sports on preventing, recognizing, and responding to a concussion.

Video incident analysis of concussions in boys' high school lacrosse.

Science.gov (United States)

Lincoln, Andrew E; Caswell, Shane V; Almquist, Jon L; Dunn, Reginald E; Hinton, Richard Y

2013-04-01

Boys' lacrosse has one of the highest rates of concussion among boys' high school sports. A thorough understanding of injury mechanisms and game situations associated with concussions in boys' high school lacrosse is necessary to target injury prevention efforts. To characterize common game-play scenarios and mechanisms of injury associated with concussions in boys' high school lacrosse using game video. Descriptive epidemiological study. In 25 public high schools of a single school system, 518 boys' lacrosse games were videotaped by trained videographers during the 2008 and 2009 seasons. Video of concussion incidents was examined to identify game characteristics and injury mechanisms using a lacrosse-specific coding instrument. A total of 34 concussions were captured on video. All concussions resulted from player-to-player bodily contact. Players were most often injured when contact was unanticipated or players were defenseless (n = 19; 56%), attempting to pick up a loose ball (n = 16; 47%), and/or ball handling (n = 14; 41%). Most frequently, the striking player's head (n = 27; 79%) was involved in the collision, and the struck player's head was the initial point of impact in 20 incidents (59%). In 68% (n = 23) of cases, a subsequent impact with the playing surface occurred immediately after the initial impact. A penalty was called in 26% (n = 9) of collisions. Player-to-player contact was the mechanism for all concussions. Most commonly, injured players were unaware of the pending contact, and the striking player used his head to initiate contact. Further investigation of preventive measures such as education of coaches and officials and enforcement of rules designed to prevent intentional head-to-head contact is warranted to reduce the incidence of concussions in boys' lacrosse.

Review of ankle inversion sprain simulators in the biomechanics laboratory

Directory of Open Access Journals (Sweden)

Sophia Chui-Wai Ha

2015-10-01

Full Text Available Ankle inversion ligamentous sprain is one of the most common sports injuries. The most direct way is to investigate real injury incidents, but it is unethical and impossible to replicate on test participants. Simulators including tilt platforms, trapdoors, and fulcrum devices were designed to mimic ankle inversion movements in laboratories. Inversion angle was the only element considered in early designs; however, an ankle sprain is composed of inversion and plantarflexion in clinical observations. Inversion velocity is another parameter that increased the reality of simulation. This review summarised the simulators, and aimed to compare and contrast their features and settings.

The Role of a School Psychologist in Concussion

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Lewandowski, Lawrence J.; Rieger, Brian

2009-01-01

School psychologists historically have received little training on topics such as mild traumatic brain injury or concussion, yet they could play a significant role in assessment, consultation, and intervention with students who have sustained a concussion. The purpose of this article is to educate school psychologists with regard to definition,…

States Address Concerns about Concussions in Youth Sports

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Kreck, Carol

2014-01-01

Education Commission of the States (ECS) reviewed legislation in the 50 states to see how state leaders are responding to concerns about concussions in youth sports. This report reviews state responses to concussion concerns, and provides examples of provisions put in place by California, Connecticut, and Texas. Three emerging innovations are…

Understanding and treating lateral ankle sprains and their consequences: a constraints-based approach.

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Wikstrom, Erik A; Hubbard-Turner, Tricia; McKeon, Patrick O

2013-06-01

Lateral ankle sprains are a common consequence of physical activity. If not managed appropriately, a cascade of negative alterations to both the joint structure and a person's movement patterns continue to stress the injured ligaments. These alterations result in an individual entering a continuum of disability as evidenced by the ~30 % of ankle sprains that develop into chronic ankle instability (CAI) and up to 78 % of CAI cases that develop into post-traumatic ankle osteoarthritis (OA). Despite this knowledge, no significant improvements in treatment efficacy have been made using traditional treatment paradigms. Therefore, the purpose of this review is to (1) provide an overview of the consequences associated with acute lateral ankle sprains, CAI and post-traumatic ankle OA; (2) introduce the patient-, clinician-, laboratory (PCL)-oriented) model that addresses the lateral ankle sprains and their consequences from a constraints perspective; and (3) introduce the dynamic systems theory as the framework to illustrate how multiple post-injury adaptations create a singular pathology that predisposes individuals with lateral ankle sprains to fall into a continuum of disability. The consequences associated with lateral ankle sprains, CAI and ankle OA are similar and encompass alterations to the structure of the ankle joint (e.g. ligament laxity, positional faults, etc.) and the sensorimotor function responsible for proper ankle joint function (e.g. postural control, gait, etc.). Further, the impairments have been quantified across a range of patient-oriented (e.g. self-report questionnaires), clinician-oriented (e.g. bedside measures of range of motion and postural control), and laboratory-oriented (e.g. arthrometry, gait analysis) outcome measures. The interaction of PCL-oriented outcomes is critically important for understanding the phenomenon of CAI across the continuum of disability. Through the integration of all three sources of evidence, we can clearly see that

Acute Ankle Sprain in a Mouse Model: Changes in Knee-Joint Space.

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Hubbard-Turner, Tricia; Wikstrom, Erik A; Guderian, Sophie; Turner, Michael J

2017-06-02

  Ankle sprains remain the most common orthopaedic injury. Conducting long-term studies in humans is difficult and costly, so the long-term consequences of an ankle sprain are not entirely known.   To measure knee-joint space after a single surgically induced ankle sprain in mice.   Randomized controlled trial.   University research laboratory.   Thirty male mice (CBA/2J) were randomly placed into 1 of 3 surgical groups: the transected calcaneofibular ligament (CFL) group, the transected anterior talofibular ligament/CFL group, or a sham treatment group. The right ankle was operated on in all mice.   Three days after surgery, all of the mice were individually housed in cages containing a solid-surface running wheel, and daily running-wheel measurements were recorded. Before surgery and every 6 weeks after surgery, a diagnostic ultrasound was used to measure medial and lateral knee-joint space in both hind limbs.   Right medial (P = .003), right lateral (P = .002), left medial (P = .03), and left lateral (P = .002) knee-joint spaces decreased across the life span. The mice in the anterior talofibular ligament/CFL group had decreased right medial (P = .004) joint space compared with the sham and CFL groups starting at 24 weeks of age and continuing throughout the life span. No differences occurred in contralateral knee-joint degeneration among any of the groups.   Based on current data, mice that sustained a surgically induced severe ankle sprain developed greater joint degeneration in the ipsilateral knee. Knee degeneration could result from accommodation to the laxity of the ankle or biomechanical alterations secondary to ankle instability. A single surgically induced ankle sprain could significantly affect knee-joint function.

Relationship Between Short Sleep Duration and Preseason Concussion Testing.

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Silverberg, Noah D; Berkner, Paul D; Atkins, Joseph E; Zafonte, Ross; Iverson, Grant L

2016-05-01

Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep. Cross-sectional observation study. Preseason concussion testing for high school athletes. A large sample (n = 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded. Athletes were divided into 4 groups based on their sleep duration the night before testing. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale. Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms. Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep. Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly.

Association Between History of Multiple Concussions and Health Outcomes Among Former College Football Players: 15-Year Follow-up From the NCAA Concussion Study (1999-2001).

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Kerr, Zachary Y; Thomas, Leah C; Simon, Janet E; McCrea, Michael; Guskiewicz, Kevin M

2018-06-01

Previous research has examined associations between concussion history and adverse health outcomes among former professional football players. Less is known about the potential effects of concussion among former college football players without additional exposure at the professional level. To examine the association between concussion and adverse health outcomes in a cohort of former college football players without exposure to professional football, 15 years after their playing careers ended. Cross-sectional study; Level of evidence, 3. A sample of 204 former collegiate football players (23.4% of eligible athletes with available contact information)-all of whom played at least 1 season of football from 1999 to 2001 in the National Collegiate Athletic Association (NCAA) and had no professional football exposure-completed a general health survey that assessed lifetime concussion history and included the following: the Veterans RAND 36 Item Health Survey, containing a physical composite score (PCS) and mental composite score (MCS); the depression module of the Patient Health Questionnaire; and the 4-item CAGE alcohol dependence questionnaire (for "cutting down, annoyance by criticism, guilty feeling, and eye-openers"). Multivariable binomial regression models estimated adjusted prevalence ratios (PRs) with 95% CIs while controlling for demographics and playing history covariates through forward selection model building. Most participants reported a concussion history (84.3%). Overall, 22.1% and 39.2% of participants reported a PCS and an MCS history of multiple concussions and adverse health outcomes were found among former collegiate football players without professional football exposure but were limited to those reporting ≥3 prior concussions. Because only 23.4% of eligible athletes responded to the survey, the possibility of ascertainment bias exists, and our findings should thus be interpreted with some caution. Continued examination within nonprofessional

Motor-neuron pool excitability of the lower leg muscles after acute lateral ankle sprain.

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Klykken, Lindsey W; Pietrosimone, Brian G; Kim, Kyung-Min; Ingersoll, Christopher D; Hertel, Jay

2011-01-01

Neuromuscular deficits in leg muscles that are associated with arthrogenic muscle inhibition have been reported in people with chronic ankle instability, yet whether these neuromuscular alterations are present in individuals with acute sprains is unknown. To compare the effect of acute lateral ankle sprain on the motor-neuron pool excitability (MNPE) of injured leg muscles with that of uninjured contralateral leg muscles and the leg muscles of healthy controls. Case-control study. Laboratory. Ten individuals with acute ankle sprains (6 females, 4 males; age= 19.2 ± 3.8 years, height= 169.4 ± 8.5 cm, mass= 66.3 ± 11.6 kg) and 10 healthy individuals(6 females,4 males; age= 20.6 ± 4.0 years, height = 169.9 ± 10.6 cm, mass= 66.3 ± 10.2 kg) participated. The independent variables were group (acute ankle sprain, healthy) and limb (injured, uninjured). Separate dependent t tests were used to determine differences in MNPE between legs. The MNPE of the soleus, fibularis longus, and tibialis anterior was measured by the maximal Hoffmann reflex (H(max)) and maximal muscle response (M(max)) and was then normalized using the H(max):M(max) ratio. The soleus MNPE in the ankle-sprain group was higher in the injured limb (H(max):M(max) = 0.63; 95% confidence interval [Cl],0.46, 0.80) than the uninjured limb (H(max):M(max) = 0.47; 95%Cl, 0.08, 0.93)(t(6) = 3.62,P =.01).In the acute ankle-sprain group, tibialis anterior MNPE tended to be lower in the injured ankle (H(max):M(max) =0.06; 95% Cl, 0.01, 0.10) than in the uninjured ankle (H(max):M(max) =0.22; 95%Cl, 0.09, 0.35),but this finding was not different (t(9) =-2.01, P =.07). No differences were detected between injured (0.22; 95% Cl, 0.14, 0.29) and uninjured (0.25; 95%Cl, 0.12, 0.38) ankles for the fibularis longus in the ankle-sprain group (t(9) =-0.739, P =.48). We found no side-to-side differences in any muscle among the healthy group. Facilitated MNPE was present in the involved soleus muscle of patients with acute

Psychiatric outcomes after pediatric sports-related concussion.

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Ellis, Michael J; Ritchie, Lesley J; Koltek, Mark; Hosain, Shahid; Cordingley, Dean; Chu, Stephanie; Selci, Erin; Leiter, Jeff; Russell, Kelly

2015-12-01

The objectives of this study were twofold: (1) to examine the prevalence of emotional symptoms among children and adolescents with a sports-related concussion (SRC) who were referred to a multidisciplinary pediatric concussion program and (2) to examine the prevalence, clinical features, risk factors, and management of postinjury psychiatric outcomes among those in this clinical population. The authors conducted a retrospective chart review of all patients with SRC referred to a multidisciplinary pediatric concussion program between September 2013 and October 2014. Clinical assessments carried out by a single neurosurgeon included clinical history, physical examination, and Post-Concussion Symptom Scale (PCSS) scoring. Postinjury psychiatric outcomes were defined as a subjective worsening of symptoms of a preinjury psychiatric disorder or new and isolated suicidal ideation or diagnosis of a novel psychiatric disorder (NPD). An NPD was defined as a newly diagnosed psychiatric disorder that occurred in a patient with or without a lifetime preinjury psychiatric disorder after a concussion. Clinical resources, therapeutic interventions, and clinical and return-to-play outcomes are summarized. One hundred seventy-four patients (mean age 14.2 years, 61.5% male) were included in the study. At least 1 emotional symptom was reported in 49.4% of the patients, and the median emotional PCSS subscore was 4 (interquartile range 1-8) among those who reported at least 1 emotional symptom. Overall, 20 (11.5%) of the patients met the study criteria for a postinjury psychiatric outcome, including 14 patients with an NPD, 2 patients with isolated suicidal ideation, and 4 patients with worsening symptoms of a preinjury psychiatric disorder. Female sex, a higher initial PCSS score, a higher emotional PCSS subscore, presence of a preinjury psychiatric history, and presence of a family history of psychiatric illness were significantly associated with postinjury psychiatric outcomes

COMPARISON OF PROPRIOCEPTIVE TRAINING OVER TECHNICAL TRAINING IN PREVENTION OF RECURRENT ANKLE SPRAIN AMONG PROFESSIONAL FOOTBALLERS

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Jibi Paul

2015-04-01

Full Text Available Background: Ankle sprain is one of the major causes of disability in professional footballers. Objective of this study was to find out the effectiveness and to compare the effectiveness of the proprioceptive training and technical training immediately after the end of the treatment and after three months follow up in prevention of recurrent ankle sprain among professional footballers. Methods: 30 subjects with previous history of grade I or grade II ankle sprain, within one year were selected for the study. They were randomly divided into two groups equally treadmill 15 in each group A and group B. Group A and B received five minutes of warm-up by brisk walk on treadmill. Group A and B underwent 20 minutes of unilateral balance board training and unilateral vertical jump respectively. Results: Pre and post data were analyzed using Mann-Whitney test, Wilcoxon’s sign rank test, paired‘t’ test. Intra group analysis showed that both groups have shown significant improvement with P < 0.001, after the treatment. Inter group were analyzed the post scores of both groups and found no significant difference on proprioceptive training over technical training on recurrence of ankle sprain among professional footballers. Conclusion: The study concluded that proprioceptive and technical training are equally effective on prevention of recurrent ankle sprain among professional footballers with previous history of grade I or grade II ankle sprain.

Assessment and management of sport-related concussions in United States high schools.

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Meehan, William P; d'Hemecourt, Pierre; Collins, Christy L; Comstock, R Dawn

2011-11-01

Little existing data describe which medical professionals and which medical studies are used to assess sport-related concussions in high school athletes. To describe the medical providers and medical studies used when assessing sport-related concussions. To determine the effects of medical provider type on timing of return to play, frequency of imaging, and frequency of neuropsychological testing. Descriptive epidemiology study. All concussions recorded by the High School Reporting Information Online (HS RIO) injury surveillance system during the 2009 to 2010 academic year were included. χ(2) analyses were conducted for categorical variables. Fisher exact test was used for nonparametric data. Logistic regression analyses were used when adjusting for potential confounders. Statistical significance was considered for P sport-related concussions, representing 14.6% of all injuries. Most (94.4%) concussions were assessed by athletic trainers (ATs), 58.8% by a primary care physician. Few concussions were managed by specialists. The assessment of 21.2% included computed tomography. Computerized neuropsychological testing was used for 41.2%. For 50.1%, a physician decided when to return the athlete to play; for 46.2%, the decision was made by an AT. After adjusting for potential confounders, no associations between timing of return to play and the type of provider (physician vs AT) deciding to return the athlete to play were found. Concussions account for nearly 15% of all sport-related injuries in high school athletes. The timing of return to play after a sport-related concussion is similar regardless of whether the decision to return the athlete to play is made by a physician or an AT. When a medical doctor is involved, most concussions are assessed by primary care physicians as opposed to subspecialists. Computed tomography is obtained during the assessment of 1 of every 5 concussions occurring in high school athletes.

Assessment and Management of Sport-Related Concussions in United States High Schools

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Meehan, William P.; d’Hemecourt, Pierre; Collins, Christy L.; Comstock, R. Dawn

2012-01-01

Background Little existing data describe which medical professionals and which medical studies are used to assess sport-related concussions in high school athletes. Purpose To describe the medical providers and medical studies used when assessing sport-related concussions. To determine the effects of medical provider type on timing of return to play, frequency of imaging, and frequency of neuropsychological testing. Study Design Descriptive epidemiology study. Methods All concussions recorded by the High School Reporting Information Online (HS RIO) injury surveillance system during the 2009 to 2010 academic year were included. χ2 analyses were conducted for categorical variables. Fisher exact test was used for nonparametric data. Logistic regression analyses were used when adjusting for potential confounders. Statistical significance was considered for P concussions, representing 14.6% of all injuries. Most (94.4%) concussions were assessed by athletic trainers (ATs), 58.8% by a primary care physician. Few concussions were managed by specialists. The assessment of 21.2% included computed tomography. Computerized neuropsychological testing was used for 41.2%. For 50.1%, a physician decided when to return the athlete to play; for 46.2%, the decision was made by an AT. After adjusting for potential confounders, no associations between timing of return to play and the type of provider (physician vs AT) deciding to return the athlete to play were found. Conclusion Concussions account for nearly 15% of all sport-related injuries in high school athletes. The timing of return to play after a sport-related concussion is similar regardless of whether the decision to return the athlete to play is made by a physician or an AT. When a medical doctor is involved, most concussions are assessed by primary care physicians as opposed to subspecialists. Computed tomography is obtained during the assessment of 1 of every 5 concussions occurring in high school athletes. PMID:21969181

Analysis of the Effects of Normal Walking on Ankle Joint Contact Characteristics After Acute Inversion Ankle Sprain.

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Bae, Ji Yong; Park, Kyung Soon; Seon, Jong Keun; Jeon, Insu

2015-12-01

To show the causal relationship between normal walking after various lateral ankle ligament (LAL) injuries caused by acute inversion ankle sprains and alterations in ankle joint contact characteristics, finite element simulations of normal walking were carried out using an intact ankle joint model and LAL injury models. A walking experiment using a volunteer with a normal ankle joint was performed to obtain the boundary conditions for the simulations and to support the appropriateness of the simulation results. Contact pressure and strain on the talus articular cartilage and anteroposterior and mediolateral translations of the talus were calculated. Ankles with ruptured anterior talofibular ligaments (ATFLs) had a higher likelihood of experiencing increased ankle joint contact pressures, strains and translations than ATFL-deficient ankles. In particular, ankles with ruptured ATFL + calcaneofibular ligaments and all ruptured ankles had a similar likelihood as the ATFL-ruptured ankles. The push off stance phase was the most likely situation for increased ankle joint contact pressures, strains and translations in LAL-injured ankles.

Concussion and the Young Athlete: Critical Management Strategies

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Faure, Caroline; Pemberton, Cynthia Lee A.

2010-01-01

One in six high school football players in the United States will sustain a concussion at some point during their playing career. The consequences of concussion can be catastrophic, especially since the symptoms are rarely visible and often overlooked. To ensure the safety of athletes in youth and interscholastic sports programs, having Certified…

Australian Football League concussion guidelines: what do community players think?

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White, Peta E; Donaldson, Alex; Sullivan, S John; Newton, Joshua

2016-01-01

Background Preventing concussion in sport is a global challenge. To assess community-level adult male Australian Football players’ views on following the Australian Football League's (AFL) concussion guidelines. Methods 3 focus groups, each comprising 6 players from 1 regional league, were conducted until saturation of issues raised. Discussions followed a semistructured script and were audio-recorded and transcribed verbatim. Thematic analysis was conducted by 2 coders independently. Results Identified advantages of the guidelines included highlighting the seriousness of concussion; changing the culture around playing with concussion and shifting return-to-play decision responsibility from players to others. Disadvantages included players being removed from play unnecessarily; removal of players’ rights to decide if they are fit to play and players changing their behaviours to avoid being removed from play. Identified facilitators to guideline use included local league enforcement; broad information dissemination and impartial medically trained staff to assess concussion. Identified barriers to guideline use included players’ desire to play at all costs; external pressure that encouraged players to return to play prematurely; and inconvenience and cost. Conclusions Players generally understand that the AFL concussion guidelines protect their long-term welfare. However, their desire to play at all costs and help their team win is a common barrier to reporting concussion and adhering to guidelines. Leagues should take a lead role by mandating and enforcing the use of the guidelines and educating coaches, game day medical providers and players. The return-to-play component of the guidelines is complex and needs further consideration in the context of community sport. PMID:28890801

Exploring Gaps in Concussion Knowledge and Knowledge Translation Among Coaches of Youth Female Hockey.

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Guo, David; Verweel, Lee; Reed, Nick

2017-10-27

To better understand the level of concussion knowledge of youth female hockey coaches and to identify preferred methods of knowledge translation for this population. Cross-sectional survey. Participants independently completed written surveys before in-person concussion information sessions or online surveys through link provided in emails. Convenience sampling yielded 130 coaches of youth female hockey from Canada. Knowledge level on concussion, resources from which coaches obtained information on concussion, opinions on the current level of concussion knowledge, and knowledge translation. Coaches demonstrated adequate knowledge on concussion, achieving 84% correct on true-false questions and 92% correct on symptom identification accuracy. However, coaches showed limited awareness of concussion specific to mechanisms for injury (identification) and postconcussion symptoms. Internet resources were rated as the most used resources for concussion yet were not rated very helpful. Nonetheless, coaches indicated online courses and web sites as the most preferred method for concussion knowledge translation. Youth female hockey coaches have overall adequate knowledge of concussion; however, gaps in knowledge do exist. Future efforts to raise the concussion knowledge among coaches of female youth hockey should include information specific to the mechanism of injury, along with sign and symptom identification, with particular attention paid to emotional symptoms. Given the reported preferences and the widespread availability of the Internet, further exploration and research validation of online courses and web sites tailored to the youth female hockey community is encouraged.

Ankle inversion taping using kinesiology tape for treating medial ankle sprain in an amateur soccer player

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Lee, Sun-Min; Lee, Jung-Hoon

2015-01-01

[Purpose] The purpose of this study was to report the effects of ankle inversion taping using kinesiology tape in a patient with a medial ankle sprain. [Subject] A 28-year-old amateur soccer player suffered a Grade 2 medial ankle sprain during a match. [Methods] Ankle inversion taping was applied to the sprained ankle every day for 2 months. [Results] His symptoms were reduced after ankle inversion taping application for 2 months. The self-reported function score, the reach distances in the S...

First-Time Sports-Related Concussion Recovery: The Role of Sex, Age, and Sport.

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Neidecker, John M; Gealt, David B; Luksch, John R; Weaver, Martin D

2017-10-01

Concussion is one of the most common injuries in athletes. Current concussion consensus statements propose that female sex may be a modifying factor in concussion management and recovery. To determine whether female athletes in middle school and high school with a first-time, sports-related concussion remained symptomatic longer than their male counterparts. A retrospective medical record analysis was performed among athletes who sustained a concussion between 2011 and 2013. Inclusion criteria consisted of age between 11 and 18 years and diagnosis of first-time concussion sustained while playing organized sports. Using the documented notes in the medical record, length of time that each athlete was symptomatic from his or her concussion was calculated. A total of 110 male and 102 female athletes (N=212) met the eligibility criteria for the study. A significant difference was found in the median number of days female athletes remained symptomatic (28 days) when compared with male athletes (11 days) (Psports played. Female athletes aged 11 to 18 years with first-time, sports-related concussions remained symptomatic for a longer period when compared with male athletes of similar age, regardless of sport played. The mechanism behind this difference needs to be further elucidated.

Chronic daily headache in U.S. soldiers after concussion.

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Theeler, Brett J; Flynn, Frederick G; Erickson, Jay C

2012-05-01

To determine the prevalence and characteristics of, and factors associated with, chronic daily headache (CDH) in U.S. soldiers after a deployment-related concussion. A cross-sectional, questionnaire-based study was conducted with a cohort of 978 U.S. soldiers who screened positive for a deployment-related concussion upon returning from Iraq or Afghanistan. All soldiers underwent a clinical evaluation at the Madigan Traumatic Brain Injury Program that included a history, physical examination, 13-item self-administered headache questionnaire, and a battery of cognitive and psychological assessments. Soldiers with CDH, defined as headaches occurring on 15 or more days per month for the previous 3 months, were compared to soldiers with episodic headaches occurring less than 15 days per month. One hundred ninety-six of 978 soldiers (20%) with a history of deployment-related concussion met criteria for CDH and 761 (78%) had episodic headache. Soldiers with CDH had a median of 27 headache days per month, and 46/196 (23%) reported headaches occurring every day. One hundred seven out of 196 (55%) soldiers with CDH had onset of headaches within 1 week of head trauma and thereby met the time criterion for posttraumatic headache (PTHA) compared to 253/761 (33%) soldiers with episodic headache. Ninety-seven out of 196 (49%) soldiers with CDH used abortive medications to treat headache on 15 or more days per month for the previous 3 months. One hundred thirty out of 196 (66%) soldiers with CDH had headaches meeting criteria for migraine compared to 49% of soldiers with episodic headache. The number of concussions, blast exposures, and concussions with loss of consciousness was not significantly different between soldiers with and without CDH. Cognitive performance was also similar for soldiers with and without CDH. Soldiers with CDH had significantly higher average scores on the posttraumatic stress disorder (PTSD) checklist compared to soldiers with episodic headaches. Forty

Dazed and confused: sports medicine, conflicts of interest, and concussion management.

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Partridge, Brad

2014-03-01

Professional sports with high rates of concussion have become increasingly concerned about the long-term effects of multiple head injuries. In this context, return-to-play decisions about concussion generate considerable ethical tensions for sports physicians. Team doctors clearly have an obligation to the welfare of their patient (the injured athlete) but they also have an obligation to their employer (the team), whose primary interest is typically success through winning. At times, a team's interest in winning may not accord with the welfare of an injured player, particularly when it comes to decisions about returning to play after injury. Australia's two most popular professional football codes-rugby league and Australian Rules football-have adopted guidelines that prohibit concussed players from continuing to play on the same day. I suggest that conflicts of interest between doctors, patients, and teams may present a substantial obstacle to the proper adherence of concussion guidelines. Concussion management guidelines implemented by a sport's governing body do not necessarily remove or resolve conflicts of interest in the doctor-patient-team triad. The instigation of a concussion exclusion rule appears to add a fourth party to this triad (the National Rugby League or the Australian Football League). In some instances, when conflicts of interest among stakeholders are ignored or insufficiently managed, they may facilitate attempts at circumventing concussion management guidelines to the detriment of player welfare.

Effects of Two Concussions on the Neuropsychological Functioning and Symptom Reporting of High School Athletes.

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Tsushima, William T; Geling, Olga; Arnold, Monica; Oshiro, Ross

2016-01-01

To assess the effects of two sports-related concussions on neuropsychological functioning and symptom reporting, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was administered to 483 high school athletes. Three groups of athletes were determined based on the number of previous concussions: no concussion (n = 409), 1 concussion (n = 58), and 2 concussions (n = 16). The results showed that the three groups did not differ in terms of their ImPACT composite scores (Verbal Memory, Visual Memory, Reaction Time, and Processing Speed) and the Total Symptom Score. As there are only a few studies that have reported the sequelae of 2 concussions in high school athletes, it is premature to declare that a repeated concussion does not have persistent neurocognitive effects on high school athletes.

Relationship between concussion history and neurocognitive test performance in National Football League draft picks.

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Solomon, Gary S; Kuhn, Andrew

2014-04-01

There are limited empirical data available regarding the relationship between concussion history and neurocognitive functioning in active National Football League (NFL) players in general and NFL draft picks in particular. Potential NFL draft picks undergo 2 neurocognitive tests at the National Invitational Camp (Scouting Combine) every year: the Wonderlic and, since 2011, the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). After conclusion of the combine and before the draft, NFL teams invite potential draft picks to their headquarters for individual visits where further assessment may occur. To examine the relationship between concussion history and neurocognitive performance (ImPACT and Wonderlic) in a sample of elite NFL draft picks. Cohort study; Level of evidence, 3. Over 7 years, 226 potential draft picks were invited to visit a specific NFL team's headquarters after the combine. The athletes were divided into 3 groups based on self-reported concussion history: no prior concussions, 1 prior concussion, and 2 or more prior concussions. Neurocognitive measures of interest included Wonderlic scores (provided by the NFL team) and ImPACT composite scores (administered either at the combine or during a visit to the team headquarters). The relationship between concussion history and neurocognitive scores was assessed, as were the relationships among the 2 neurocognitive tests. Concussion history had no relationship to neurocognitive performance on either the Wonderlic or ImPACT. Concussion history did not affect performance on either neurocognitive test, suggesting that for this cohort, a history of concussion may not have adverse effects on neurocognitive functioning as measured by these 2 tests. This study reveals no correlation between concussion history and neurocognitive test scores (ImPACT, Wonderlic) in soon-to-be active NFL athletes.

Relationship of collegiate football experience and concussion with hippocampal volume and cognitive outcomes.

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Singh, Rashmi; Meier, Timothy B; Kuplicki, Rayus; Savitz, Jonathan; Mukai, Ikuko; Cavanagh, LaMont; Allen, Thomas; Teague, T Kent; Nerio, Christopher; Polanski, David; Bellgowan, Patrick S F

2014-05-14

Concussion and subconcussive impacts have been associated with short-term disrupted cognitive performance in collegiate athletes, but there are limited data on their long-term neuroanatomic and cognitive consequences. To assess the relationships of concussion history and years of football experience with hippocampal volume and cognitive performance in collegiate football athletes. Cross-sectional study conducted between June 2011 and August 2013 at a US psychiatric research institute specializing in neuroimaging among collegiate football players with a history of clinician-diagnosed concussion (n = 25), collegiate football players without a history of concussion (n = 25), and non-football-playing, age-, sex-, and education-matched healthy controls (n = 25). History of clinician-diagnosed concussion and years of football experience. High-resolution anatomical magnetic resonance imaging was used to quantify brain volumes. Baseline scores on a computerized concussion-related cognitive battery were used for cognitive assessment in athletes. Players with and without a history of concussion had smaller hippocampal volumes relative to healthy control participants (with concussion: t48 = 7.58; P history of concussion had smaller hippocampal volumes than players without concussion (t48 = 3.15; P football played (t46 = -3.62; P history on 5 cognitive measures but did show an inverse correlation between years of playing football and reaction time (ρ42 = -0.43; 95% CI, -0.46 to -0.40; P = .005). Among a group of collegiate football athletes, there was a significant inverse relationship of concussion and years of football played with hippocampal volume. Years of football experience also correlated with slower reaction time. Further research is needed to determine the temporal relationships of these findings.

Concussion guidelines step 1: systematic review of prevalent indicators.

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Carney, Nancy; Ghajar, Jamshid; Jagoda, Andy; Bedrick, Steven; Davis-OʼReilly, Cynthia; du Coudray, Hugo; Hack, Dallas; Helfand, Nora; Huddleston, Amy; Nettleton, Tracie; Riggio, Silvana

2014-09-01

Currently, there is no evidence-based definition for concussion that is being uniformly applied in clinical and research settings. To conduct a systematic review of the highest-quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion. The goal was to establish an evidence-based foundation from which to derive, in future work, a definition, diagnostic criteria, and prognostic indicators for concussion. Key questions were developed, and an electronic literature search from 1980 to 2012 was conducted to acquire evidence about the prevalence of and associations among signs, symptoms, and neurologic and cognitive deficits in samples of individuals exposed to potential concussive events. Included studies were assessed for potential for bias and confound and rated as high, medium, or low potential for bias and confound. Those rated as high were excluded from the analysis. Studies were further triaged on the basis of whether the definition of a case of concussion was exclusive or inclusive; only those with wide, inclusive case definitions were used in the analysis. Finally, only studies reporting data collected at fixed time points were used. For a study to be included in the conclusions, it was required that the presence of any particular sign, symptom, or deficit be reported in at least 2 independent samples. From 5437 abstracts, 1362 full-text publications were reviewed, of which 231 studies were included in the final library. Twenty-six met all criteria required to be used in the analysis, and of those, 11 independent samples from 8 publications directly contributed data to conclusions. Prevalent and consistent indicators of concussion are (1) observed and documented disorientation or confusion immediately after the event, (2) impaired balance within 1 day after injury, (3) slower reaction time within 2 days after injury, and/or (4) impaired verbal learning and memory within 2 days after injury

National Football League concussions from 2009 – 2015: A secondary data analysis.

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Kelly, E.

2017-07-01

Full Text Available In recent years, the National Football League (NFL has made an effort to lower the prevalence of concussions, partially by enacting rule changes designed to limit contact to the head. This study aims to determine whether NFL rule changes from 2009 – 2015 have resulted in a decrease in the number of reported concussions through analyzing publicly available injury reports, which were compared with rule changes for each season. A second component of the study aims to determine whether teams are underreporting the number of concussions suffered by gathering concussion data for each team. This study found that there was a general increase in the number of concussions from 2009 – 2015 and it is not possible to determine whether rule changes are effective in decreasing head impact exposure. This study also found that certain teams reported a significantly low number of concussions throughout the years analyzed, and underreporting is likely occurring.

Spontaneous nervous system concussion in dogs: A description of ...

African Journals Online (AJOL)

In human medicine, central nervous system (CNS) concussion is defined as a transient neurological dysfunction following a traumatic event, without evidence of structural abnormalities of the affected region on advanced diagnostic imaging. Depending on the anatomical region involved, three forms of concussive ...

Multidisciplinary Management of Pediatric Sports-Related Concussion.

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Ellis, Michael J; Ritchie, Lesley J; McDonald, Patrick J; Cordingley, Dean; Reimer, Karen; Nijjar, Satnam; Koltek, Mark; Hosain, Shahid; Johnston, Janine; Mansouri, Behzad; Sawyer, Scott; Silver, Norm; Girardin, Richard; Larkins, Shannon; Vis, Sara; Selci, Erin; Davidson, Michael; Gregoire, Scott; Sam, Angela; Black, Brian; Bunge, Martin; Essig, Marco; MacDonald, Peter; Leiter, Jeff; Russell, Kelly

2017-01-01

To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.

Concussion in sport: what is known and what is new? | Grant | South ...

African Journals Online (AJOL)

The aim of this article was to summarise the latest definition of concussion, signs of concussion, as well as important facts on recovery and graduated return to play, for different age groups. New technologies available to the sports physician are listed. Keywords: concussion, diagnosis, return to play, signs ...

[Forensic application of brainstem auditory evoked potential in patients with brain concussion].

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Zheng, Xing-Bin; Li, Sheng-Yan; Huang, Si-Xing; Ma, Ke-Xin

2008-12-01

To investigate changes of brainstem auditory evoked potential (BAEP) in patients with brain concussion. Nineteen patients with brain concussion were studied with BAEP examination. The data was compared to the healthy persons reported in literatures. The abnormal rate of BAEP for patients with brain concussion was 89.5%. There was a statistically significant difference between the abnormal rate of patients and that of healthy persons (Pconcussion was 73.7%, indicating dysfunction of the brainstem in those patients. BAEP might be helpful in forensic diagnosis of brain concussion.

An Acute Lateral Ankle Sprain Significantly Decreases Physical Activity across the Lifespan

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Tricia Hubbard-Turner, Erik A. Wikstrom, Sophie Guderian, Michael J. Turner

2015-09-01

Full Text Available We do not know the impact an ankle sprain has on physical activity levels across the lifespan. With the negative consequences of physical inactivity well established, understanding the effect of an ankle sprain on this outcome is critical. The objective of this study was to measure physical activity across the lifespan after a single ankle sprain in an animal model. Thirty male mice (CBA/J were randomly placed into one of three groups: the transected calcaneofibular ligament (CFL group, the transected anterior talofibular ligament (ATFL/CFL group, and a SHAM group. Three days after surgery, all of the mice were individually housed in a cage containing a solid surface running wheel. Physical activity levels were recorded and averaged every week across the mouse’s lifespan. The SHAM mice ran significantly more distance each day compared to the remaining two running groups (post hoc p = 0.011. Daily duration was different between the three running groups (p = 0.048. The SHAM mice ran significantly more minutes each day compared to the remaining two running groups (post hoc p=0.046 while the ATFL/CFL mice ran significantly less minutes each day (post hoc p = 0.028 compared to both the SHAM and CFL only group. The SHAM mice ran at a faster daily speed versus the remaining two groups of mice (post hoc p = 0.019 and the ATFL/CFL mice ran significantly slower each day compared to the SHAM and CFL group (post hoc p = 0.005. The results of this study indicate that a single ankle sprain significantly decreases physical activity across the lifespan in mice. This decrease in physical activity can potentially lead to the development of numerous chronic diseases. An ankle sprain thus has the potential to lead to significant long term health risks if not treated appropriately.

Inadequate Helmet Fit Increases Concussion Severity in American High School Football Players

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Greenhill, Dustin A.; Navo, Paul; Zhao, Huaqing; Torg, Joseph; Comstock, R. Dawn; Boden, Barry P.

2016-01-01

Background: There is limited information on the relationship between football helmet fit and concussion severity. Hypothesis: Poor helmet fit may predispose football players to a more severe concussion. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: Data from concussion injury reports were obtained from the National High School Sports-Related Injury Surveillance System over a 9-year period. Symptoms, duration, and helmet parameters (fit, interior padding) were analyzed for all first-time concussions. Results: Data from 4580 concussions were analyzed. Patients who suffered concussions with a helmet that did not fit properly (3.22%), as determined by an athletic trainer, had higher rates of drowsiness (RR, 1.46; P = 0.005), hyperexcitability (RR, 2.38; P = 0.047), and sensitivity to noise (RR, 1.88; P < 0.001); had more symptoms (5.34 vs 4.54, P = 0.004); and had longer symptom duration (P = 0.04). Athletes with helmets lined with an air bladder had greater rates of sensitivity to light (RR, 1.13; P = 0.02), sensitivity to noise (RR, 1.25; P = 0.009), and longer symptom duration (P = 0.004) compared with foam or gel liners. Conclusion: An improperly fitted football helmet is a risk factor for a concussion with more symptoms and of longer duration. Concussions of longer duration are also more common in players with an air bladder–lined helmet. Current high school football rules should mandate supervision and maintenance of helmet fit throughout the season, prior to impact. Clinical Relevance: Team physicians, athletic trainers, coaches, and high school officials should ensure proper oversight of helmet fit in high school athletes to decrease concussion severity and duration. PMID:27005467

Using Balance Tests to Discriminate Between Participants With a Recent Index Lateral Ankle Sprain and Healthy Control Participants: A Cross-Sectional Study.

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Pourkazemi, Fereshteh; Hiller, Claire; Raymond, Jacqueline; Black, Deborah; Nightingale, Elizabeth; Refshauge, Kathryn

2016-03-01

The first step to identifying factors that increase the risk of recurrent ankle sprains is to identify impairments after a first sprain and compare performance with individuals who have never sustained a sprain. Few researchers have restricted recruitment to a homogeneous group of patients with first sprains, thereby introducing the potential for confounding. To identify impairments that differ in participants with a recent index lateral ankle sprain versus participants with no history of ankle sprain. Cross-sectional study. We recruited a sample of convenience from May 2010 to April 2013 that included 70 volunteers (age = 27.4 ± 8.3 years, height = 168.7 ± 9.5 cm, mass = 65.0 ± 12.5 kg) serving as controls and 30 volunteers (age = 31.1 ± 13.3 years, height = 168.3 ± 9.1 cm, mass = 67.3 ± 13.7 kg) with index ankle sprains. We collected demographic and physical performance variables, including ankle-joint range of motion, balance (time to balance after perturbation, Star Excursion Balance Test, foot lifts during single-legged stance, demi-pointe balance test), proprioception, motor planning, inversion-eversion peak power, and timed stair tests. Discriminant analysis was conducted to determine the relationship between explanatory variables and sprain status. Sequential discriminant analysis was performed to identify the most relevant variables that explained the greatest variance. The average time since the sprain was 3.5 ± 1.5 months. The model, including all variables, correctly predicted a sprain status of 77% (n = 23) of the sprain group and 80% (n = 56) of the control group and explained 40% of the variance between groups ([Formula: see text] = 42.16, P = .03). Backward stepwise discriminant analysis revealed associations between sprain status and only 2 tests: Star Excursion Balance Test in the anterior direction and foot lifts during single-legged stance ([Formula: see text] = 15.2, P = .001). These 2 tests explained 15% of the between-groups variance

Investigation of the Concussion Goggle™ Education Program with Secondary School Athletic Teams: A Pilot Study

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Ellen K. Payne

2017-04-01

Full Text Available Background: Researchers have investigated different types of concussion education programs within various populations with mixed results. To date, no research has been published using the Concussion Goggles™ educational program Objective: To compare secondary school student-athletes’ knowledge about concussions before and after attending a concussion education program using the Concussion Goggles™. Design: Pre- posttest. Setting: Public secondary school. Patients or Other Participants: 41 secondary school students (14 girls soccer players, 14 boys basketball players, and 13 girls basketball players with a mean age of 15.37 ± 1.22 years. Intervention(s: Participants completed the Concussion Goggles™ concussion educational program consisting of PowerPoint slides with 3 activities and short video segments within the presentation. Participants completed a test developed by the manufacturers of the Concussion Goggles™ educational program prior to and following the intervention to measure change in concussion knowledge. Main Outcome Measure(s: A 3-way mixed factorial analysis of variance (sport x grade level x gender for repeated measures was utilized to determine statistical significance. Results: A statistically significant difference between the overall pretest (9.37 ± 1.20 and posttest (9.63 ± 1.04 scores was not found (p = 0.28. Repeated measures analysis did not indicate significant interaction effects for test score x grade (p = 0.18, test score x sport (p = 0.63, nor test score x grade x sport (p = 0.96. Conclusion: The Concussion Goggle™ education program did not affect participant knowledge of concussions in the posttest. In its current form, the Concussion Goggle™ program may not be an effective concussion education program.

Heart Rate Variability of Athletes Across Concussion Recovery Milestones: A Preliminary Study.

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Senthinathan, Arrani; Mainwaring, Lynda M; Hutchison, Michael

2017-05-01

To assess heart rate variability (HRV) in athletes with concussion across three phases of recovery. A prospective matched control group design included the collection of HRV and symptoms measured by the Rivermead Post-Concussion Questionnaire. These measures were taken at 3 phases of recovery [(1) symptomatic; (2). asymptomatic; and (3) one-week after return-to-play (RTP)]. The same protocol was completed by noninjured athletes. Interuniversity sports teams at a single institution. 11 athletes, across 7 sports, diagnosed with concussion, and 11 matched-athlete controls volunteered for the study. Physician diagnosed concussion and a sitting to standing protocol for HRV monitoring. The frequency, time, and nonlinear domains of HRV were assessed along with the absolute difference between sitting and standing for each. A 2 x 3 (group x phase) repeated-measures analysis of variance revealed significant interactions for sitting High Frequency (HF) norm, sitting Low Frequency (LF) norm, the difference between sitting and standing HF norm, and difference between sitting and standing LF norm. Acutely, athletes with concussion displayed increased LF norm and decreased HF norm while sitting and a decreased change in their HF and LF norm measures between sitting and standing. A significant group effect for sample entropy when standing was detected, with the concussed group displaying decreased values compared with the matched controls. Athletes with concussion displayed autonomic dysfunction in some measures of HRV that persisted beyond RTP and were related to a previous history of concussion.

Concussions are associated with decreased batting performance among Major League Baseball players.

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Wasserman, Erin B; Abar, Beau; Shah, Manish N; Wasserman, Daniel; Bazarian, Jeffrey J

2015-05-01

Concussions impair balance, visual acuity, and reaction time--all of which are required for high-level batting performance--but the effects of concussion on batting performance have not been reported. The authors examined this relationship between concussion and batting performance among Major League Baseball (MLB) players. Batting performance among concussed MLB players will be worse upon return to play than batting performance among players missing time for noninjury reasons. Cohort study; Level of evidence, 3. The authors identified MLB players who sustained a concussion between 2007 and 2013 through league disabled-list records and a Baseball Prospectus database. For a comparison group, they identified players who went on paternity or bereavement leave during the same period. Using repeated-measures generalized linear models, the authors compared 7 batting metrics between the 2 groups for the 2 weeks upon return, as well as 4 to 6 weeks after return, controlling for pre-leave batting metrics, number of days missed, and position. The authors identified 66 concussions and 68 episodes of bereavement/paternity leave to include in the analysis. In the 2 weeks after return, batting average (.235 vs .266), on-base percentage (.294 vs .326), slugging percentage (.361 vs .423), and on-base plus slugging (.650 vs .749) were significantly lower among concussed players relative to the bereavement/paternity leave players (time×group interaction, Pperformance after concussion is adversely affected and to identify better measures to use for return-to-play decisions. © 2015 The Author(s).

A knock to the system: A new sociotechnical systems approach to sport-related concussion.

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Clacy, Amanda; Goode, Natassia; Sharman, Rachael; Lovell, Geoff P; Salmon, Paul M

2017-11-01

Broader contextual factors that influence concussion management have tended to be overlooked. To address this, the present study used a sociotechnical systems approach to identify perceived responsibilities and applied strategies for three domains of concussion management (i.e., prevention, identification and treatment). Participants were 118 members of the community rugby union system in Australia (69.2% male). Participants from throughout the rugby system (e.g., players, parents, coaches, club management) were asked open-ended questions about their perceived responsibilities and the strategies they use for concussion management. It was found that (a) proper training, technique correction and education were recurrent prevention themes; (b) the majority of key stakeholders felt that they could consistently identify concussion; however, medical aids (medics) were the only system actors who stated a responsibility to use standardised concussion assessment measures and (c) less than one third of the respondents indicated their involvement in treating concussion. This study identifies specific junctures in the system that prevents effective concussion management strategies. A sociotechnical systems approach improves the understanding of concussion prevention, and management beliefs and behaviours.

Nuclear Medicine Imaging in Concussive Head Injuries in Sports

NARCIS (Netherlands)

Vállez Garcia, David; Otte, Andreas; Glaudemans, Andor WJM; Dierckx, Rudi AJO; Gielen, Jan LMA; Zwerver, Johannes

2015-01-01

Concussions in sports and during recreational activities are a major source of traumatic brain injury in our society. This is mainly relevant in adolescence and young adulthood, where the annual rate of diagnosed concussions is increasing from year to year. Contact sports (e.g., ice hockey, American

A multi-modal approach to assessing recovery in youth athletes following concussion.

Science.gov (United States)

Reed, Nick; Murphy, James; Dick, Talia; Mah, Katie; Paniccia, Melissa; Verweel, Lee; Dobney, Danielle; Keightley, Michelle

2014-09-25

Concussion is one of the most commonly reported injuries amongst children and youth involved in sport participation. Following a concussion, youth can experience a range of short and long term neurobehavioral symptoms (somatic, cognitive and emotional/behavioral) that can have a significant impact on one's participation in daily activities and pursuits of interest (e.g., school, sports, work, family/social life, etc.). Despite this, there remains a paucity in clinically driven research aimed specifically at exploring concussion within the youth sport population, and more specifically, multi-modal approaches to measuring recovery. This article provides an overview of a novel and multi-modal approach to measuring recovery amongst youth athletes following concussion. The presented approach involves the use of both pre-injury/baseline testing and post-injury/follow-up testing to assess performance across a wide variety of domains (post-concussion symptoms, cognition, balance, strength, agility/motor skills and resting state heart rate variability). The goal of this research is to gain a more objective and accurate understanding of recovery following concussion in youth athletes (ages 10-18 years). Findings from this research can help to inform the development and use of improved approaches to concussion management and rehabilitation specific to the youth sport community.

Returning to School after a Concussion: Facilitating Problem Solving through Effective Communication

Science.gov (United States)

Bradley-Klug, Kathy L.; Garofano, Jeffrey; Lynn, Courtney; DeLoatche, Kendall Jeffries; Lam, Gary Yu Hin

2015-01-01

Concussions are a major public health concern in the United States, especially among children and adolescents. Although there is a growing body of literature regarding the underlying physiologic processes that occur after a concussion, there is no consensus regarding the risk factors for a concussion or the reasons for significant differences in…

Balance assessment in the management of sport-related concussion.

Science.gov (United States)

Guskiewicz, Kevin M

2011-01-01

Although neuropsychological testing has proven to be a valuable tool in concussion management, it is most useful when administered as part of a comprehensive assessment battery that includes grading of symptoms and clinical balance tests. A thorough sideline and clinical examination by the certified athletic trainer and team physician is considered an important first step in the management of concussion. The evaluation should be conducted in a systematic manner, whether on the field or in the clinical setting. The evaluation should include obtaining a history for specific details about the injury (eg, mechanism, symptomatology, concussion history), followed by assessing neurocognitive function and balance, which is the focus of this article. The objective measures from balance testing can provide clinicians with an additional piece of the concussion puzzle, remove some of the guesswork in uncovering less obvious symptoms, and assist in determining readiness to return safely to participation. Copyright © 2011 Elsevier Inc. All rights reserved.

Analysis of Medical Events among Battlefield Airmen Trainees

Science.gov (United States)

2012-04-01

foot, 1 was of the sacroiliac region, 5 were of the back, and 3 were unspecified. 7 Distribution A: Approved for public release; distribution is...Strain/Sprain of Hip/Thigh 4 Strain/Sprain, Unspecified 3 Strain/Sprain of Wrist/Hand 1 Strain/Sprain of Sacroiliac Region

Clinical Evaluation of the Concussed Athlete: A View From the Sideline.

Science.gov (United States)

Putukian, Margot

2017-03-01

The sideline assessment of concussion is challenging, given its variable presentations, the limited sensitivity and specificity of sideline assessment tools, and how the presentation of the injury evolves over time. In addition, the diagnostic process, as well as the tools used to assess and manage concussion, continue to progress as research and what we know about concussion advance. This paper focuses on the initial assessment on the sideline by reviewing the concussion-evaluation literature, drawing from clinical experience to emphasize a standardized approach, and underscoring the importance of both familiarity with the athlete and clinical judgment. To review the evidence regarding the clinical assessment of sport-related concussion on the sideline. Additional considerations included making same-day return-to-play decisions, the sensitivity and specificity of sideline testing, and the importance of ongoing assessment and follow-up of injured athletes. I conducted a systematic literature review of the assessment of concussion on the sideline. The PubMed and MEDLINE databases were searched using the key term athletic injuries with concussion and mild traumatic brain injury. The search was refined by adding the key terms sideline assessment and on-field assessment. In addition, select additional position statements and guidelines on concussion were included in the review. The PubMed search using athletic injuries and concussion as key terms produced 1492 results. Refining the search by sideline assessment and on-field assessment produced 29 and 35 results, respectively. When athletic injuries and traumatic brain injury were combined, 1912 results were identified. Refining the search by sideline assessment and on-field assessment led to 28 and 35 results, respectively. Only papers that were English-language titles, original work, and limited to human participants and included sideline assessments of sport-related concussion in athletes older than 13 years were

Imaging Correlates of Memory and Concussion History in Retired National Football League Athletes.

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Strain, Jeremy F; Womack, Kyle B; Didehbani, Nyaz; Spence, Jeffrey S; Conover, Heather; Hart, John; Kraut, Michael A; Cullum, C Munro

2015-07-01

To our knowledge, this is the first study to show an association between concussion, cognition, and anatomical structural brain changes across the age spectrum in former National Football League athletes. To assess the relationship of hippocampal volume, memory performance, and the influence of concussion history in retired National Football League athletes with and without mild cognitive impairment (MCI). This retrospective cohort study assessed differences between groups, mean hippocampal volumes, and memory performance by computing age quintiles based on group-specific linear regression models corrected for multiple comparisons for both athletes and control participants. The study was conducted starting in November 2010 and is ongoing at a research center in the northern region of Texas. This current analysis was conducted from October 9, 2013, to August 21, 2014. Participants included 28 retired National Football League athletes, 8 of whom had MCI and a history of concussion, 21 cognitively healthy control participants, and 6 control participants with MCI without concussion. Hippocampal volume, age, California Verbal Learning Test scores, and the number of grade 3 (G3) concussions. In addition, the number of games played was examined as an objective variable pertaining to football history. The mean (SD) age was 58.1 (13) years for the 28 former athletes and 59.0 (12) years for the 27 control participants. Retired athletes with concussion history but without cognitive impairment had normal but significantly lower California Verbal Learning Test scores compared with control participants (mean [SD], 52.5 [8] vs 60.24 [7]; P = .002); those with a concussion history and MCI performed worse (mean [SD], 37 [8.62]) compared with both control participants (P history of G3 concussion were more likely to have MCI (7 of 7) compared with retired athletes without a history of G3 concussion (1 of 5) older than 63 years (P = .01). In addition, the left hippocampal

A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types.

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Kemler, Ellen; van de Port, Ingrid; Backx, Frank; van Dijk, C Niek

2011-03-01

Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip™, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute

Conservative treatment of ankle sprain according to a recent literature

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Urszula Kaźmierczak

2017-02-01

Full Text Available Due to complicated structure of ankle, it is exceptionally susceptible to injuries, of which one of the most common is a sprain. The sprain involves soft-tissue injuries that, depending on their level of seriousness, are categorized as first-, second- or third-degree sprains. The main goals of rehabilitation in the acute phase after the injury include reduction of pain, swelling and hematoma, as well as prevention from secondary injuries. During the subacute phase the emphasis should be put on restoring the joint’s function and its range of motion, as well as on gentle loading of the joint. Proprioception training, strength and stretching exercises should also be introduced. The next stage, during which the reconstruction of the damaged tissues takes place, involves the implementation of gradual progressive loading and the variety of earlier introduced procedures. In the final phase of rehabilitation, it is vital to reassure that the patient is able to return to full activity, especially if he or she is an athlete. Therefore, functional testing such as the Dorsiflexion Lunge Test or The Star Excursion Balance Test may be of help. The main predisposing factor for an ankle sprain is a previous injury of the same type. It is due to the fact that such an injury leads to impaired proprioceptive function and impaired postural control. Improper rehabilitation or the lack of thereof may cause the development of chronic ankle instability, which substantially reduces the chances of physical activity and the patient’s quality of life. The implementation of adequate preventive measures based on employing external stabilisers and neuromuscular training appears to be essential. The objective is to regain a good sense of proprioception as well as muscle reaction time within the ankle joint.

Exposure to Surgery and Anesthesia After Concussion Due to Mild Traumatic Brain Injury.

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Abcejo, Arnoley S; Savica, Rodolfo; Lanier, William L; Pasternak, Jeffrey J

2017-07-01

To describe the epidemiology of surgical and anesthetic procedures in patients recently diagnosed as having a concussion due to mild traumatic brain injury. Study patients presented to a tertiary care center after a concussion due to mild traumatic brain injury from July 1, 2005, through June 30, 2015, and underwent a surgical procedure and anesthesia support under the direct or indirect care of a physician anesthesiologist. During the study period, 1038 patients met all the study inclusion criteria and subsequently received 1820 anesthetics. In this population of anesthetized patients, rates of diagnosed concussions due to sports injuries, falls, and assaults, but not motor vehicle accidents, increased during 2010-2011. Concussions were diagnosed in 965 patients (93%) within 1 week after injury. In the 552 patients who had surgery within 1 week after concussive injury, 29 (5%) had anesthesia and surgical procedures unrelated to their concussion-producing traumatic injury. The highest use of surgery occurred early after injury and most frequently required general anesthesia. Orthopedic and general surgical procedures accounted for 57% of procedures. Nine patients received 29 anesthetics before a concussion diagnosis, and all of these patients had been involved in motor vehicle accidents and received at least 1 anesthetic within 1 week of injury. Surgical and anesthesia use are common in patients after concussion. Clinicians should have increased awareness for concussion in patients who sustain a trauma and may need to take measures to avoid potentially injury-augmenting cerebral physiology in these patients. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Evaluation of the Centers for Disease Control and Prevention's Concussion Initiative for High School Coaches: "Heads up: Concussion in High School Sports"

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Sarmiento, Kelly; Mitchko, Jane; Klein, Cynthia; Wong, Sharon

2010-01-01

Background: To reduce the number of sports-related concussions, the Centers for Disease Control and Prevention (CDC), with the support of partners and experts in the field, has developed a tool kit for high school coaches with practical, easy-to-use concussion-related information. This study explores the success of the tool kit in changing…

UNDERSTANDING THE NEUROINFLAMMATORY RESPONSE FOLLOWING CONCUSSION TO DEVELOP TREATMENT STRATEGIES

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Zachary Robert Patterson

2012-12-01

Full Text Available Mild traumatic brain injuries (mTBI have been associated with long-term cognitive deficits relating to trauma-induced neurodegeneration. These long-term deficits include impaired memory and attention, changes in executive function, emotional instability and sensorimotor deficits. Furthermore, individuals with concussions show a high co-morbidity with a host of psychiatric illnesses (e.g. depression, anxiety, addiction and dementia. The neurological damage seen in mTBI patients is the result of the direct impact and mechanical injury, followed by a delayed neuroimmune response that can last hours, days and even months after the injury. As part of the neuroimmune response, a cascade of pro- and anti-inflammatory cytokines are released and can be detected at the site of injury as well as subcortical, and often contralateral, regions. It has been suggested that the delayed neuroinflammatory response to concussions is more damaging then the initial impact itself. However, evidence exists for favourable consequences of cytokine production following traumatic brain injuries as well. In some cases, treatments that reduce the inflammatory response will also hinder the brain's intrinsic repair mechanisms. At present, there is no evidence-based pharmacological treatment for concussions in humans. The ability to treat concussions with drug therapy requires an in-depth understanding of the pathophysiological and neuroinflammatory changes that accompany concussive injuries. The use of neurotrophic factors (e.g. nerve growth factor and anti-inflammatory agents as an adjunct for the management of post-concussion symptomology will be explored in this review.

Descriptive Epidemiology of Musculoskeletal Injuries and Concussions in the National Football League, 2012-2014

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Lawrence, David W.; Hutchison, Michael G.; Comper, Paul

2015-01-01

Background: The risk of all-cause injury and concussion associated with football is significant. The National Football League (NFL) has implemented changes to increase player safety warranting investigation into the incidence and patterns of injury. Purpose: To document the incidence and patterns of all-cause injury and concussions in the NFL. Study Design: Descriptive epidemiology study. Methods: Injury data were collected prospectively from official NFL injury reports over 2 regular seasons from 2012 to 2014, with identification of injury incidence rates and patterns. Concussion rate ratios were calculated using previously reported NFL rates. Results: A total of 4284 injuries were identified, including 301 concussions. The all-cause injury rate was 395.8 per 1000 athletes at risk (AAR) and concussion incidence was 27.8 per 1000 AAR. Only 2.3% of team games were injury free. Wide receivers, tight ends, and defensive backs had the highest incidence of injury and concussion. Concussion incidence was 1.61-fold higher in 2012 to 2014 compared with 2002 to 2007. The knee was injured most frequently, followed by the ankle, hamstring, shoulder, and head. Conclusion: The incidence of all-cause injury and concussion in the NFL is significant. Concussion injury rates are higher than previous reports, potentially reflecting an improvement in recognition and awareness. Injury prevention efforts should continue to reduce the prevalence of injury associated with football. PMID:26675321

Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes.

Science.gov (United States)

Herman, Daniel C; Jones, Debi; Harrison, Ashley; Moser, Michael; Tillman, Susan; Farmer, Kevin; Pass, Anthony; Clugston, James R; Hernandez, Jorge; Chmielewski, Terese L

2017-05-01

Laboratory-based studies on neuromuscular control after concussion and epidemiological studies suggest that concussion may increase the risk of subsequent musculoskeletal injury. The purpose of this study was to determine if athletes have an increased risk of lower extremity musculoskeletal injury after return to play from a concussion. Injury data were collected from 2006 to 2013 for men's football and for women's basketball, soccer and lacrosse at a National Collegiate Athletic Association Division I university. Ninety cases of in-season concussion in 73 athletes (52 male, 21 female) with return to play at least 30 days prior to the end of the season were identified. A period of up to 90 days of in-season competition following return to play was reviewed for time-loss injury. The same period was studied in up to two control athletes who had no concussion within the prior year and were matched for sport, starting status and position. Lower extremity musculoskeletal injuries occurred at a higher rate in the concussed athletes (45/90 or 50 %) than in the non-concussed athletes (30/148 or 20 %; P relationship between concussion and an increased risk of lower extremity musculoskeletal injury after return to play, and may have implications for current medical practice standards regarding evaluation and management of concussion injuries.

Knowledge about sports-related concussion: is the message getting through to coaches and trainers?

Science.gov (United States)

White, Peta E; Newton, Joshua D; Makdissi, Michael; Sullivan, S John; Davis, Gavin; McCrory, Paul; Donaldson, Alex; Ewing, Michael T; Finch, Caroline F

2014-01-01

The need for accurate diagnosis and appropriate return-to-play decisions following a concussion in sports has prompted the dissemination of guidelines to assist managing this condition. This study aimed to assess whether key messages within these guidelines are reflected in the knowledge of coaches and sports trainers involved in community sport. An online knowledge survey was widely promoted across Australia in May-August 2012 targeting community Australian Football (AF) and Rugby League (RL) coaches and sports trainers. 260 AF coaches, 161 AF sports trainers, 267 RL coaches and 228 RL sports trainers completed the survey. Knowledge scores were constructed from Likert scales and compared across football codes and respondent groups. General concussion knowledge did not differ across codes but sports trainers had higher levels than did coaches. There were no significant differences in either concussion symptoms or concussion management knowledge across codes or team roles. Over 90% of respondents correctly identified five of the eight key signs or symptoms of concussion. Fewer than 50% recognised the increased risk of another concussion following an initial concussion. Most incorrectly believed or were uncertain that scans typically show damage to the brain after a concussion occurs. Fewer than 25% recognised, and >40% were uncertain that younger players typically take longer to recover from concussion than adults. The key messages from published concussion management guidelines have not reached community sports coaches and sports trainers. This needs to be redressed to maximise the safety of all of those involved in community sport.

Heads Up! Play it Safe When it Comes to Concussions

Centers for Disease Control (CDC) Podcasts

2007-05-21

As many as 3.8 million sports- and recreation-related concussions are estimated to occur in the United States each year. This podcast is a radio interview with CDC's Dr. Julie Gilchrist on the newly available “Heads Up: Concussion in Youth Sports" tool kit, which was developed to provide information to coaches, parents, and athletes involved in youth sports on preventing, recognizing, and responding to a concussion.  Created: 5/21/2007 by National Center for Injury Prevention and Control, Division of Injury Response.   Date Released: 10/31/2007.

Microstructural brain injury in post-concussion syndrome after minor head injury

International Nuclear Information System (INIS)

Smits, Marion; Wielopolski, Piotr A.; Vernooij, Meike W.; Lugt, Aad van der; Houston, Gavin C.; Dippel, Diederik W.J.; Koudstaal, Peter J.; Hunink, M.G.M.

2011-01-01

After minor head injury (MHI), post-concussive symptoms commonly occur. The purpose of this study was to correlate the severity of post-concussive symptoms in MHI patients with MRI measures of microstructural brain injury, namely mean diffusivity (MD) and fractional anisotropy (FA), as well as the presence of microhaemorrhages. Twenty MHI patients and 12 healthy controls were scanned at 3 T using diffusion tensor imaging (DTI) and high-resolution gradient recalled echo (HRGRE) T2*-weighted sequences. One patient was excluded from the analysis because of bilateral subdural haematomas. DTI data were preprocessed using Tract Based Spatial Statistics. The resulting MD and FA images were correlated with the severity of post-concussive symptoms evaluated with the Rivermead Postconcussion Symptoms Questionnaire. The number and location of microhaemorrhages were assessed on the HRGRE T2*-weighted images. Comparing patients with controls, there were no differences in MD. FA was decreased in the right temporal subcortical white matter. MD was increased in association with the severity of post-concussive symptoms in the inferior fronto-occipital fasciculus (IFO), the inferior longitudinal fasciculus and the superior longitudinal fasciculus. FA was reduced in association with the severity of post-concussive symptoms in the uncinate fasciculus, the IFO, the internal capsule and the corpus callosum, as well as in the parietal and frontal subcortical white matter. Microhaemorrhages were observed in one patient only. The severity of post-concussive symptoms after MHI was significantly correlated with a reduction of white matter integrity, providing evidence of microstructural brain injury as a neuropathological substrate of the post-concussion syndrome. (orig.)

Knowledge and management of sports concussions among coaches and certified athletic trainers in Alabama.

Science.gov (United States)

Naftel, Kimberly G; Yust, Elizabeth M; Nichols, Michele H; King, William D; Davis, Drew

2014-07-01

To identify modifiable barriers in resources, knowledge, and management that may improve the care of young athletes with concussions in the state of Alabama. An electronic survey was distributed to 2668 middle and high school coaches of contact sports in Alabama, and a paper survey was completed by 79 certified athletic trainers (ATCs) in 2010. Questions focused on their resource availability, knowledge of concussions based on the 2008 Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport (commonly known as the Zurich consensus statement), and management of concussions. A total of 402 (16% response rate) coaches and 55 ATCs (70% response rate) responded to the survey. This study highlights that ATC coverage often is limited to the high school level, football, and competitions. Both coaches and ATCs primarily use physicians to make return-to-play decisions, although coaches (43.7%) usually refer to primary care physicians, whereas ATCs (43.6%) refer to orthopedic or sports medicine physicians. The study also revealed that coaches and ATCs desire education and could expand concussion awareness by providing education to parents and athletes. No overall difference was seen in the knowledge and management of concussions between coaches and ATCs; however, ATCs were more likely to identify symptoms that are positive for concussions (P = 0.04). Both groups had difficulty recognizing subtle symptoms such as trouble sleeping, personality changes, and dizziness; they also were unaware that strenuous mental activities could delay concussion recovery, although ATCs scored significantly better than coaches (P < 0.001). Neither coaches nor ATCs consistently use standardized measures such as the Sports Concussion Assessment Tool 2 (7.5% vs 56.4%) or neuropsychological testing (5.3% vs 14.5%). This study describes coaches' and ATCs' varying knowledge and management techniques and highlights areas in which targeted interventions and

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial

OpenAIRE

Fisher Beth E; Kulig Kornelia; Davenport Todd E

2010-01-01

Abstract Background Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains...

Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification.

Science.gov (United States)

Moreau, William J; Nabhan, Dustin C; Walden, Taylor

2015-09-01

The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool-3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool-3 as a sideline assessment tool.

A Systematic Review on the Treatment of Acute Ankle Sprain Brace versus Other Functional Treatment Types

NARCIS (Netherlands)

Kemler, Ellen; van de Port, Ingrid; Backx, Frank; van Dijk, C. Niek

2011-01-01

Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of

Evaluation of the King-Devick test as a concussion screening tool in high school football players.

Science.gov (United States)

Seidman, Daniel H; Burlingame, Jennifer; Yousif, Lina R; Donahue, Xinh P; Krier, Joshua; Rayes, Lydia J; Young, Rachel; Lilla, Muareen; Mazurek, Rochelle; Hittle, Kristie; McCloskey, Charles; Misra, Saroj; Shaw, Michael K

2015-09-15

Concussion is the most common type of traumatic brain injury, and results from impact or impulsive forces to the head, neck or face. Due to the variability and subtlety of symptoms, concussions may go unrecognized or be ignored, especially with the pressure placed on athletes to return to competition. The King-Devick (KD) test, an oculomotor test originally designed for reading evaluation, was recently validated as a concussion screening tool in collegiate athletes. A prospective study was performed using high school football players in an attempt to study the KD as a concussion screening tool in this younger population. 343 athletes from four local high school football teams were recruited to participate. These athletes were given baseline KD tests prior to competition. Individual demographic information was collected on the subjects. Standard team protocol was employed to determine if a concussion had occurred during competition. Immediately after diagnosis, the KD test was re-administered to the concussed athlete for comparison to baseline. Post-season testing was also performed in non-concussed individuals. Of the 343 athletes, nine were diagnosed with concussions. In all concussed players, cumulative read times for the KD test were significantly increased (phistory of concussion was the only demographic factor predictive of concussion in this cohort. The KD test is an accurate and easily administered sideline screening tool for concussion in adolescent football players. Copyright © 2015 Elsevier B.V. All rights reserved.

Assessment of acute foot and ankle sprains.

Science.gov (United States)

Lynam, Louise

2006-07-01

Acute ankle and foot trauma is a regular emergency presentation and prompt strategic assessment skills are required to enable nurses to categorise and prioritise these injuries appropriately. This article provides background information on the anatomy and physiology of the lower limb to help nurses to identify various grades of ankle sprain as well as injuries that are limb threatening

ANKLE SPRAIN: WHO IS MOST FREQUENTLY INJURED AND HOW LONG ATHLETES ARE ABSENT FROM THE FIELD?

Directory of Open Access Journals (Sweden)

Ljiljana Cvejanov Kezunović

2011-09-01

Full Text Available Some sports, such as basketball and soccer, have very high incidence of ankle sprains. Because of this, a seemingly trivial injury, gained in the prime of their health and strength, active athletes were sidelined in the past for the entire half-season at the peak of their competitive form. Also, recreational athletes lose continuity in the maintenance of their form and often temporarily or permanently cease their activities, sometimes just because of fear from new injuries. The aim of this study was to examine whether the specific demands of different sports and other parameters such as gender and age, had an effect on the incidence of ankle sprains in athletes. Results: Among the injured athletes there were nine times more men than women, out of which half were soccer players. Volleyball and basketball players are often injured during the landing, soccer and tennis players during the running. It is usually diagnosed with stage III sprains (rupture of lateral ligaments. Temporary absence from the field lasted between 14 days for light sprains, 47 days for severe and over 69 days for avulsions. Conclusion: It would be necessary to put more effort in order to improve prevention, establish doctrine and recommendations in the application of treatment protocols for ankle sprains in athletes.

Concussions--The Role of the School Nurse. Position Statement

Science.gov (United States)

Diaz, Anne L.; Wyckoff, Leah J.

2012-01-01

It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as school nurse) is an essential member of the team addressing concussions. As the school-based clinical professional on the team, the school nurse has the knowledge and skills to provide concussion prevention…

Concussion attitudes, behaviors, and education among youth ages 12-17: Results from the 2014 YouthStyles survey.

Science.gov (United States)

Donnell, Zoe; Hoffman, Rosanne; Sarmiento, Kelly; Hays, Cameron

2018-02-01

This study assessed young athletes' (ages 12 to 17) concussion attitudes and behaviors, particularly their self-reported experience learning about concussion and intentions to report a concussion and disparities in these experiences. We used data from Porter Novelli's 2014 YouthStyles survey that is conducted each year to gather insights about American consumers. Of the 1,005 respondents, 57% reported sports participation. Fourteen percent reported they may have had a previous concussion, and among them 41% reported having a concussion more than once while playing sports. Males (17.7%) were significantly more likely to report having a concussion than females (10.0%; χ 2 (1)=7.01, p=0.008). Fifty-five percent of respondents reported having learned about what to do if they think they may have a concussion, and 92% reported that they would tell their coach if they thought they sustained a concussion while playing youth or high school sports. Youth from higher income families ($75,000-$124,999) were significantly more likely than youth from lower income families (less than $35,000) to report that they learned about what do if they suspected that they had a concussion. Age of athlete, parental income level, athlete's sex, and living in a metro versus non-metro area led to disparities in athletes' concussion education. There is a need for increased access to concussion education and an emphasis on customizing concussion education efforts to meet the needs of different groups. We identified athletes' self-reported previously sustained concussions and predictors of education related to concussion. Further research is needed to explore the age, gender and income gaps in concussion education among athletes. Published by Elsevier Ltd.

Protective equipment and the prevention of concussion - what is the evidence?

Science.gov (United States)

Navarro, Rodolfo R

2011-01-01

The complex nature of the evaluation and management of concussion lends to controversy, and the immediate and long-term implications still are being investigated. Various types of protective equipment have been used as a means to prevent concussions, and protective equipment is being used more frequently in different sports. Recent investigations have suggested that a protective, but not preventive, effect may be afforded by mouthguard use in rugby players, headgear use in soccer players, and customized mandibular orthotic use in football players. The use of faceshields has not shown a proven benefit in preventing the incidence of sport-related concussion in ice hockey or field hockey participants. Further studies are needed to clarify the role of protective equipment in the prevention of sport-related concussion.

Concussion knowledge and management practices among coaches and medical staff in Irish professional rugby teams.

Science.gov (United States)

Fraas, M R; Coughlan, G F; Hart, E C; McCarthy, C

2015-06-01

Self-reported concussion rates among U-20 and elite rugby union players in Ireland are 45-48%. Half of these injuries go unreported. Accurate knowledge of concussion signs and symptoms and appropriate management practices among coaches and medical staff is important to improve the welfare of players. Examine concussion knowledge among coaches, and management techniques among medical staff of professional Irish rugby teams. Surveys were administered to 11 coaches and 12 medical staff at the end of the 2010-2011 season. Coaches demonstrated an accurate knowledge of concussion with a good understanding of concussion-related symptoms. Medical staff reported using a variety of methods for assessing concussion and making return-to-play decisions. Reliance on subjective clinical methods was evident, with less reliance on objective postural stability performance. Overall, the coaches in this investigation have accurate knowledge of concussion and medical staff use effective techniques for managing this injury. On-going education is needed to assist coaches in identifying concussion signs and symptoms. It is recommended that medical staff increase their reliance on objective methods for assessment and return-to-play decision making.

Significance of Concussions in Hawai'i: From Land to Sea.

Science.gov (United States)

Cifu, David X; Uchima, Olivia K; Davis, Alaina S; Lower, Amy E; Jin, Jingyu L; Lew, Henry L

2016-09-01

Head injuries are a particular concern in Hawai'i given the large military population, the presence of many land and water sports such as football and surfing, and the lenient helmet laws for motorcycle and bicycle riders. Physical, psychological, and cognitive symptoms from single or repeated concussions can affect an individual's reentry to society and activity. Current literature indicates that repeated head injuries are associated with chronic traumatic encephalopathy (CTE) which is thought to lead to dementia. This paper reviews literature discussing causes of concussion including its incidence and prevalence in Hawai'i. Furthermore, the neurophysiological and neurobiological etiologies are discussed followed by an overview of methods for identification and management of concussion. The paper serves as information for professionals in the community such as educators, military personnel, and healthcare workers to identify risks of concussion, management of symptoms, and to connect with resources and programs available in Hawai'i.

A Paired Comparison of Initial and Recurrent Concussions Sustained by US High School Athletes Within a Single Athletic Season.

Science.gov (United States)

Currie, Dustin W; Comstock, R Dawn; Fields, Sarah K; Cantu, Robert C

To compare initial and recurrent concussions regarding average number of days between concussions, acute concussion symptoms and symptom resolution time, and return to play time. High school athletes sustaining multiple concussions linked within sport seasons drawn from a large sports injury surveillance study. Retrospective analysis of longitudinal surveillance data. Number of days between concussions, number of symptoms endorsed, specific symptoms endorsed, symptom resolution time, return to play time. Median time between initial and recurrent concussions was 21 days (interquartile range = 10-43 days). Loss of consciousness, the only significant symptom difference, occurred more frequently in recurrent (6.8%) than initial (1.7%) concussions (P = .04). No significant difference was found in the number of symptoms (P = .84) or symptom resolution time (P = .74). Recurrent concussions kept athletes from play longer than initial concussions (P concussions were season ending. We found that athletes' initial and recurrent concussions had similar symptom presentations and resolution time. Despite these similarities, athletes were restricted from returning to play for longer periods following a recurrent concussion, indicating clinicians are managing recurrent concussions more conservatively. It is probable that concussion recognition and management are superior now compared with when previous studies were published, possibly improving recurrent concussion outcomes.

A study of semi-rigid support on ankle supination sprain kinematics.

Science.gov (United States)

Tang, Y M; Wu, Z H; Liao, W H; Chan, K M

2010-12-01

Ankle sprain injury is very common in sports and the use of ankle support is crucial. This research investigated the effect of an ankle brace in reducing the ankle angular displacement and angular velocity during sudden supination. In the experiment, 11 healthy males were tested. The bracing condition, semi-rigid ankle braces were investigated. The angular displacement and angular velocity of the ankle were computed. The motion-capture system was adopted to capture the three-dimensional coordinates of the reflective markers. The coordinates of the reflective markers were used to compute the ankle kinematics during simulated ankle supination. A mechanical supination platform was used to simulate the sprain motions. Experimental results showed that the semi-rigid brace tested significantly reduced the ankle angular displacement and angular velocity compared with control conditions during sudden supination. In conclusion, the semi-rigid-type brace can provide significant restriction to reduce the magnitudes of the angular displacement and angular velocity of the ankle during sudden supination sprain. The semi-rigid-type brace is suggested as the prophylactic bracing for the ankle. © 2009 John Wiley & Sons A/S.

Cumulative Effects of Concussion History on Baseline Computerized Neurocognitive Test Scores: Systematic Review and Meta-analysis.

Science.gov (United States)

Alsalaheen, Bara; Stockdale, Kayla; Pechumer, Dana; Giessing, Alexander; He, Xuming; Broglio, Steven P

It is unclear whether individuals with a history of single or multiple clinically recovered concussions exhibit worse cognitive performance on baseline testing compared with individuals with no concussion history. To analyze the effects of concussion history on baseline neurocognitive performance using a computerized neurocognitive test. PubMed, CINAHL, and psycINFO were searched in November 2015. The search was supplemented by a hand search of references. Studies were included if participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) at baseline (ie, preseason) and if performance was stratified by previous history of single or multiple concussions. Systematic review and meta-analysis. Level 2. Sample size, demographic characteristics of participants, as well as performance of participants on verbal memory, visual memory, visual-motor processing speed, and reaction time were extracted from each study. A random-effects pooled meta-analysis revealed that, with the exception of worsened visual memory for those with 1 previous concussion (Hedges g = 0.10), no differences were observed between participants with 1 or multiple concussions compared with participants without previous concussions. With the exception of decreased visual memory based on history of 1 concussion, history of 1 or multiple concussions was not associated with worse baseline cognitive performance.

Concussion Awareness Education: A Design and Development Research Study

Science.gov (United States)

Pilbeam, Renee M.

2016-01-01

This research study looks at the design and development of an online concussion awareness education module. The Keep Your Head in the Game: Concussion Awareness Training for High School Athletes, or Brainbook, is a stand-alone e-learning module designed to run for fifty minutes and to be highly interactive using short video clips with associated…

National Athletic Trainers' Association Position Statement: Management of Sport Concussion

Science.gov (United States)

Broglio, Steven P.; Cantu, Robert C.; Gioia, Gerard A.; Guskiewicz, Kevin M.; Kutcher, Jeffrey; Palm, Michael; McLeod, Tamara C. Valovich

2014-01-01

Objective: 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. PMID:24601910

The first concussion crisis: head injury and evidence in early American football.

Science.gov (United States)

Harrison, Emily A

2014-05-01

In the early 21st century, sports concussion has become a prominent public health problem, popularly labeled "The Concussion Crisis." Football-related concussion contributes much of the epidemiological burden and inspires much of the public awareness. Though often cast as a recent phenomenon, the crisis in fact began more than a century ago, as concussions were identified among footballers in the game's first decades. This early concussion crisis subsided-allowing the problem to proliferate-because work was done by football's supporters to reshape public acceptance of risk. They appealed to an American culture that permitted violence, shifted attention to reforms addressing more visible injuries, and legitimized football within morally reputable institutions. Meanwhile, changing demands on the medical profession made practitioners reluctant to take a definitive stance. Drawing on scientific journals, public newspapers, and personal letters of players and coaches, this history of the early crisis raises critical questions about solutions being negotiated at present.

Concussion assessment and management knowledge among chiropractic fourth year interns and residents.

Science.gov (United States)

Kazemi, Mohsen; Pichini, Alessandro; Scappaticci, Steven; Savic, Mitchell

2016-12-01

To investigate the degree of knowledge chiropractic fourth year interns and post-graduate chiropractic residents have in regard to concussion diagnosis and management. A survey modified from a study conducted by Boggild and Tator (2012), was administered to fourth year chiropractic interns and post-graduate residents via SurveyMonkey.com. Chiropractic fourth year interns and postgraduate chiropractic specialty college residents scored 5.2 and 5.25 out of 9 respectively, which compares well with Bogglid and Tator's reports on medical students and residents. Several knowledge gaps were identified in the sample population. The results from this survey show that the concussion knowledge among Canadian fourth year chiropractic interns and specialty college residents compares favorably with the knowledge of fourth year medical students and residents in diagnosing and managing concussions. Chiropractors appear to possess the skills and knowledge to diagnose and manage concussion equal to their medical counterparts. However, knowledge gaps regarding concussion diagnosis and management were found among chiropractic students and residents.

Sport and Sex-Specific Reporting Trends in the Epidemiology of Concussions Sustained by High School Athletes.

Science.gov (United States)

Schallmo, Michael S; Weiner, Joseph A; Hsu, Wellington K

2017-08-02

Approximately 300,000 U.S. adolescents sustain concussions annually while participating in organized athletics. This study aimed to track sex and sport-specific trends among high school sports-related concussions over time, to identify whether a particular sport predisposes athletes to a higher risk, and to assess whether traumatic brain injury law enactments have been successful in improving recognition. Injury data for academic years 2005 to 2014 were collected from annual reports generated by High School RIO (Reporting Information Online). The relative proportions of total estimated concussions to total estimated injuries were compared using an injury proportion ratio. The concussion rate was defined as the number of concussions per 10,000 athlete exposures (1 athlete participating in 1 practice or competition), with rates compared using a rate ratio. To evaluate the impact of legislation on sports-related concussions in this population, trends in concussion rates and proportions were analyzed before enactment (academic years 2005-2009) and after enactment (academic years 2010-2014). Between 2005-2006 and 2014-2015, a significant increase (p concussions for all sports combined, the overall concussion rate (rate ratio, 2.30 [95% confidence interval, 2.04 to 2.59]), and the overall proportion of concussions (injury proportion ratio, 2.68 [95% confidence interval, 2.66 to 2.70]) was seen. Based on the injury proportion ratio, during the 2014-2015 academic year, concussions were more common in girls' soccer than in any other sport (p concussion prevention and recognition measures continue to be emphasized in high school contact sports. The data in our study suggest that significant increases in the overall rate and proportion of reported concussions during the past decade could have been affected by traumatic brain injury legislation. To our knowledge, this is the first study to show that girls' soccer players may have an even greater risk of sustaining a concussion

The Role of Physical Activity in Recovery From Concussion in Youth: A Neuroscience Perspective.

Science.gov (United States)

Schmidt, Julia; Rubino, Cristina; Boyd, Lara A; Virji-Babul, Naznin

2018-07-01

Concussion is a major public health concern and one of the least understood neurological injuries. Children and youth are disproportionally affected by concussion, and once injured, take longer to recover. Current guidelines recommend a period of physical and cognitive rest with a gradual progressive return to activity. Although there is limited high-quality evidence (eg, randomized controlled trials) on the benefit of physical activity and exercise after concussion, most studies report a positive impact of exercise in facilitating recovery after concussion. In this article we characterize the complex and dynamic changes in the brain following concussion by reviewing recent results from neuroimaging studies and to inform physical activity participation guidelines for the management of a younger population (eg, 14-25 years of age) after concussion. Novel imaging methods and tools are providing a picture of the changes in the structure and function of the brain following concussion. These emerging results will, in the future, assist in creating objective, evidence-based pathways for clinical decision-making. Until such time, physical therapists should be aware that current neuroimaging evidence supports participation in physical activity after an initial and brief period of rest, and consider how best to incorporate exercise into rehabilitation to enhance recovery following concussion. It is important that physical therapists understand the neurobiological impact of concussion injury and recovery, and be informed of the scientific rationale for the recommendations and guidelines for engagement in physical activity.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A205).

The King–Devick test for sideline concussion screening in collegiate football

Directory of Open Access Journals (Sweden)

Danielle F. Leong

2015-04-01

Conclusions: The data show worsening of K–D test scores following concussion further supporting utility of the K–D test as an objective, reliable and effective sideline visual screening tool to help identify athletes with concussion.

The first week after concussion: Blood flow, brain function and white matter microstructure

Directory of Open Access Journals (Sweden)

Nathan W. Churchill

2017-01-01

Full Text Available Concussion is a major health concern, associated with short-term deficits in physical function, emotion and cognition, along with negative long-term health outcomes. However, we remain in the early stages of characterizing MRI markers of concussion, particularly during the first week post-injury when symptoms are most severe. In this study, 52 varsity athletes were scanned using Magnetic Resonance Imaging (MRI, including 26 athletes with acute concussion (scanned 1–7 days post-injury and 26 matched control athletes. A comprehensive set of functional and structural MRI measures were analyzed, including cerebral blood flow (CBF and global functional connectivity (Gconn of grey matter, along with fractional anisotropy (FA and mean diffusivity (MD of white matter. An analysis comparing acutely concussed athletes and controls showed limited evidence for reliable mean effects of acute concussion, with only MD showing spatially extensive differences between groups. We subsequently demonstrated that the number of days post-injury explained a significant proportion of inter-subject variability in MRI markers of acutely concussed athletes. Athletes scanned at early acute injury (1–3 days had elevated CBF and Gconn and reduced FA, but those scanned at late acute injury (5–7 days had the opposite response. In contrast, MD showed a more complex, spatially-dependent relationship with days post-injury. These novel findings highlight the variability of MRI markers during the acute phase of concussion and the critical importance of considering the acute injury time interval, which has significant implications for studies relating acute MRI data to concussion outcomes.

Stuttering as a Symptom of Concussion: Confirmation of Association Using Nontraditional Information Sources.

Science.gov (United States)

Cherry, Jonathan C; Gordon, Kevin Eric

2017-11-01

A 12-year-old girl presented to our pediatric emergency department after a head injury with symptoms of concussion and acute stuttering. A PubMed search identified only 1 similar pediatric case. We investigated whether new-onset stuttering may be seen in the presence of acute concussive symptoms using an infodemiologic approach. We conducted a search with a metabrowser search engine (www.dogpile.com) using the free-text words "concussion" and "stuttering." The first 100 hits were scanned specifically for forum posts, extracting reports of concussions that were followed by new-onset stuttering. Duplicates were minimized by cross-referencing user name, location, date, and reported age and sex. Of the first 100 hits, we identified 17 unique posts that described an injury leading to a concussion followed within a short interval by new-onset stuttering. Posts were primarily by the affected individual (76%) and 64% involved female individuals. Sports and falls/injury accounted for most injuries (71%). Forty-one percent of posts explicitly stated that the concussion had been formally diagnosed. For those that reported the timing of stuttering onset (47%), the stuttering was documented within 1 hour of the injury (4/8) or between 1 and 24 hours (4/8). The ease with which we found so many reports of stuttering after head injury with concussive symptoms confirms that new-onset stuttering may be a symptom of concussion. Our experience highlights both a failure of using conventional medical literature and a success of using nontraditional information sources in identifying uncommonly associated symptoms of frequently encountered conditions.

Epidemiology, trends, assessment and management of sport-related concussion in United States high schools.

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Guerriero, Réjean M; Proctor, Mark R; Mannix, Rebekah; Meehan, William P

2012-12-01

Sport-related concussion affects athletes at every level of participation. The short and long-term effects of concussions that occur during childhood and adolescence are not fully understood. The purpose of this review is to describe the current burden of disease, current practice patterns and current recommendations for the assessment and management of sport-related concussions sustained by United States high school athletes. Millions of high school students participate in organized sports in the United States. Current estimates suggest that, across all sports, approximately 2.5 concussions occur for every 10 000 athletic exposures, in which an athletic exposure is defined as one athlete participating in one game or practice. At schools that employ at least one athletic trainer, most high school athletes who sustain sport-related concussions will be cared for by athletic trainers and primary care physicians. Approximately 40% will undergo computerized neurocognitive assessment. The number of high school athletes being diagnosed with sport-related concussions is rising. American football has the highest number of concussions in high school with girls' soccer having the second highest total number. Fortunately, coaches are becoming increasingly aware of these injuries and return-to-play guidelines are being implemented.

The King-Devick test for sideline concussion screening in collegiate football.

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Leong, Danielle F; Balcer, Laura J; Galetta, Steven L; Evans, Greg; Gimre, Matthew; Watt, David

2015-01-01

Sports-related concussion has received increasing attention as a result of neurologic sequelae seen among athletes, highlighting the need for a validated, rapid screening tool. The King-Devick (K-D) test requires vision, eye movements, language function and attention in order to perform and has been proposed as a promising tool for assessment of concussion. We investigated the K-D test as a sideline screening tool in a collegiate cohort to determine the effect of concussion. Athletes (n=127, mean age 19.6±1.2 years) from the Wheaton College football and men's and women's basketball teams underwent baseline K-D testing at pre-season physicals for the 2012-2013 season. K-D testing was administered immediately on the sidelines for football players with suspected head injury during regular games and changes compared to baseline were determined. Post-season testing was also performed to compare non-concussed athletes' test performance. Concussed athletes (n=11) displayed sideline K-D scores that were significantly higher (worse) than baseline (36.5±5.6s vs. 31.3±4.5s, pWilcoxon signed-rank test). Post-season testing demonstrated improvement of scores and was consistent with known learning effects (35.1±5.2s vs. 34.4±5.0s, pWilcoxon signed-rank test). Test-retest reliability was analyzed between baseline and post-season administrations of the K-D test resulting in high levels of test-retest reliability (intraclass correlation coefficient (ICC)=0.95 [95% Confidence Interval 0.85-1.05]). The data show worsening of K-D test scores following concussion further supporting utility of the K-D test as an objective, reliable and effective sideline visual screening tool to help identify athletes with concussion. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

The relationship between psychological distress and baseline sports-related concussion testing.

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Bailey, Christopher M; Samples, Hillary L; Broshek, Donna K; Freeman, Jason R; Barth, Jeffrey T

2010-07-01

This study examined the effect of psychological distress on neurocognitive performance measured during baseline concussion testing. Archival data were utilized to examine correlations between personality testing and computerized baseline concussion testing. Significantly correlated personality measures were entered into linear regression analyses, predicting baseline concussion testing performance. Suicidal ideation was examined categorically. Athletes underwent testing and screening at a university athletic training facility. Participants included 47 collegiate football players 17 to 19 years old, the majority of whom were in their first year of college. Participants were administered the Concussion Resolution Index (CRI), an internet-based neurocognitive test designed to monitor and manage both at-risk and concussed athletes. Participants took the Personality Assessment Inventory (PAI), a self-administered inventory designed to measure clinical syndromes, treatment considerations, and interpersonal style. Scales and subscales from the PAI were utilized to determine the influence psychological distress had on the CRI indices: simple reaction time, complex reaction time, and processing speed. Analyses revealed several significant correlations among aspects of somatic concern, depression, anxiety, substance abuse, and suicidal ideation and CRI performance, each with at least a moderate effect. When entered into a linear regression, the block of combined psychological symptoms accounted for a significant amount of baseline CRI performance, with moderate to large effects (r = 0.23-0.30). When examined categorically, participants with suicidal ideation showed significantly slower simple reaction time and complex reaction time, with a similar trend on processing speed. Given the possibility of obscured concussion deficits after injury, implications for premature return to play, and the need to target psychological distress outright, these findings heighten the clinical

Analysis of Workplace Accidents in Automotive Repair Workshops in Spain.

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López-Arquillos, Antonio; Rubio-Romero, Juan Carlos

2016-09-01

To analyze the effects of the factors associated with different types of injury (superficial wounds, dislocations and sprains, bone fractures, concussion and internal injuries, burns scalding and freezing) caused by occupational accidents in automotive repair workshops. Study of a sample consisting of 89,954 industry accidents reported from 2003 to 2008. Odds ratios were calculated with a 95% confidence interval. Belonging to a small company is a risk factor for suffering three of the five types of injury studied. Women are less likely to suffer burns and superficial wounds, and more likely to suffer dislocations or sprains. Foreign workers are more likely to suffer concussion and internal injuries. Health and safety strategies and accident prevention measures should be individualized and adapted to the type of worker most likely to be injured in each type of accident. Occupational health and safety training courses designed according to worker profile, and improving the participation of the workers in small firms creating regional or roving safety representatives would improve working conditions.

A qualitative review of sports concussion education: prime time for evidence-based knowledge translation.

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Mrazik, Martin; Dennison, Christopher R; Brooks, Brian L; Yeates, Keith Owen; Babul, Shelina; Naidu, Dhiren

2015-12-01

Educating athletes, coaches, parents and healthcare providers about concussion management is a public health priority. There is an abundance of information on sports concussions supported by position statements from governing sport and medical organisations. Yet surveys of athletes, parents, coaches and healthcare providers continue to identify multiple barriers to the successful management of sports concussion. To date, efforts to provide education using empirically sound methodologies are lacking. To provide a comprehensive review of scientific research on concussion education efforts and make recommendations for enhancing these efforts. Qualitative literature review of sports concussion education. Databases including PubMed, Sport Discus and MEDLINE were searched using standardised terms, alone and in combination, including 'concussion', 'sport', 'knowledge', 'education' and 'outcome'. Studies measuring the success of education interventions suggest that simply presenting available information may help to increase knowledge about concussions, but it does not produce long-term changes in behaviour among athletes. Currently, no empirical reviews have evaluated the success of commercially available sports concussion applications. The most successful education efforts have taken steps to ensure materials are user-friendly, interactive, utilise more than one modality to present information and are embedded in mandated training programmes or support legislation. Psychosocial theory-driven methods used to understand and improve 'buy in' from intended audiences have shown promise in changing behaviour. More deliberate and methodologically sound steps must be taken to optimise education and knowledge translation efforts in sports concussion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Repetitive concussions in adolescent athletes – translating clinical and experimental research into perspectives on rehabilitation strategies

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Bridgette D Semple

2015-04-01

Full Text Available Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions amongst professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally-timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management.

Repetitive Concussions in Adolescent Athletes – Translating Clinical and Experimental Research into Perspectives on Rehabilitation Strategies

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Semple, Bridgette D.; Lee, Sangmi; Sadjadi, Raha; Fritz, Nora; Carlson, Jaclyn; Griep, Carrie; Ho, Vanessa; Jang, Patrice; Lamb, Annick; Popolizio, Beth; Saini, Sonia; Bazarian, Jeffrey J.; Prins, Mayumi L.; Ferriero, Donna M.; Basso, D. Michele; Noble-Haeusslein, Linda J.

2015-01-01

Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions among professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical, and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management. PMID:25883586

The King-Devick (K-D) test and concussion diagnosis in semi-professional rugby union players.

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Molloy, John H; Murphy, Ian; Gissane, Conor

2017-08-01

To determine the utility of the King-Devick (K-D) test in identifying sports-related concussion in semi-professional rugby players. Descriptive cohort study. 176 male players were recruited from a semi-professional rugby union competition in New Zealand (NZ). Baseline K-D scores were obtained in the pre-season. Post-match K-D and Pitch Side Concussion Assessment Version 2 (PSCA2) scores were obtained in those with suspected concussion. Post-match K-D scores were also administered to selected control players. 19 concussions in 18 players were analysed. In addition, 33 controls were used for analysis. A positive K-D test was identified in 53% of players with concussion post-match. Conversely, a positive test was identified in 33% of controls. The sensitivity and specificity of the K-D test was calculated as 53% and 69% respectively. The positive predictive value and negative predictive value was 48% and 73% respectively. The PSCA2 correctly identified 74% of concussions. The K-D test identified 3 cases not identified by the PSCA2. When the PSCA2 and K-D were combined, 89% of concussions were correctly identified. The K-D test does not appear to be effective if used as a stand-alone test for the diagnosis of concussion. However, if used alongside current side-line cognitive and balance tests, it may assist in more accurately diagnosing sports-related concussion. Further research should look to utilise the K-D test in in-match protocols to establish if this improves the diagnostic accuracy of in-match protocols for sports-related concussion. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Concussion Knowledge and Communication Behaviors of Collegiate Wrestling Coaches.

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Kroshus, Emily; Kerr, Zachary Y; DeFreese, J D; Parsons, John T

2017-08-01

Sport coaches can play an important role in shaping a team's approach to concussion safety through their communication with team members. However, across all sports, there is limited knowledge about factors that make coaches more or less likely to engage in safety-supportive communication. The objectives of this study were to assess the concussion-related knowledge and attitudes of wrestling coaches, as well as the extent to which they engage in autonomy-supportive coaching practices, and to determine how these factors are related to communication with athletes in support of concussion safety. Data were collected through an online survey of head coaches of National Collegiate Athletic Association (NCAA) wrestling teams (n = 89, 40.5% response rate). On average, coaches answered five out of a possible nine knowledge questions correctly and were significantly more likely to think it was acceptable for an athlete to continue playing after sustaining a concussion during a national qualifying competition as compared to during an early-season competition. Engaging in autonomy-supportive coaching behaviors was the coach factor explaining the largest percentage of variability in communication. Findings suggest that while knowledge deficits and attitudes about the acceptability of continued play while symptomatic during more consequential competitive matches should be addressed in educational programming for collegiate wrestling coaches, these changes alone may not be a sufficient for adequately increasing concussion safety communication. Targeting more distal factors such as autonomy-supportive approaches to coaching may hold promise for intervention design and should be explored in future prospective research.

Examination of the sprained ankle: Anterior drawer test or arthrography

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Laehde, S.; Putkonen, M.; Puranen, J.; Raatikainen, T.

1988-11-01

The accuracy of the anterior drawer test for the diagnosis of recent lateral ligament tears in the ankle was evaluated in a series of 192 patients using surgical or arthrographic findings for reference. Considerable overlapping of results was obtained in ankles with and without ligament tear. Twenty-eight per cent of the anterior talofibular ligament tears, and 38% of the combined anterior talofibular and calcaneofibular tears were not detected, and single and combined tears could not be differentiated. It is concluded that the anterior drawer test is too unreliable as a basis for any decision regarding surgical treatment of a recent sprain. Therefore, arthrography is recommended as the method of choice in such cases of recent ankle sprain, where the need of surgery has to be supported by X-ray analysis.

Examination of the sprained ankle: Anterior drawer test or arthrography?

International Nuclear Information System (INIS)

Laehde, S.; Putkonen, M.; Puranen, J.; Raatikainen, T.

1988-01-01

The accuracy of the anterior drawer test for the diagnosis of recent lateral ligament tears in the ankle was evaluated in a series of 192 patients using surgical or arthrographic findings for reference. Considerable overlapping of results was obtained in ankles with and without ligament tear. Twenty-eight per cent of the anterior talofibular ligament tears, and 38% of the combined anterior talofibular and calcaneofibular tears were not detected, and single and combined tears could not be differentiated. It is concluded that the anterior drawer test is too unreliable as a basis for any decision regarding surgical treatment of a recent sprain. Therefore, arthrography is recommended as the method of choice in such cases of recent ankle sprain, where the need of surgery has to be supported by X-ray analysis. (orig.)

Functional Treatment Comparing with Immobilization after Acute Ankle Sprain

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Hamidreza Mohammadi

2013-02-01

Full Text Available Background: Ankle injuries are among the most prevalent injuries with which a physician may encounter. In this study, the efficiency of the functional treatment was compared with the immobilization treatment in healing the acute ankle sprain. Materials and Methods: This clinical trial study was carried out on 100 male patients whose ankle sprain had been diagnosed by Yasuj Shahid Beheshti Hospital. Using block allocation randomization method and regardless of damage degree, patients were divided into two groups, functional method (1st group or immobilization with plaster (2nd group, for treatment. Several variables such as range of motion, pain intensity, inflammation, joint tenderness and returning to work after 2, 6 and 12 weeks were examined. Results: After two weeks, the average pain intensity in the first group (33.2±3.2 has been decreased compared to the second group (55±1.2, which showed a significant difference between the two groups (p<0.05. The average ankle range of motion in the first and second groups was 29.08±1.2 degrees and 20.4±2.2 degrees, respectively which had been increased significantly in the first group compared to the second group (p<0.03. Similarly, a considerable difference was observed in decreased inflammation and tenderness in the first group compared to the second one. Conclusion: In acute ankle sprains, the functional treatment is better than the immobilization treatment in alleviating pain, inflammation and improving the range of joint motion.

Rehabilitation of distal tibiofibular syndesmosis sprains: a case report

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Pajaczkowski, Jason A

2007-01-01

Objective To present the epidemiology, etiology, diagnostic criteria and therapeutic interventions for an important clinical entity – tibiofibular syndesmosis or “high ankle” sprains. Clinical Features The most common mechanism of injury is forced external rotation in a dorsiflexed foot. Pain is located anteriorly over the anterior tibiofibular ligament, and is elicited through a variety of tests designed to stress this articulation through diastatic forces. Pain with ambulation is typical, and is usually present during the push-off phase of gait. Radiographs may be useful in determining the extent of this injury, as syndesmotic sprains with malleolar fractures are more common than those without. Intervention and Outcome Convalescence is generally protracted compared with a lateral ankle sprain, and care must be taken to avoid stressing the supporting ligaments during the early course of therapy. Initial treatment is aimed at reducing pain and inflammation using modalities such as microcurrent, electroacupuncture and P.R.I.C.E. principles. Treatment over subsequent weeks involves progressive resistance exercises, proprioceptive challenges, plyometric exercises and sport-specific agility drills, while maintaining cardiovascular fitness. Conclusion The practitioner should also be cognizant of the indolent nature of this injury and possibility for sequelae. Anterior ankle pain and pain with a deep squat or during the push-off phase of gait are typical of this injury. Radiographs to rule out fracture and evaluate the extent of the injury may be warranted. Conservative therapy involving rehabilitation and tissue injury care is appropriate for Grade I and II injuries, while Grade III injuries require a surgical intervention. PMID:17657290

The comparative incidence of reported concussions presenting for follow-up management in South African Rugby Union.

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Shuttleworth-Edwards, Ann B; Noakes, Timothy D; Radloff, Sarah E; Whitefield, Victoria J; Clark, Susan B; Roberts, Craig O; Essack, Fathima B; Zoccola, Diana; Boulind, Melissa J; Case, Stephanie E; Smith, Ian P; Mitchell, Julia L G

2008-09-01

The objective of this study was to compare the seasonal concussion incidence for school, university, club and provincial level Rugby Union players in South Africa. The study presents a retrospective statistical analysis of the number of reported concussions documented annually for groups of Rugby Union players as a proportion of those who received preseason neurocognitive assessment. Between 2002 and 2006, concussion management programs using computerized neuropsychological assessment were implemented for clinical and research purposes by psychologists in selected South African institutions involved in Rugby Union from school through to the professional level. The incidence figures were based on 175 concussive episodes reported for 165 athletes who were referred for neurocognitive assessment from a population of 1366 athletes who received preseason baseline testing. Concussion management routines varied according to the protocols adopted by the different psychologists and rugby organizations. It was expected that the incidence of concussion would vary significantly due to level of play and different management protocols. There was wide disparity in the manner in which concussion follow-up was managed by the various organizations. Within broadly comparable cohorts, tighter control was associated with a relatively higher concussion incidence for athletes per rugby playing season, with average institutional figures ranging from 4% to 14% at school level and 3% to 23% at adult level. This analysis suggests that concussion goes unrecognized and therefore incorrectly managed in a number of instances. Recommendations for optimal identification of concussed athletes for follow-up management are presented.

The King-Devick test as a concussion screening tool administered by sports parents.

Science.gov (United States)

Leong, D F; Balcer, L J; Galetta, S L; Liu, Z; Master, C L

2014-02-01

Sports-related concussion has received increasing awareness due to short- and long-term neurologic sequelae seen among athletes. The King-Devick (K-D) test captures impairment of eye movements and other correlates of suboptimal brain function. We investigated the K-D test as a screening for concussion when administered by layperson sports parents in a cohort of amateur boxers. The K-D test was administered pre-fight and post-fight by laypersons masked to the head trauma status of each athlete. Matches were watched over by a ringside physician and boxing trainer. Athletes with suspected head trauma received testing with the Military Acute Concussion Evaluation (MACE) by the ringside physician to determine concussion status. Athletes sustaining concussion were compared to the athletes screened using the K-D test. Post-fight K-D scores were lower (better) than the best baseline score (41 vs. 39.3 s, P=0.34, Wilcoxon signed-rank test), in the absence of concussion. One boxer sustained a concussion as determined by the ringside physician. This boxer was accurately identified by the layperson K-D testers due to a worsening in K-D test compared to baseline (3.2 seconds) and an increased number of errors. High levels of test-retest reliability were observed (intraclass correlation coefficient 0.90 [95% CI 0.84-0.97]). Additionally, 6 boxers who participated in multiple bouts showed no worsening of their K-D times further supporting that scores are not affected by the fatigue associated with sparring. The K-D test is a rapid sideline screening tool for concussion that can be effectively administered by non-medically trained laypersons.

Impact locations and concussion outcomes in high school football player-to-player collisions.

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Kerr, Zachary Y; Collins, Christy L; Mihalik, Jason P; Marshall, Stephen W; Guskiewicz, Kevin M; Comstock, R Dawn

2014-09-01

Little research has examined concussion outcomes in terms of impact location (ie, the area on the head in which the impact occurred). This study describes the epidemiology of concussions resulting from player-to-player collision in high school football by impact location. National High School Sports-Related Injury Surveillance Study data (2008/2009-2012/2013) were analyzed to calculate rates and describe circumstances of football concussion (eg, symptomology, symptom resolution time, return to play) resulting from player-to-player collisions by impact location (ie, front-, back-, side-, and top-of-the-head). Most concussions resulting from player-to-player collisions occurred from front-of-the-head (44.7%) and side-of-the-head (22.3%) impacts. Number of symptoms reported, prevalence of reported symptoms, symptom resolution time, and length of time to return to play were not associated with impact location. However, a larger proportion of football players sustaining concussions from top-of-the-head impacts experienced loss of consciousness (8.0%) than those sustaining concussions from impacts to other areas of the head (3.5%) (injury proportion ratio 2.3; 95% confidence interval 1.2-4.2; P = .008). Players had their head down at the time of impact in a higher proportion of concussions caused by top-of-the-head impacts (86.4%) than concussions from impacts to other areas of the head (24.0%) (injury proportion ratio 3.6; 95% confidence interval 3.2-4.0; P impact location. Recommended strategies for reducing the proportion of top-of-the-head impacts include improved education regarding tackling with proper "head-up" technique. Copyright © 2014 by the American Academy of Pediatrics.

Developing A mobile App for the Rehabilitation of Ankle Sprains

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Suzanne McDonough

2015-10-01

Full Text Available Background: Musculoskeletal injuries are common and costly. Ankle sprains are one of the most common such injuries, carrying significant risk of persistent disabling symptoms. Rehabilitation has been shown to be more effective than standard conservative approaches for musculoskeletal injuries. The use of a mobile app to present rehabilitation guidance may offer a more accessible, engaging and effective solution to ankle sprain rehabilitation. Several existing apps target the prevention and rehabilitation of ankle sprains, however evaluation details are limited. Aim: To develop a mobile phone app that provides interactive, personalised and tailored rehabilitation for people following ankle sprains. Method(s: In order to build requirements and produce content for the app (entitled ReApp 2, relevant literature was reviewed and behaviour change strategies identified from the Behaviour Change Taxonomy (BCT developed by Michie et al (2013. A flexible and team orientated methodology called Agile was used to refine the technical specification and implemented software using feedback from technical experts (n=5 and clinicians (n=6. Technical experts consisted of participants with at least five years of experience in ICT or a related discipline. These technical experts completed the System Usability Scale (SUS to rate the usability of the software. The SUS is a widely used usability survey, which provides a single overall score for each participant. These scores can be used to provide comparison between user groups and other software. The clinicians consisted of five physiotherapists and one sport and exercise consultant, all of whom had at least five years of experience in providing rehabilitation treatment for ankle injuries. These clinicians also completed a questionnaire and gave qualitative feedback on the clinical appropriateness of the app. Results: The identified BCTs were prioritised according to clinical importance, technical complexity and time

Short-term Outcomes Following Concussion in the NFL: A Study of Player Longevity, Performance, and Financial Loss.

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Navarro, Sergio M; Sokunbi, Olumide F; Haeberle, Heather S; Schickendantz, Mark S; Mont, Michael A; Figler, Richard A; Ramkumar, Prem N

2017-11-01

A short-term protocol for evaluation of National Football League (NFL) athletes incurring concussion has yet to be fully defined and framed in the context of the short-term potential team and career longevity, financial risk, and performance. To compare the short-term career outcomes for NFL players with concussions by analyzing the effect of concussions on (1) franchise release rate, (2) career length, (3) salary, and (4) performance. Cohort study; Level of evidence, 3. NFL player transaction records and publicly available injury reports from August 2005 to January 2016 were analyzed. All players sustaining documented concussions were evaluated for a change to inactive or DNP ("did not participate") status. A case-control design compared franchise release rates and remaining NFL career span. Career length was analyzed via survival analysis. Salary and performance differences were analyzed with publicly available contract data and a performance-scoring algorithm based on position/player level. Of the 5894 eligible NFL players over the 11-year period, 307 sustained publicly reported concussions resulting in the DNP injury protocol. Analysis of the probability of remaining in the league demonstrated a statistically significantly shorter career length for the concussion group at 3 and 5 years after concussion. The year-over-year change in contract value for the concussion group resulted in a mean overall salary reduction of $300,000 ± $1,300,000 per year (interquartile range, -$723,000 to $450,000 per year). The performance score reduction for all offensive scoring players sustaining concussions was statistically significant. This retrospective study demonstrated that NFL players who sustain a concussion face a higher overall franchise release rate and shorter career span. Players who sustained concussions may incur significant salary reductions and perform worse after concussion. Short-term reductions in longevity, performance, and salary after concussion exist and

The Effect of Gender and Socioeconomic Factors on Reporting of Concussions among NCAA Student-Athletes

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Hansen, Joshua

2018-01-01

Concussions are traumatic brain injuries that result from “brain shaking” as a result of transmit force to the head. Concussions result in immediate and transient post-traumatic impairment of neural functions which lead to both psychological and physiological symptoms. As knowledge of the long-term implications of these injuries grows, concussions are becoming an increasing health concern worldwide. One subset, sports-related concussions, are receiving an increasing amount of attention fro...

Two Kampo Medicines, Jidabokuippo and Hachimijiogan Alleviate Sprains, Bruises and Arthritis

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Yasuyo Hijikata

2007-01-01

Full Text Available In traditional Chinese medicine theory (TCM, the affected parts of sprains, bruises and arthritis are considered to be under certain conditions of TCM concept. We administered two Kampo medicines with synergistic effects to promote quick recovery from these conditions. Jidabokuippo (Zhidapuyifang in Chinese, which means ‘decoction for contusions’ is expected to remove these conditions. Hachimijiogan (Baweidihuangwan in Chinese, which translates as ‘eight-ingredient pill with Rehmannia’ is expected to restore presumed minute bone injury and regulates bone metabolism by changing such conditions based on TCM theory. We administered the two prescriptions to 10 patients (age range: 40–85 years; 1 male, 9 females suffering from bruises, sprains, arthritis and spinal compression fracture without changing their routine intake of other drugs. Patients reported on changes in the pain of affected body parts by using the visual analog scale (VAS before and after administration of Kampo medicine. In almost all cases, recovery began promptly after administration and the pain disappeared within ∼2 weeks. Large doses for a short time brought about much quicker recovery than small doses. Administration of a combination of two Kampo medicines, Jidabokuippo and Hachimijiogan, quickly resolved the pain of bruises, sprains, arthritis and one spinal compression fracture.

The Young Brain and Concussion: Imaging as a Biomarker for Diagnosis and Prognosis

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Toledo, E.; Lebel, A.; Becerra, L.; Minster, A.; Linnman, C; Maleki, N; Dodick, D.W.; Borsook, D.

2012-01-01

Concussion (mild traumatic brain injury (mTBI)) is a significant pediatric public health concern. Despite increased awareness, a comprehensive understanding of the acute and chronic effects of concussion on central nervous system structure and function remains incomplete. Here we review the definition, epidemiology, and sequelae of concussion within the developing brain, during childhood and adolescence, with current data derived from studies of pathophysiology and neuroimaging. These findings may contribute to a better understanding of the neurological consequences of traumatic brain injuries, which in turn, may lead to the development of brain biomarkers to improve identification, management and prognosis of pediatric patients suffering from concussion. PMID:22476089

Mild Traumatic Brain Injury: Lessons Learned from Clinical, Sports, and Combat Concussions

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Judy C. Kelly

2012-01-01

Full Text Available Over the past forty years, a tremendous amount of information has been gained on the mechanisms and consequences of mild traumatic brain injuries. Using sports as a laboratory to study this phenomenon, a natural recovery curve emerged, along with standards for managing concussions and returning athletes back to play. Although advances have been made in this area, investigation into recovery and return to play continues. With the increase in combat-related traumatic brain injuries in the military setting, lessons learned from sports concussion research are being applied by the Department of Defense to the assessment of blast concussions and return to duty decision making. Concussion management and treatment for military personnel can be complicated by additional combat related stressors not present in the civilian environment. Cognitive behavioral therapy is one of the interventions that has been successful in treating symptoms of postconcussion syndrome. While we are beginning to have an understanding of the impact of multiple concussions and subconcussive blows in the sports world, much is still unknown about the impact of multiple blast injuries.

Osteoarthritis Prevalence in Retired National Football League Players With a History of Concussion and Lower Extremity Injury.

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Lynall, Robert C; Pietrosimone, Brian; Kerr, Zachary Y; Mauntel, Timothy C; Mihalik, Jason P; Guskiewicz, Kevin M

2017-06-02

  Dynamic balance deficits have been described postconcussion, even after athletes return to play. Lower extremity (LE) musculoskeletal injury rates increase for up to 1 year after concussion, but the long-term musculoskeletal implications of concussion are unclear.   To (1) examine the association of concussion and LE injury histories with osteoarthritis (OA) prevalence in retired National Football League players and (2) examine the association of concussion and LE injury histories with OA prevalence in those ≤55 years of age.   Case-control study.   Survey.   We administered the Health Survey of Retired National Football League Players, which collects information about demographics, OA, LE injury, and concussion history.   Twelve discrete categories were created based on concussion and LE injury history, ranging from 0 concussions and 0 LE injuries (referent group) to 3+ concussions and 2+ LE injuries. Binomial regression analysis modeled lifetime OA prevalence. Covariates were body mass index, age at the time of the survey, and total years playing professional football.   Complete data were available for 2696 participants. Lifetime OA prevalence was smallest in the referent group (21.1%) and largest in the 3+ concussion and 2+ LE group (50.6%; 2.5 times the referent; 95% confidence interval [CI] = 2.1, 3.1). Participants in all concussion groups (1, 2, 3+) who reported a history of 0 LE injuries had a greater OA prevalence than the referent group. When participants were stratified by age, the ≤55 years of age, 3+ concussions, and 2+ LE injuries group prevalence ratio (3.6; 95% CI = 2.7, 5.2) was larger than that of the >55 years of age, 3+ concussions, and 2+ LE injuries group (1.8; 95% CI = 1.3, 2.4) compared with the respective referent groups.   Concussion with or without a history of LE injury may be an important moderator of OA. Future researchers should seek to better understand the mechanisms that influence the association among

Multiple Past Concussions in High School Football Players: Are There Differences in Cognitive Functioning and Symptom Reporting?

Science.gov (United States)

Brooks, Brian L; Mannix, Rebekah; Maxwell, Bruce; Zafonte, Ross; Berkner, Paul D; Iverson, Grant L

2016-12-01

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. To determine if there are measureable differences in cognitive functioning or symptom reporting in high school football players with a history of multiple concussions. Cross-sectional study; Level of evidence, 3. 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. 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). 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. © 2016 The Author(s).

Dual-Task Assessment Protocols in Concussion Assessment: A Systematic Literature Review.

Science.gov (United States)

Kleiner, Michelle; Wong, Lynne; Dubé, Alexandra; Wnuk, Katie; Hunter, Susan W; Graham, Laura J

2018-02-01

Study Design Systematic review. Background When assessed in isolation, balance and neurocognitive testing may not be sufficiently responsive to capture changes that occur with concussion. Normal daily activities require simultaneous cognitive and physical demands. Therefore, a dual-task assessment paradigm should be considered to identify performance deficits. Objectives To evaluate the literature and to identify dual-task testing protocols associated with changes in gait after concussion. Methods A systematic review of articles of individuals with concussion who underwent dual-task testing with a combination of motor and cognitive tasks was conducted. The AMED, CINAHL, Embase, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science databases and gray literature were searched from inception to January 29, 2017. Title and abstract, full-text, and quality review and data abstraction were performed by 2 independent reviewers. Results Twenty-four articles met the inclusion criteria. Eleven articles reported decreased gait velocity and increased medial-lateral displacement for individuals with concussion during dual-task conditions. Overall, included articles were of poor to moderate methodological quality. Fifteen articles used the same participants and data sets, creating a threat to validity and limiting the ability to make conclusions. Conclusion A deterioration in gait performance during dual-task testing is present among people with concussion. Specific recommendations for the use of a dual-task protocol to assess individuals with suspected concussion injury in a clinical setting have yet to be determined. J Orthop Sports Phys Ther 2018;48(2):87-103. Epub 7 Nov 2017. doi:10.2519/jospt.2018.7432.

Intention to use sport concussion guidelines among community-level coaches and sports trainers.

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Newton, Joshua D; White, Peta E; Ewing, Michael T; Makdissi, Michael; Davis, Gavin A; Donaldson, Alex; Sullivan, S John; Seward, Hugh; Finch, Caroline F

2014-09-01

Sporting bodies have developed guidelines for managing community-level players with suspected concussion in response to international consensus statements on concussion in sport. The purpose of this study was to examine the factors that influence the intended use of concussion guidelines among community-level coaches and sports trainers from two popular football codes in Australia: Australian football and rugby league. Cross-sectional survey. The survey, based on an extended theory of planned behaviour model, was completed by 183 Australian football coaches, 121 Australian football sports trainers, 171 rugby league coaches, and 142 rugby league sports trainers. Personal norms and self-efficacy were significant predictors of intention to use concussion guidelines, although the relationship between self-efficacy and intention was stronger among Australian football coaches than rugby league coaches. Analysis of the salient beliefs that underpin self-efficacy found that coaches, irrespective of football code, felt less familiar (χ(2)=25.70, psports trainers in using the concussion guidelines. At the same time, Australian football personnel, irrespective of their team role, felt that they had insufficient time (χ(2)=8.04, psport concussion guidelines should focus on enhancing self-efficacy and leveraging personal norms. Increasing coaches' familiarity and experience in using the concussion guidelines would also be warranted, as would finding ways to overcome the perceived time and resource constraints identified among Australian football personnel. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Impact of a State Law on Physician Practice in Sports-Related Concussions.

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Flaherty, Michael R; Raybould, Toby; Jamal-Allial, Aziza; Kaafarani, Haytham M A; Lee, Jarone; Gervasini, Alice; Ginsburg, Richard; Mandell, Mark; Donelan, Karen; Masiakos, Peter T

2016-11-01

To determine physician-reported adherence to and support of the 2010 Massachusetts youth concussion law, as well as barriers to care and clinical practice in the context of legislation. Primary care physicians (n = 272) in a large pediatric network were eligible for a cross-sectional survey in 2014. Survey questions addressed key policy and practice provisions: concussion knowledge, state regulations and training, practice patterns, referrals, patient characteristics, and barriers to care. Analyses explored relationships between practice and policy, adjusting for physician demographic and practice characteristics. The survey response rate was 64% among all responders (173 of 272). A total of 146 respondents who had evaluated, treated, or referred patients with a suspected sports-related concussion in the previous year were eligible for analysis. The vast majority (90%) of providers agreed that the current Massachusetts laws regarding sports concussions are necessary and support the major provisions. Three-quarters (74%) had taken a required clinician training course on concussions. Those who took training courses were significantly more likely to develop individualized treatment plans (OR, 3.6; 95% CI, 1.1-11.0). Physician training did not improve screening of youth with concussion for depression or substance use. Most physicians (77%) advised patients to refrain from computer, telephone, or television for various time periods. Physicians reported limited communication with schools. Primary care physicians report being comfortable with the diagnosis and management of concussions, and support statewide regulations; however, adherence to mandated training and specific legal requirements varied. Broader and more frequent training may be necessary to align current best evidence with clinical care and state-mandated practice. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between recurrent concussion and late-life cognitive impairment in retired professional football players.

Science.gov (United States)

Guskiewicz, Kevin M; Marshall, Stephen W; Bailes, Julian; McCrea, Michael; Cantu, Robert C; Randolph, Christopher; Jordan, Barry D

2005-10-01

Cerebral concussion is common in collision sports such as football, yet the chronic neurological effects of recurrent concussion are not well understood. The purpose of our study was to investigate the association between previous head injury and the likelihood of developing mild cognitive impairment (MCI) and Alzheimer's disease in a unique group of retired professional football players with previous head injury exposure. A general health questionnaire was completed by 2552 retired professional football players with an average age of 53.8 (+/-13.4) years and an average professional football playing career of 6.6 (+/- 3.6) years. A second questionnaire focusing on memory and issues related to MCI was then completed by a subset of 758 retired professional football players (> or = 50 yr of age). Results on MCI were then cross-tabulated with results from the original health questionnaire for this subset of older retirees. Of the former players, 61% sustained at least one concussion during their professional football career, and 24% sustained three or more concussions. Statistical analysis of the data identified an association between recurrent concussion and clinically diagnosed MCI (chi = 7.82, df = 2, P = 0.02) and self-reported significant memory impairments (chi = 19.75, df = 2, P = 0.001). Retired players with three or more reported concussions had a fivefold prevalence of MCI diagnosis and a threefold prevalence of reported significant memory problems compared with retirees without a history of concussion. Although there was not an association between recurrent concussion and Alzheimer's disease, we observed an earlier onset of Alzheimer's disease in the retirees than in the general American male population. Our findings suggest that the onset of dementia-related syndromes may be initiated by repetitive cerebral concussions in professional football players.

Concussions: What a neurosurgeon should know about current scientific evidence and management strategies

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Neal, Matthew T.; Wilson, Jonathan L.; Hsu, Wesley; Powers, Alexander K.

2012-01-01

Background: There has been a tremendous amount of interest focused on the topic of concussions over the past few decades. Neurosurgeons are frequently consulted to manage patients with mild traumatic brain injuries (mTBI) that have radiographic evidence of cerebral injury. These injuries share significant overlap with concussions, injuries that typically do not reveal radiographic evidence of structural injury, in the realms of epidemiology, pathophysiology, outcomes, and management. Further, neurosurgeons often manage patients with extracranial injuries that have concomitant concussions. In these cases, neurosurgeons are often the only “concussion experts” that patients encounter. Results: The literature has been reviewed and data have been synthesized on the topic including sections on historical background, epidemiology, pathophysiology, diagnostic advances, clinical sequelae, and treatment suggestions, with neurosurgeons as the intended target audience. Conclusions: Neurosurgeons should have a fundamental knowledge of the scientific evidence that has developed regarding concussions and be prepared to guide patients with treatment plans. PMID:22439107

Use of the stepwise progression return-to-play protocol following concussion among practicing athletic trainers

Directory of Open Access Journals (Sweden)

Jessica Wallace

2018-04-01

Full Text Available Purpose: The purpose of this study was to determine whether practicing athletic trainers (ATs were using the stepwise progression to make return-to-play (RTP decisions after concussion and to determine what factors influenced their decision to use the stepwise progression. Methods: A total of 166 ATs (response rate = 16.6% completed a 21-item questionnaire that evaluated participant demographics, methods of concussion management, and RTP decision-making using the stepwise progression. Descriptive statistics and a logistic regression were completed to analyze data. Results: Factors such as education level (p = 0.05 and number of concussions treated (p = 0.05 predicted use of the stepwise progression, whereas sex (p = 0.17, employment setting (p = 0.17, state law (p = 0.86, and years practicing (p = 0.17 did not predict whether ATs were following the stepwise progression. Conclusion: The majority of the ATs from this study are employing the stepwise progression to safely return athletes to play after sustaining a concussion. This demonstrates that ATs are providing a standard of care for concussed athletes across various athletic training settings; however, having a graduate degree and treating more concussions per year are predictors of whether an AT follows all steps of the stepwise progression. Keywords: Athletic trainers, Concussion, Concussion management, Graduate degree, Return to play, Sports medicine, Stepwise progression

Reliability and Validity Evidence of Multiple Balance Assessments in Athletes With a Concussion

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Murray, Nicholas; Salvatore, Anthony; Powell, Douglas; Reed-Jones, Rebecca

2014-01-01

Context: An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. Objective: To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. Data Sources: Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. Data Extraction: We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. Data Synthesis: No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%, specificity = 87%). However, the Romberg test and Wii Fit have been shown to be reliable tools in the assessment of balance in Parkinson patients. Conclusions: The BESS can evaluate balance problems after a concussion. However, it lacks the ability to detect balance problems after the third day of recovery. Further investigation is needed to establish the use of the CTSIB, SOT, Romberg test, and Wii Fit for

Reliability and validity evidence of multiple balance assessments in athletes with a concussion.

Science.gov (United States)

Murray, Nicholas; Salvatore, Anthony; Powell, Douglas; Reed-Jones, Rebecca

2014-01-01

An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%, specificity = 87%). However, the Romberg test and Wii Fit have been shown to be reliable tools in the assessment of balance in Parkinson patients. The BESS can evaluate balance problems after a concussion. However, it lacks the ability to detect balance problems after the third day of recovery. Further investigation is needed to establish the use of the CTSIB, SOT, Romberg test, and Wii Fit for assessing balance in athletes with concussions.

Taking Care After A Concussion

Centers for Disease Control (CDC) Podcasts

2010-03-17

This podcast describes how to take care of yourself after a concussion, including proper recognition and response recommendations.  Created: 3/17/2010 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 3/17/2010.

Concussions in Collision Youth Sports

Directory of Open Access Journals (Sweden)

Kathleen A. Linzmeier

2016-03-01

Full Text Available Investigators from the University of Pittsburg, University of Arkansas, Lake Erie College of Osteopathic Medicine, and Boston Children’s Hospital/Harvard Medical College researched the incidence of concussions in youth hockey in relation to age and activity setting.

Examination of Teacher Knowledge, Dissemination Preferences, and Classroom Management of Student Concussions: Implications for Return-to-Learn Protocols.

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Dreer, Laura E; Crowley, Maria T; Cash, Augusta; O'Neill, Jilian A; Cox, Molly K

2017-05-01

To determine teacher knowledge of (1) concussion symptomatology, (2) dissemination preferences, and (3) classroom management practices of student concussions. A cross-sectional survey assessing concussion-related information was completed by teachers/instructors in the state of Alabama. One-hundred and thirty participants completed the survey. Only a quarter perceived they were "very" or "extremely" confident enough to recognize signs related to a concussion (22.3%), and only 12.4% reported they were "very knowledgeable" about concussions. The majority were able to recognize more common concussion symptoms/challenges: headaches (95.4%), trouble concentrating (86.2%), memory (82.3%), balance problems/dizziness (82.3%), changes vision/hearing (76.2%), difficulty completing tasks (70.8%), difficulty making decisions (66.2%), changes in sleep (61.5%), and fatigue (60.8%); only half recognized emotional symptoms (e.g., mood) or symptoms associated with more prolonged recovery. Concussion informants were school nurses (74.4%), followed by parents (46.2%), students (46.2%), and coaches/athletic trainers (45.4%). A little under half of participants received concussion information as part of their job (41.9%). About 14.1% of teachers reported that someone had come to their school to talk with them as a group about concussions, and 82% felt they needed more information. Of the 37% who taught a concussed student, 83% reported they altered the classroom management strategies. In general, teachers were able to recognize the more commonly experienced concussion symptoms as well as management strategies. However, they appear to want greater concussion information and training. Given the daily influence of teachers on student tasks involving cognitive exertion, incorporation of formal concussion education for teachers is warranted.

The auditory comprehension changes over time after sport-related concussion can indicate multisensory processing dysfunctions.

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Białuńska, Anita; Salvatore, Anthony P

2017-12-01

Although science findings and treatment approaches of a concussion have changed in recent years, there continue to be challenges in understanding the nature of the post-concussion behavior. There is growing a body of evidence that some deficits can be related to an impaired auditory processing. To assess auditory comprehension changes over time following sport-related concussion (SRC) in young athletes. A prospective, repeated measures mixed-design was used. A sample of concussed athletes ( n  = 137) and the control group consisted of age-matched, non-concussed athletes ( n  = 143) were administered Subtest VIII of the Computerized-Revised Token Test (C-RTT). The 88 concussed athletes selected for final analysis (neither previous history of brain injury, neurological, psychiatric problems, nor auditory deficits) were evaluated after injury during three sessions (PC1, PC2, and PC3); controls were tested once. Between- and within-group comparisons using RMANOVA were performed on the C-RTT Efficiency Score (ES). ES of the SRC athletes group improved over consecutive testing sessions ( F  =   14.7, p   2.0, Ps integration and/or motor execution can be compromised after a concussion.

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial.

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Davenport, Todd E; Kulig, Kornelia; Fisher, Beth E

2010-10-19

Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle sprains. However, these interventions have yet to be longitudinally compared against a placebo study condition. We developed a randomized, placebo-controlled clinical trial designed to test the hypotheses that hands-on treatment procedures administered to individuals following ankle sprains during the post-acute injury period can improve short-, intermediate-, and long-term disablement, as well as reduce the risk for re-injury. This study is designed to measure the clinical effects of hands-on passive stretching treatment procedures directed to the talocrural joint that vary in treatment speed during the post-acute injury period, compared to hands-on placebo control intervention. http://www.clinicaltrials.gov identifier NCT00888498.

Ambulatory Medical Care Utilization Estimates for 2007

Science.gov (United States)

... ulna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fracture of hand and fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fracture of lower limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sprains and strains of wrist and hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sprains ... ulna . . . . . . . . . . . . . . . . . . . . Fracture of hand and fingers . . . . . . . . . . . . . . . . . . . Fracture of lower limb . . . . . . . . . . . . . . . . . . . . . . . Other fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sprains and strains of wrist and hand. . . . . . . . . . . . . . Sprains ...

Autonomic Nervous System Responses to Concussion: Arterial Pulse Contour Analysis

Directory of Open Access Journals (Sweden)

Michael F La Fountaine

2016-02-01

Full Text Available The arterial pulse wave (APW has a distinct morphology whose contours reflect dynamics in cardiac function and peripheral vascular tone as a result of sympathetic nervous system (SNS control. With a transition from rest to increased metabolic demand, the expected augmentation of SNS outflow will not only affect arterial blood pressure and heart rate, it will also induce changes to the contours of the APW. Following a sports concussion, a transient state cardiovascular autonomic dysfunction is present. How this state affects the APW, has yet to be described. A prospective, parallel-group study on cardiovascular autonomic control (i.e., digital electrocardiogram and continuous beat-to-beat blood pressure was performed in the seated upright position in ten athletes with concussion and 7 non-injured control athletes. Changes in APW were compared at rest and during the first 60 seconds (F60 of an isometric handgrip test (IHGT in concussed athletes and non-injured controls within 48 hours (48hr and 1 week (1wk of injury. The concussion group was further separated by the length of time until they were permitted to return to play (RTP>1wk; RTP≤1wk. SysSlope, an indirect measurement of stroke volume, was significantly lower in the concussion group at rest and during F60 at 48hr and 1wk; a paradoxical decline in SysSlope occurred at each visit during the transition from rest to IHGT F60. The RTP>1wk group had lower SysSlope (405±200; 420±88; 454±236 mmHg/s, respectively at rest 48hr compared to the RTP≤1wk and controls. Similarly at 48hr rest, several measurements of arterial stiffness were abnormal in RTP>1wk compared to RTP≤1wk and controls: Peak-to-Notch Latency (0.12±0.04; 0.16±0.02; 0.17±0.05, respectively, Notch Relative Amplitude (0.70±0.03; 0.71±0.04; 0.66±0.14, respectively and Stiffness Index (6.4±0.2; 5.7±0.4; 5.8±0.5, respectively. Use of APW revealed that concussed athletes have a transient increase in peripheral artery

Vision training methods for sports concussion mitigation and management.

Science.gov (United States)

Clark, Joseph F; Colosimo, Angelo; Ellis, James K; Mangine, Robert; Bixenmann, Benjamin; Hasselfeld, Kimberly; Graman, Patricia; Elgendy, Hagar; Myer, Gregory; Divine, Jon

2015-05-05

There is emerging evidence supporting the use vision training, including light board training tools, as a concussion baseline and neuro-diagnostic tool and potentially as a supportive component to concussion prevention strategies. This paper is focused on providing detailed methods for select vision training tools and reporting normative data for comparison when vision training is a part of a sports management program. The overall program includes standard vision training methods including tachistoscope, Brock's string, and strobe glasses, as well as specialized light board training algorithms. Stereopsis is measured as a means to monitor vision training affects. In addition, quantitative results for vision training methods as well as baseline and post-testing *A and Reaction Test measures with progressive scores are reported. Collegiate athletes consistently improve after six weeks of training in their stereopsis, *A and Reaction Test scores. When vision training is initiated as a team wide exercise, the incidence of concussion decreases in players who participate in training compared to players who do not receive the vision training. Vision training produces functional and performance changes that, when monitored, can be used to assess the success of the vision training and can be initiated as part of a sports medical intervention for concussion prevention.

What are the real risks of sport-related concussion, and are they modifiable?

Science.gov (United States)

Randolph, Christopher; Kirkwood, Michael W

2009-07-01

Over the past two decades, the management of sport-related concussion has been the topic of increased attention in the scientific literature and in the popular media. Despite a proliferation of competing guidelines for concussion management, the widespread use of neuropsychological "baseline" testing designed to monitor postinjury recovery, and several prospective controlled studies of the natural history of concussion, there has been virtually no attempt to quantify the risks associated with sport-related concussion or to determine whether these risks are modifiable via management strategies. Using American football as a model, the short- and long-term risks of sport-related concussion are reviewed. It is concluded that serious short-term consequences of sport-related concussion are extremely rare and unlikely to be significantly modified via management strategies that rely on baseline testing. Other less serious short-term adverse outcomes are also quite rare, transient, and not likely to be altered by specific management guidelines. The long-term consequences of multiple sport-related head trauma remain unclear but are potentially of greater public health concern and should be the focus of increased research. Based on available evidence, there is little rationale for the use of rigid strategies or guidelines in the place of individual clinical decision-making in the management of these injuries.

Joint stability characteristics of the ankle complex in female athletes with histories of lateral ankle sprain, part II: clinical experience using arthrometric measurement.

Science.gov (United States)

Kovaleski, John E; Heitman, Robert J; Gurchiek, Larry R; Hollis, J M; Liu, Wei; Pearsall, Albert W

2014-01-01

This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Cross-sectional study. University research laboratory. Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.

Plasma soluble prion protein, a potential biomarker for sport-related concussions: a pilot study.

Science.gov (United States)

Pham, Nam; Akonasu, Hungbo; Shishkin, Rhonda; Taghibiglou, Changiz

2015-01-01

Sport-related mild traumatic brain injury (mTBI) or concussion is a significant health concern to athletes with potential long-term consequences. The diagnosis of sport concussion and return to sport decision making is one of the greatest challenges facing health care clinicians working in sports. Blood biomarkers have recently demonstrated their potential in assisting the detection of brain injury particularly, in those cases with no obvious physical injury. We have recently discovered plasma soluble cellular prion protein (PrP(C)) as a potential reliable biomarker for blast induced TBI (bTBI) in a rodent animal model. In order to explore the application of this novel TBI biomarker to sport-related concussion, we conducted a pilot study at the University of Saskatchewan (U of S) by recruiting athlete and non-athlete 18 to 30 year-old students. Using a modified quantitative ELISA method, we first established normal values for the plasma soluble PrP(C) in male and female students. The measured plasma soluble PrP(C) in confirmed concussion cases demonstrated a significant elevation of this analyte in post-concussion samples. Data collected from our pilot study indicates that the plasma soluble PrP(C) is a potential biomarker for sport-related concussion, which may be further developed into a clinical diagnostic tool to assist clinicians in the assessment of sport concussion and return-to-play decision making.

Does fair play reduce concussions? A prospective, comparative analysis of competitive youth hockey tournaments.

Science.gov (United States)

Smith, Aynsley M; Gaz, Daniel V; Larson, Dirk; Jorgensen, Janelle K; Eickhoff, Chad; Krause, David A; Fenske, Brooke M; Aney, Katie; Hansen, Ashley A; Nanos, Stephanie M; Stuart, Michael J

2016-01-01

To determine if Boys Bantam and Peewee and Girls U14 sustain fewer concussions, head hits, 'other injuries' and penalties in hockey tournaments governed by intensified fair play (IFP) than non-intensified fair play (NIFP). A prospective comparison of IFP, a behaviour modification programme that promotes sportsmanship, versus control (non-intensified, NIFP) effects on numbers of diagnosed concussions, head hits without diagnosed concussion (HHWDC), 'other injuries', number of penalties and fair play points (FPPs). 1514 players, ages 11-14 years, in 6 IFP (N=950) and 5 NIFP (N=564) tournaments were studied. Two diagnosed concussions, four HHWDC, and six 'other injuries' occurred in IFP tournaments compared to one concussion, eight HHWDC and five 'other injuries' in NIFP. There were significantly fewer HHWDC in IFP than NIFP (p=0.018). However, diagnosed concussions, 'other injuries', penalties and FPPs did not differ significantly between conditions. In IFP, a minority of teams forfeited the majority of FPPs. Most diagnosed concussions, HHWDC, and other injuries occurred to Bantam B players and usually in penalised teams that forfeited their FPPs. In response to significant differences in HHWDC between IFP and NIFP tournaments, the following considerations are encouraged: mandatory implementation of fair play in regular season and tournaments, empowering tournament directors to not accept heavily penalised teams, and introducing 'no body checking' in Bantam.

Muscle Reaction Time During a Simulated Lateral Ankle Sprain After Wet-Ice Application or Cold-Water Immersion.

Science.gov (United States)

Thain, Peter K; Bleakley, Christopher M; Mitchell, Andrew C S

2015-07-01

Cryotherapy is used widely in sport and exercise medicine to manage acute injuries and facilitate rehabilitation. The analgesic effects of cryotherapy are well established; however, a potential caveat is that cooling tissue negatively affects neuromuscular control through delayed muscle reaction time. This topic is important to investigate because athletes often return to exercise, rehabilitation, or competitive activity immediately or shortly after cryotherapy. To compare the effects of wet-ice application, cold-water immersion, and an untreated control condition on peroneus longus and tibialis anterior muscle reaction time during a simulated lateral ankle sprain. Randomized controlled clinical trial. University of Hertfordshire human performance laboratory. A total of 54 physically active individuals (age = 20.1 ± 1.5 years, height = 1.7 ± 0.07 m, mass = 66.7 ± 5.4 kg) who had no injury or history of ankle sprain. Wet-ice application, cold-water immersion, or an untreated control condition applied to the ankle for 10 minutes. Muscle reaction time and muscle amplitude of the peroneus longus and tibialis anterior in response to a simulated lateral ankle sprain were calculated. The ankle-sprain simulation incorporated a combined inversion and plantar-flexion movement. We observed no change in muscle reaction time or muscle amplitude after cryotherapy for either the peroneus longus or tibialis anterior (P > .05). Ten minutes of joint cooling did not adversely affect muscle reaction time or muscle amplitude in response to a simulated lateral ankle sprain. These findings suggested that athletes can safely return to sporting activity immediately after icing. Further evidence showed that ice can be applied before ankle rehabilitation without adversely affecting dynamic neuromuscular control. Investigation in patients with acute ankle sprains is warranted to assess the clinical applicability of these interventions.

Wireless nanosensors for monitoring concussion of football players

Science.gov (United States)

Ramasamy, Mouli; Harbaugh, Robert E.; Varadan, Vijay K.

2015-04-01

Football players are more to violent impacts and injuries more than any athlete in any other sport. Concussion or mild traumatic brain injuries were one of the lesser known sports injuries until the last decade. With the advent of modern technologies in medical and engineering disciplines, people are now more aware of concussion detection and prevention. These concussions are often overlooked by football players themselves. The cumulative effect of these mild traumatic brain injuries can cause long-term residual brain dysfunctions. The principle of concussion is based the movement of the brain in the neurocranium and viscerocranium. The brain is encapsulated by the cerebrospinal fluid which acts as a protective layer for the brain. This fluid can protect the brain against minor movements, however, any rapid movements of the brain may mitigate the protective capability of the cerebrospinal fluid. In this paper, we propose a wireless health monitoring helmet that addresses the concerns of the current monitoring methods - it is non-invasive for a football player as helmet is not an additional gear, it is efficient in performance as it is equipped with EEG nanosensors and 3D accelerometer, it does not restrict the movement of the user as it wirelessly communicates to the remote monitoring station, requirement of individual monitoring stations are not required for each player as the ZigBee protocol can couple multiple transmitters with one receiver. A helmet was developed and validated according to the above mentioned parameters.

Concussive convulsions as differential diagnosis of posttraumatic epilepsy

Directory of Open Access Journals (Sweden)

Vojvodić Nikola M.

2002-01-01

Full Text Available Concussive convulsions are motor manifestations in acute head injury. This clinical phenomenon should be distin- guished from epileptic seizures. We present two young men with motor and convulsive manifestations in acute head injury. Patient 1. A18-year old basketball player felt on the parquet during a game. Initially he was struck on the right shoulder which caused brief and vigorous twitch of the head towards the ground and additional temporal impact. At the moment of impact he lost consciousness and developed tonic leg and arm posturing with both clenched fists. His legs were extended during next 20 seconds. Thereafter he was still and his loss of consciousness lasted 3 minutes. Patient 2. A 26-year old man felt on the wooden ground from a 4 m high ferry. He got head impact and lost consciousness. In a few seconds he had tonic/clonic convulsions for the next 10-15 seconds. Ten minutes later he awaked. Results of subsequent neurological examination, electroencephalography and cerebral magnetic resonance imaging studies were normal in both patients. They returned to their occupations after four weeks without problems for a further one year. Conclusion. Described motor manifestations present concussive convulsions. These clinical features are due to transient functional decerebration and corticomedullary dissociation during cerebral concussion. Concussive convulsions are a non-epileptic phenomenon, they are not associated with structural brain injury and have good prognosis. Antiepileptic treatment is not indicated.

Comparison of the balance accelerometer measure and balance error scoring system in adolescent concussions in sports.

Science.gov (United States)

Furman, Gabriel R; Lin, Chia-Cheng; Bellanca, Jennica L; Marchetti, Gregory F; Collins, Michael W; Whitney, Susan L

2013-06-01

High-technology methods demonstrate that balance problems may persist up to 30 days after a concussion, whereas with low-technology methods such as the Balance Error Scoring System (BESS), performance becomes normal after only 3 days based on previously published studies in collegiate and high school athletes. To compare the National Institutes of Health's Balance Accelerometer Measure (BAM) with the BESS regarding the ability to detect differences in postural sway between adolescents with sports concussions and age-matched controls. Cohort study (diagnosis); Level of evidence, 2. Forty-three patients with concussions and 27 control participants were tested with the standard BAM protocol, while sway was quantified using the normalized path length (mG/s) of pelvic accelerations in the anterior-posterior direction. The BESS was scored by experts using video recordings. The BAM was not able to discriminate between healthy and concussed adolescents, whereas the BESS, especially the tandem stance conditions, was good at discriminating between healthy and concussed adolescents. A total BESS score of 21 or more errors optimally identified patients in the acute concussion group versus healthy participants at 60% sensitivity and 82% specificity. The BAM is not as effective as the BESS in identifying abnormal postural control in adolescents with sports concussions. The BESS, a simple and economical method of assessing postural control, was effective in discriminating between young adults with acute concussions and young healthy people, suggesting that the test has value in the assessment of acute concussions.

A systematic video analysis of National Hockey League (NHL) concussions, part I: who, when, where and what?

Science.gov (United States)

Hutchison, Michael G; Comper, Paul; Meeuwisse, Willem H; Echemendia, Ruben J

2015-04-01

Although there is a growing understanding of the consequences of concussions in hockey, very little is known about the precipitating factors associated with this type of injury. To describe player characteristics and situational factors associated with concussions in the National Hockey League (NHL). Case series of medically diagnosed concussions for regular season games over a 3.5-year period during the 2006-2010 seasons using an inclusive cohort of professional hockey players. Digital video records were coded and analysed using the Heads Up Checklist. Of 197 medically diagnosed concussions, 88% involved contact with an opponent. Forwards accounted for more concussions than expected compared with on-ice proportional representation (95% CI 60 to 73; p=0.04). Significantly more concussions occurred in the first period (47%) compared with the second and third periods (p=0.047), with the majority of concussions occurring in the defensive zone (45%). Approximately 47% of the concussions occurred in open ice, 53% occurred in the perimeter. Finally, 37% of the concussions involved injured players' heads contacting the boards or glass. This study describes several specific factors associated with concussions in the NHL, including period of the game, player position, body size, and specific locations on the ice and particular situations based on a player's position. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Genetics and Other Risk Factors for Past Concussions in Active-Duty Soldiers.

Science.gov (United States)

Dretsch, Michael N; Silverberg, Noah; Gardner, Andrew J; Panenka, William J; Emmerich, Tanja; Crynen, Gogce; Ait-Ghezala, Ghania; Chaytow, Helena; Mathura, Venkat; Crawford, Fiona C; Iverson, Grant L

2017-02-15

Risk factors for concussion in active-duty military service members are poorly understood. The present study examined the association between self-reported concussion history and genetics (apolipoprotein E [APOE], brain-derived neurotrophic factor [BDNF], and D2 dopamine receptor genes [DRD2]), trait personality measures (impulsive-sensation seeking and trait aggression-hostility), and current alcohol use. The sample included 458 soldiers who were preparing to deploy for Operation Iraqi Freedom/Operation Enduring Freedom. For those with the BDNF Met/Met genotype, 57.9% (11/19) had a history of one or more prior concussions, compared with 35.6% (154/432) of those with other BDNF genotypes (p = 0.049, odds ratio [OR] = 2.48). APOE and DRD2 genotypes were not associated with risk for past concussions. Those with the BDNF Met/Met genotype also reported greater aggression and hostility personality characteristics. When combined in a predictive model, prior military deployments, being male, and having the BDNF Met/Met genotype were independently associated with increased lifetime history of concussions in active-duty soldiers. Replication in larger independent samples is necessary to have more confidence in both the positive and negative genetic associations reported in this study.

Development of a risk prediction model among professional hockey players with visible signs of concussion.

Science.gov (United States)

Bruce, Jared M; Echemendia, Ruben J; Meeuwisse, Willem; Hutchison, Michael G; Aubry, Mark; Comper, Paul

2017-04-04

Little research examines how to best identify concussed athletes. The purpose of the present study was to develop a preliminary risk decision model that uses visible signs (VS) and mechanisms of injury (MOI) to predict the likelihood of subsequent concussion diagnosis. Coders viewed and documented VS and associated MOI for all NHL games over the course of the 2013-2014 and 2014-2015 regular seasons. After coding was completed, player concussions were identified from the NHL injury surveillance system and it was determined whether players exhibiting VS were subsequently diagnosed with concussions by club medical staff as a result of the coded event. Among athletes exhibiting VS, suspected loss of consciousness, motor incoordination or balance problems, being in a fight, having an initial hit from another player's shoulder and having a secondary hit on the ice were all associated with increased risk of subsequent concussion diagnosis. In contrast, having an initial hit with a stick was associated with decreased risk of subsequent concussion diagnosis. A risk prediction model using a combination of the above VS and MOI was superior to approaches that relied on individual VS and associated MOI (sensitivity=81%, specificity=72%, positive predictive value=26%). Combined use of VS and MOI significantly improves a clinician's ability to identify players who need to be evaluated for possible concussion. A preliminary concussion prediction log has been developed from these data. Pending prospective validation, the use of these methods may improve early concussion detection and evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Risk of Concussion During Sports Versus Physical Education Among New Mexico Middle and High School Students.

Science.gov (United States)

Campbell, Richard A; Gorman, Stephanie A; Thoma, Robert J; Annett, Robert D; McGrew, Christopher A; Yeo, Ronald A; Mayer, Andrew R; King, John H; Rowland, Andrew S

2018-01-01

To measure the risk of concussion among New Mexico middle and high school students during both sports and physical education. Athletic directors or athletic trainers in 147 schools were asked to report the number of concussions occurring during sports and physical education in the 2013 to 2014 school year. We calculated 1-year cumulative incidence rates. Of the 147 schools, 99 responded (67%). During the school year, 598 students were removed from athletics because of a concussion, a 1-year cumulative incidence of 3.5 per 100. The concussion rate during sports was 3.0: 3.5 for boys and 2.4 for girls (relative risk [RR] = 1.5; 95% confidence interval [CI] = 1.2, 1.7). An additional 335 students experienced concussions during physical education. Concussion rates during physical education were 60% higher than during sports (RR = 1.6; 95% CI = 1.4, 1.8). In our data, the risk of concussion was higher in physical education than in sports. This suggests that concussions should be tracked for a wide range of youth athletic activities, not just for sports. Monitoring cumulative incidence, in addition to other measures, may allow comparisons across schools and regions. More prevention efforts are needed.

Physical Activity Level and Symptom Duration Are Not Associated After Concussion.

Science.gov (United States)

Howell, David R; Mannix, Rebekah C; Quinn, Bridget; Taylor, J Andrew; Tan, Can Ozan; Meehan, William P

2016-04-01

Physical rest after a concussion has been described as a key component in the management of the injury. Evidence supporting this recommendation, however, is limited. To examine the association between physical activity and symptom duration in a cohort of patients after a concussion. Cohort study; Level of evidence, 2. This study included 364 patients who were diagnosed with a concussion, were seen by a physician within 3 weeks of injury, and completed a questionnaire at the initial clinic visit. The questionnaire assessed the postconcussion symptom scale (PCSS) score, previous number of concussions, presence of the loss of consciousness or amnesia at the time of injury, and prior treatment for headaches. During each follow-up clinic visit, physical activity level was self-reported. A Cox proportional hazard model was constructed to determine the association between symptom duration, initial clinic visit responses, and self-reported physical activity level after the injury. Study participants ranged in age from 8 to 27 years (mean age, 15.0 years) and had sustained a mean of 0.8 prior concussions; 222 patients (61%) were male. On initial examination, the mean PCSS score was 34.7. The mean symptom duration was 48.9 days after the injury. Among the variables included in the model, initial PCSS score and female sex were independently associated with symptom duration, while physical activity level after the injury was not. For participants aged between 13 and 18 years, however, higher levels of physical activity after the injury were associated with a shorter symptom duration. Results from this study indicate that physical activity after the injury may not be universally detrimental to the recovery of concussion symptoms. © 2016 The Author(s).

Concussion Knowledge and Reporting Behavior Differences Between High School Athletes at Urban and Suburban High Schools.

Science.gov (United States)

Wallace, Jessica; Covassin, Tracey; Nogle, Sally; Gould, Daniel; Kovan, Jeffrey

2017-09-01

We determined differences in knowledge of concussion and reporting behaviors of high school athletes attending urban and suburban high schools, and whether a relationship exists between underreporting and access to an athletic trainer in urban schools. High school athletes (N = 715) from 14 high schools completed a validated knowledge of concussion survey consisting of 83 questions. The independent variable was school type (urban/suburban). We examined the proportion of athletes who correctly identified signs and symptoms of concussion, knowledge of concussion and reasons why high school athletes would not disclose a potential concussive injury across school classification. Data were analyzed using descriptive, non-parametric, and inferential statistics. Athletes attending urban schools have less concussion knowledge than athletes attending suburban schools (p urban schools without an athletic trainer have less knowledge than urban athletes at schools with an athletic trainer (p urban schools and 10 reasons for not reporting. Concussion education efforts cannot be homogeneous in all communities. Education interventions must reflect the needs of each community. © 2017, American School Health Association.

Concussion knowledge and attitudes amongst Stellenbosch ...

African Journals Online (AJOL)

Kathryn van Boom

Department Sport Science, Stellenbosch University, Stellenbosch, South. Africa ... of concussion and improving the management thereof. [3] In the ... and game time. [7] The ..... knowledge and awareness in youth Australian Rules Football. The.

Concussion Management in Community College Athletics: Revealing and Understanding the Gap between Knowledge and Practice

Science.gov (United States)

Chinn, Nancy Resendes; Porter, Paul

2013-01-01

The seriousness of concussions in athletics is only recently becoming fully understood and appreciated. There are significant implications for the concussed student-athlete both in returning to the playing field and the classroom. Although practices are now in place to improve identification and management of concussions in professional sports,…

Do family physicians, emergency department physicians, and pediatricians give consistent sport-related concussion management advice?

Science.gov (United States)

Stoller, Jacqueline; Carson, James D; Garel, Alisha; Libfeld, Paula; Snow, Catherine L; Law, Marcus; Frémont, Pierre

2014-06-01

To identify differences and gaps in recommendations to patients for the management of sport-related concussion among FPs, emergency department physicians (EDPs), and pediatricians. A self-administered, multiple-choice survey was e-mailed to FPs, EDPs, and pediatricians. The survey had been assessed for content validity. Two community teaching hospitals in the greater Toronto area in Ontario. Two hundred seventy physicians, including FPs, EDPs, and pediatricians, were invited to participate. Identification of sources of concussion management information, usefulness of concussion diagnosis strategies, and whether physicians use common terminology when explaining cognitive rest strategies to patients after sport-related concussions. The response rate was 43.7%. Surveys were completed by 70 FPs, 23 EDPs, and 11 pediatricians. In total, 49% of FP, 52% of EDP, and 27% of pediatrician respondents reported no knowledge of any consensus statements on concussion in sport, and 54% of FPs, 86% of EDPs, and 78% of pediatricians never used the Sport Concussion Assessment Tool, version 2. Only 49% of FPs, 57% of EDPs, and 36% of pediatricians always advised cognitive rest. This study identified large gaps in the knowledge of concussion guidelines and implementation of recommendations for treating patients with sport-related concussions. Although some physicians recommended physical and cognitive rest, a large proportion failed to consistently advise this strategy. Better knowledge transfer efforts should target all 3 groups of physicians. Copyright© the College of Family Physicians of Canada.

Annual Trends in Follow-Up Visits for Pediatric Concussion in Emergency Departments and Physicians' Offices.

Science.gov (United States)

Fridman, Liraz; Scolnik, Michal; Macpherson, Alison; Rothman, Linda; Guttmann, Astrid; Grool, Anne M; Rodriguez Duque, Daniel; Zemek, Roger L

2018-01-01

To assess whether children and youth with concussion receive follow-up visits in accordance with the recommended guidelines. We conducted a retrospective, population-based study using linked health administrative data from all concussion-related visits to emergency department and physician offices by children aged 5 through 18 years (range, 5.00-18.99) in Ontario between 2003 and 2013. We analyzed the percentage of children and youth seen for follow-up. The Mann-Kendall test for trends was used to assess a monotonic increasing trend over time in concussion follow-up visits. A total of 126 654 children and youth were evaluated for an index concussion visit. The number of children and youth assessed for concussion follow-up (N = 45 155) has increased significantly over time (P < .001). In 2003, 781 of 7126 patients (11.0%; 95% CI, 10.3-11.7) with an index visit for concussion had a follow-up assessment. By 2013, 6526 of 21 681 (30.1%; 95% CI, 29.5-30.7) patients received follow-up care. The proportion of children and youth receiving follow-up after an acute concussion has significantly increased between 2003 and 2013. Nevertheless, more than two-thirds of all patients do not seek medical follow-up or clearance as recommended by current concussion guidelines, suggesting that ongoing efforts to improve and monitor compliance with recommended guidelines by patients and physicians are important. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of infrared thermography for the diagnosis and grading of sprained ankle injuries

Science.gov (United States)

Oliveira, João; Vardasca, Ricardo; Pimenta, Madalena; Gabriel, Joaquim; Torres, João

2016-05-01

Ankle joint sprains are a common medical condition estimated to be responsible for 15-25% of all musculoskeletal injuries worldwide. The pathophysiology of the lesion can represent considerable time lost to injury, as well as long-term disability in up to 60% of patients. A percentage between 10% and 20% may complicate with chronic instability of the ankle joint and disability in walking, contributing to morbidity and poor life quality. Ankle sprains can be classified as grade I, II, or III, based on the extent of damage and number of ligaments affected. The diagnostic grading is important for setting further treatment and rehabilitation, since more severe injuries carries risk of recurrence, added morbidity and decrease in life quality. The aim of this work was to evaluate the adequacy of infrared thermography as a potential complimentary diagnostic tool of the distinct lesions grades. Evaluation of different thermographic values of the ankle region (in both affected and non-affected foot) was conducted for this purpose. The principal results to be highlighted are that some of the regions, namely anterior view for non defined time after injury analysis, and anterior, frontal, posterior and anterior talofibular ligament regions and proximal calcaneofibular ligament regions in acute lesions (herein defined as less than 6 h post-traumatic event) presented consistent profiles of variation. The analyses were performed considering affected and non-affected ankles results on plotted graphics representing termographic evaluation and grading of these lesions performed using ultrasound by experimented medical radiologists. An increase in temperature values was observed when progressing from mild to severe ankle sprain injuries, with these regions presenting lower values for the affected ankle when compared to the non-affected ankle in all the analysis performed. The remaining analysed regions did not present the same variations. Statistical analysis using Kruskal

Return to Play Guidelines Cannot Solve the Football-Related Concussion Problem

Science.gov (United States)

Johnson, L. Syd M.

2012-01-01

Background: High school football players are the single largest cohort of athletes playing tackle football, and account for the majority of sport-related concussions. Return to play guidelines (RTPs) have emerged as the preferred approach for addressing the problem of sport-related concussion in youth athletes. Methods: This article reviews…

Neurophysiological correlates of persistent psycho-affective alterations in athletes with a history of concussion.

Science.gov (United States)

Moore, Robert Davis; Sauve, William; Ellemberg, Dave

2016-12-01

Understanding the neuropathological underpinnings of sport-related concussion are critical for diagnosis, prognosis, and remediation. Although electro-encephalographic (EEG) methods have proven invaluable for understanding psycho-affective pathologies in various clinical conditions, they have not been used to understand the psycho-affective outcomes of concussive injuries. Accordingly, we evaluated the relation of electroencephalographic (EEG) power in collegiate athletes to psycho-affective measures. We predicted that athletes with a history of concussion would exhibit alterations in frontal EEG asymmetries indicative of increased depression, anxiety and more general mood disturbance. During this cross-sectional study, resting EEG and measures of mood and affect, including the Beck Depression Inventory-II (BDI-II) and Profile of Mood States (POMS) were collected in 81 young-adult male athletes (52 concussion history; 29 controls). All athletes with a history of concussion (9+ months from injury) reported to be symptom free, and all participants were actively taking part in their sport at the time of testing. Compared to control athletes, the athletes with a history of concussion exhibited alterations in frontal-alpha and frontal-beta asymmetry (p's psycho-affective health before they manifest as clinical disorders.

Heads Up: Concussion in Youth Sports

Medline Plus

Full Text Available ... What's this? Submit Button Concussion in Youth Sports Training course: This page has moved Recommend on Facebook Tweet Share Compartir This training course has been updated and moved. You will ...

Concussion: A History of Science and Medicine, 1870-2005.

Science.gov (United States)

Casper, Stephen T

2018-03-14

To review the intellectual history of concussion from the mid-19th century to the opening decade of the 21st century. Head injuries (HI) and their acute and long-term effects have been investigated for centuries, with major reviews of the topic appearing by 1870. Thus, while it has long been acknowledged that chronic traumatic encephalopathy was first described by Harrison Martland in 1928, an examination of the history of concussion research up to Martland's seminal report places his studies in a deeper historical context. This history makes clear that Martland's findings were one among many such studies showcasing the lasting dangers of blows to the head. In the years after Martland published his study, his paper was frequently cited in other papers that made clear that blows to the head, of all ranges of severity, were dangerous injuries with potentially life-changing consequences. The author has engaged in an historical analysis of the development and elaboration of concussion research in clinical medicine, neurology, neurosurgery, and those scientific disciplines related to clinical medicine. The author has found numerous primary sources from the history of medicine and science that describe the acute and chronic effects of single and repeated sub-concussive and concussive blows to the head. This study makes clear that evidence-based methodologies inevitably short-change the knowledge of past clinicians and scientists by holding these figures to normative standards of recent invention. What criticism of this kind fails to recognize is that past investigators, many of them pioneers in their fields, published their work in ways that matched the highest normative standards of their day for the presentation of evidence. It has been recognized for a long time that concussions are dangerous injuries with potentially life-changing consequences, ranging from permanent symptoms to degenerative neurological states. The intellectual history of medicine and science from

ANAM4 TBI Reaction Time-Based Tests have Prognostic Utility for Acute Concussion

Science.gov (United States)

2013-07-01

7:767. 2013 ANAM4 TBI Reaction Time-Based Tests Have Prognostic Utility for Acute Concussion LT Jacob N. Norris, MSC USN*; LCDR Waiter Carr, MSC USN...CDR Thomas Herzig, MSC USNf; CDR D. Waiter Labrie, MSC USNf; CDR Richard Sams, MC USN§ ABSTRACT The Concussion Restoration Care Center has used the...Work Unit No. N24LB. REFERENCES 1. Department of Defense: DoD Poiicy Guidance for Management of Mild Traumatic Brain Injury/Concussion in the Deployed

Assessment of Information on Concussion Available to Adolescents on Social Media.

Science.gov (United States)

Kollia, Betty; Basch, Corey H; Mouser, Christina; Deleon, Aurea J

2018-01-01

Considering how many people obtain information about their health online, the aim of this study was to describe the content of the currently most widely viewed YouTube videos related to concussions and to test the hypothesis that consumer videos would be anecdotal, while other sources would be more informational. The term "concussion" was used to search for videos with 100,000 or more views on YouTube that were posted in English or Spanish. Descriptive information about each video was recorded, as was information on whether certain content was conveyed during the video. The main outcome measures are sources of upload and content of videos. Consumer videos accounted for 48% of the videos, television based accounted for 50% of the videos, and internet based accounted for only 2% of the videos. None of the videos viewed fell into the professional category. Television based videos were viewed significantly more than consumer or internet based videos. Consumer and television based videos were equally anecdotal. Many of the videos focused on adolescents and were related to sports injuries. The majority of the videos (70.4%) addressed concussion causes, with 48% stating sports. Few videos discussed symptoms of concussion and prevention. The potential for widespread misinformation necessitates caution when obtaining information on concussion on a freely accessible and editable medium, such as YouTube.

The effects of attention capacity on dynamic balance control following concussion

Directory of Open Access Journals (Sweden)

Chou Li-Shan

2011-02-01

Full Text Available Abstract The purpose of this study was to examine how individuals modulate attention in a gait/cognition dual task during a 4-week period following a concussion. Ten individuals suffering from a grade 2 concussion and 10 matched controls performed a single task of level walking, a seated auditory Stroop task and a simultaneous auditory Stroop and walking task. Reaction time and accuracy were measured from the Stroop task. Dynamic balance control during gait was measured by the interaction (displacement and velocity between the center of mass (CoM and center of pressure (CoP in the coronal and sagittal planes. Concussed individuals shifted from conservative control of balance (shorter separation between CoM and CoP immediately after injury to normal balance control over 28 days post-injury. Immediately after injury, correlations analyses using each subject on each testing day as a data point showed that there was a spectrum of deficient performance among concussed individuals on the first testing day. Within a testing session, deficiencies in reaction time of processing involved in the Stroop task were commonly seen with reduce dynamic balance control. However, the prioritization was not always towards the same task between trials. There were no correlations in the control group. Information provided in this study would enhance our understanding of the interaction between attention and gait following concussion.

A Scoping Review to Address the Culture of Concussion in Youth and High School Sports.

Science.gov (United States)

Sarmiento, Kelly; Donnell, Zoe; Hoffman, Rosanne

2017-10-01

In 2013, the National Academy of Sciences emphasized the need to develop, implement, and evaluate effective large-scale educational strategies to improve the culture of concussion in youth and high school sports. In support of this recommendation, in this article we summarize research on factors that contribute to the culture of concussion. We conducted the literature search using 7 electronic databases. We used a scoping review method to identify studies that addressed knowledge, attitudes, behaviors, use of educational resources, and interventions related to concussion among young athletes, coaches, and parents. Of the 33 articles identified, most focused on concussion education (N = 15), followed by knowledge (N = 13), behaviors (N = 13), and attitudes (N = 5). Three studies addressed multiple study populations. The rapid spread of concussion education and awareness efforts has outpaced research on effective strategies to improve knowledge, attitudes, and behaviors that contribute to the culture of concussion. Further research is critical to inform the development and implementation of large-scale educational efforts. This research should incorporate rigorous study designs; be inclusive of diverse ages, socioeconomic status, and racial/ethnic groups; and examine opportunities to improve behavioral outcomes around concussion prevention, reporting, and management. © 2017, American School Health Association.

New and Recurrent Concussions in High-School Athletes Before and After Traumatic Brain Injury Laws, 2005-2016.

Science.gov (United States)

Yang, Jingzhen; Comstock, R Dawn; Yi, Honggang; Harvey, Hosea H; Xun, Pengcheng

2017-12-01

To examine the trends of new and recurrent sports-related concussions in high-school athletes before and after youth sports traumatic brain injury laws. We used an interrupted time-series design and analyzed the concussion data (2005-2016) from High School Reporting Injury Online. We examined the trends of new or recurrent concussion rates among US representative high-school athletes participating in 9 sports across prelaw, immediate-postlaw, and postlaw periods by using general linear models. We defined 1 athlete exposure as attending 1 competition or practice. We included a total of 8043 reported concussions (88.7% new, 11.3% recurrent). The average annual concussion rate was 39.8 per 100 000 athlete exposures. We observed significantly increased trends of reported new and recurrent concussions from the prelaw, through immediate-postlaw, into the postlaw period. However, the recurrent concussion rate showed a significant decline 2.6 years after the laws went into effect. Football exhibited different trends compared with other boys' sports and girls' sports. Observed trends of increased concussion rates are likely attributable to increased identification and reporting. Additional research is needed to evaluate intended long-term impact of traumatic brain injury laws.

Talofibular compartment of the ankle joint after recent ankle sprain

International Nuclear Information System (INIS)

Lindstrand, A.; Mortensson, W.; Norman, O.

1978-01-01

The validity of predicting the condition of the anterior talofibular ligament from the shape of the lateral compartment of the ankle joint was investigated in patients with recent ankle sprain. The diagnostic value of the method was found to be restricted. (Auth.)

Acute motor, neurocognitive and neurophysiological change following concussion injury in Australian amateur football. A prospective multimodal investigation.

Science.gov (United States)

Pearce, Alan J; Hoy, Kate; Rogers, Mark A; Corp, Daniel T; Davies, Charlotte B; Maller, Jerome J; Fitzgerald, Paul B

2015-09-01

This multimodal study investigated the motor, neurocognitive and neurophysiological responses following a sports related concussion injury in the acute-phase (up to 10 days) in sub-elite Australian football players. Between-group, repeated measures. Over the course of one season (six months), 43 male players from one football club (25.1 ± 4.5 years) were assessed for fine motor dexterity, visuomotor reaction time, implicit learning and attention. Motor cortex excitability and inhibition were assessed using transcranial magnetic stimulation. Of the 43 players, eight suffered concussion injuries, and were compared to 15 non-concussed players (active control) who returned for follow up testing. Post-concussion assessments using the aforementioned tests were carried out at 48 and 96 h, and 10 days. Compared to the non-concussed players, those who suffered concussion showed slowed fine dexterity (P = 0.02), response (P = 0.02) and movement times (P = 0.01) 48 h post-concussion. Similarly, attentional performance was reduced in the concussed group at all time points (48 h: P football players show abnormalities in motor, cognitive and neurophysiological measures with variable rates of recovery. These findings suggest that measuring the recovery of concussed athletes should incorporate a range of testing modalities rather than relying on one area of measurement in determining return to play. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Effects of Repeated Concussions and Sex on Early Processing of Emotional Facial Expressions as Revealed by Electrophysiology.

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Carrier-Toutant, Frédérike; Guay, Samuel; Beaulieu, Christelle; Léveillé, Édith; Turcotte-Giroux, Alexandre; Papineau, Samaël D; Brisson, Benoit; D'Hondt, Fabien; De Beaumont, Louis

2018-05-06

Concussions affect the processing of emotional stimuli. This study aimed to investigate how sex interacts with concussion effects on early event-related brain potentials (ERP) measures (P1, N1) of emotional facial expressions (EFE) processing in asymptomatic, multi-concussion athletes during an EFE identification task. Forty control athletes (20 females and 20 males) and 43 multi-concussed athletes (22 females and 21 males), recruited more than 3 months after their last concussion, were tested. Participants completed the Beck Depression Inventory II, the Beck Anxiety Inventory, the Post-Concussion Symptom Scale, and an Emotional Facial Expression Identification Task. Pictures of male and female faces expressing neutral, angry, and happy emotions were randomly presented and the emotion depicted had to be identified as fast as possible during EEG acquisition. Relative to controls, concussed athletes of both sex exhibited a significant suppression of P1 amplitude recorded from the dominant right hemisphere while performing the emotional face expression identification task. The present study also highlighted a sex-specific suppression of the N1 component amplitude after concussion which affected male athletes. These findings suggest that repeated concussions alter the typical pattern of right-hemisphere response dominance to EFE in early stages of EFE processing and that the neurophysiological mechanisms underlying the processing of emotional stimuli are distinctively affected across sex. (JINS, 2018, 24, 1-11).

A systems approach to understanding the identification and treatment of sport-related concussion in community rugby union.

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Clacy, Amanda; Goode, Natassia; Sharman, Rachael; Lovell, Geoff P; Salmon, Paul

2017-07-04

The aim of the present study was to utilise a systems thinking approach to explore the perceived responsibilities for identifying and treating concussion held by different actors across the community rugby system (e.g., players, coaches, parents, medics, referees, and management), as well as their role-specific concussion management strategies. A systems approach was taken to assess what different stakeholders within rugby systems perceive their roles to be regarding concussion identification and treatment. Through an online survey, 118 members of the amateur (community) rugby union system were asked about their role-specific concussion management responsibilities and strategies. Respondents included players, parents, medics, coaches, club managers, administrators, and volunteers. The majority of respondents indicated that they were able to identify the symptoms of rugby-related concussion, however, only medics stated their responsibility to use formal concussion assessments (e.g., SCAT2). A smaller number of the respondents indicated that they were involved in treating concussion within their current role/s (majority of which were medics). This study illustrated that the current challenges in the identification and treatment of rugby-related concussion in community sport may be due to role/responsibility confusion and possible overreliance on field-side medics. These findings offer insight into the possible limitations of the current concussion management guidelines and may offer empirically based direction for future revisions. Copyright © 2017 Elsevier Ltd. All rights reserved.

走出急性扭伤按摩禁忌误区，巧妙治疗踝关节扭伤%Treatment of Ankle Sprains in a Special Way without the Misunderstanding of the Acute Sprain Massage Contraindication

Institute of Scientific and Technical Information of China (English)

陈云华; 杨燕琼; 李梦如; 李冰; 常宇田; 张迪; 王宇鹏

2014-01-01

Objective :To introduce a kind of unique method as Four -step acupoint method for ankle sprains which avoids acute sprain massage contraindication .Methods:the article illustrates the operating essentials of four -step acupoint method .The theory and precautions are discussed with some cases and an effective point for ankle sprains is introduced .Results :The therapy is simple but effective .Conclusion:acute ankle sprains can be treated with acupoint method and the four -step acupoint for ankle sprains has strong promotional value .%目的：本文突破急性扭伤按摩禁忌，介绍了一种独特的踝关节扭伤四步点穴法。方法：文章说明了四步点穴法的操作要领，并结合实例对四步点穴法的注意事项与原理进行了分析与探讨。并提出了治疗踝关节扭伤的特效穴---崴脚穴。结果：该疗法简单易行，疗效明显。结论：急性踝关节扭伤可以运用点穴方法治疗，四步点穴法对踝关节扭伤的治疗具有较强的推广价值。

Suppression of oxidative stress and 5-lipoxygenase activation by edaravone improves depressive-like behavior after concussion.

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Higashi, Youichirou; Hoshijima, Michihiro; Yawata, Toshio; Nobumoto, Atsuya; Tsuda, Masayuki; Shimizu, Takahiro; Saito, Motoaki; Ueba, Tetuya

2014-10-15

Brain concussions are a serious public concern and are associated with neuropsychiatric disorders, such as depression. Patients with concussion who suffer from depression often experience distress. Nevertheless, few pre-clinical studies have examined concussion-induced depression, and there is little information regarding its pharmacological management. Edaravone, a free radical scavenger, can exert neuroprotective effects in several animal models of neurological disorders. However, the effectiveness of edaravone in animal models of concussion-induced depression remains unclear. In this study, we examined whether edaravone could prevent concussion-induced depression. Mice were subjected to a weight-drop injury and intravenously administered edaravone (3.0 mg/kg) or vehicle immediately after impact. Serial magnetic resonance imaging showed no abnormalities of the cerebrum on diffusion T1- and T2-weighted images. We found that edaravone suppressed concussion-induced depressive-like behavior in the forced swim test, which was accompanied by inhibition of increased hippocampal and cortical oxidative stress (OS) and suppression of 5-lipoxygenase (5-LOX) translocation to the nuclear envelope in hippocampal astrocytes. Hippocampal OS in concussed mice was also prevented by the nicotinamide adenine dinucleotide phosphate oxidase inhibitor, apocynin, and administration of BWB70C, a 5-LOX inhibitor, immediately and 24 h after injury prevented depressive-like behaviors in concussed mice. Further, antidepressant effects of edaravone were observed in mice receiving 1.0 or 3.0 mg/kg of edaravone immediately after impact, but not at a lower dose of 0.1 mg/kg. This antidepressant effect persisted up to 1 h after impact, whereas edaravone treatment at 3 h after impact had no effect on concussion-induced depressive-like behavior. These results suggest that edaravone protects against concussion-induced depression, and this protection is mediated by suppression of OS and 5

Cognitive-motor integration deficits in young adult athletes following concussion.

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Brown, Jeffrey A; Dalecki, Marc; Hughes, Cindy; Macpherson, Alison K; Sergio, Lauren E

2015-01-01

The ability to perform visually-guided motor tasks requires the transformation of visual information into programmed motor outputs. When the guiding visual information does not align spatially with the motor output, the brain processes rules to integrate the information for an appropriate motor response. Here, we look at how performance on such tasks is affected in young adult athletes with concussion history. Participants displaced a cursor from a central to peripheral targets on a vertical display by sliding their finger along a touch sensitive screen in one of two spatial planes. The addition of a memory component, along with variations in cursor feedback increased task complexity across conditions. Significant main effects between participants with concussion history and healthy controls without concussion history were observed in timing and accuracy measures. Importantly, the deficits were distinctly more pronounced for participants with concussion history compared to healthy controls, especially when the brain had to control movements having two levels of decoupling between vision and action. A discriminant analysis correctly classified athletes with a history of concussion based on task performance with an accuracy of 94 %, despite the majority of these athletes being rated asymptomatic by current standards. These findings correspond to our previous work with adults at risk of developing dementia, and support the use of cognitive motor integration as an enhanced assessment tool for those who may have mild brain dysfunction. Such a task may provide a more sensitive metric of performance relevant to daily function than what is currently in use, to assist in return to play/work/learn decisions.

Sport Concussion Management Using Facebook: A Feasibility Study of an Innovative Adjunct "iCon".

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Ahmed, Osman Hassan; Schneiders, Anthony G; McCrory, Paul R; Sullivan, S John

2017-04-01

  Sport concussion is currently the focus of much international attention. Innovative methods to assist athletic trainers in facilitating management after this injury need to be investigated.   To investigate the feasibility of using a Facebook concussion-management program termed iCon (interactive concussion management) to facilitate the safe return to play (RTP) of young persons after sport concussion.   Observational study.   Facebook group containing interactive elements, with moderation and support from trained health care professionals.   Eleven participants (n = 9 men, n = 2 women; range, 18 to 28 years old) completed the study.   The study was conducted over a 3-month period, with participant questionnaires administered preintervention and postintervention. The primary focus was on the qualitative experiences of the participants and the effect of iCon on their RTP. Usage data were also collected.   At the completion of the study, all participants (100%) stated that they would recommend an intervention such as iCon to others. Their supporting quotes all indicated that iCon has the potential to improve the management of concussion among this cohort. Most participants (n = 9, 82%) stated they were better informed with regard to their RTP due to participating in iCon.   This interactive adjunct to traditional concussion management was appreciated among this participant group, which indicates the feasibility of a future, larger study of iCon. Athletic trainers should consider the role that multimedia technologies may play in assisting with the management of sport concussion.

Plasma soluble prion protein, a potential biomarker for sport-related concussions: a pilot study.

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Nam Pham

Full Text Available Sport-related mild traumatic brain injury (mTBI or concussion is a significant health concern to athletes with potential long-term consequences. The diagnosis of sport concussion and return to sport decision making is one of the greatest challenges facing health care clinicians working in sports. Blood biomarkers have recently demonstrated their potential in assisting the detection of brain injury particularly, in those cases with no obvious physical injury. We have recently discovered plasma soluble cellular prion protein (PrP(C as a potential reliable biomarker for blast induced TBI (bTBI in a rodent animal model. In order to explore the application of this novel TBI biomarker to sport-related concussion, we conducted a pilot study at the University of Saskatchewan (U of S by recruiting athlete and non-athlete 18 to 30 year-old students. Using a modified quantitative ELISA method, we first established normal values for the plasma soluble PrP(C in male and female students. The measured plasma soluble PrP(C in confirmed concussion cases demonstrated a significant elevation of this analyte in post-concussion samples. Data collected from our pilot study indicates that the plasma soluble PrP(C is a potential biomarker for sport-related concussion, which may be further developed into a clinical diagnostic tool to assist clinicians in the assessment of sport concussion and return-to-play decision making.

Severe diffuse axon injury in chronic alcoholic rat medulla oblongata following a concussion blow.

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Luo, Jianming; Chen, Guang; Wei, Lai; Qian, Hong; Lai, Xiaoping; Wang, Dian; Lv, Junyao; Yu, Xiaojun

2014-01-01

We investigated the axonal morphological changes and expression of both tau protein and β-APP following concussion to the medulla oblongata, in a rat model of chronic alcoholism. Fifty-nine male Sprague-Dawley rats were randomly divided into EtOH, EtOH-TBI and control groups (water group, water-TBI group). To establish chronic alcoholic rats, rats were intragastrically given edible spirituous liquor twice daily. Rats also received a blow on the occipital tuberosity with an iron pendulum. Morphological changes and expression of tau and β-APP proteins in the medulla oblongata were examined. (a) Nerve fibre thickening and twisting were observed in alcoholic rats, with nerve fibre changes becoming more significant following a concussion blow, which leads to some nerve fibres fracturing. (b) Transmission electron microscopy revealed that the nerve fibre myelin became loosened and displayed lamellar separation, which became more significant following concussion. (c) The integral optical density (IOD) sum value of β-APP of the EtOH-TBI group was lower than that in the EtOH group (P Chronic alcoholism caused nerve fibre and neuronal morphology damage in the rat medulla oblongata, with structural damage becoming more significant following concussion. (b) Concussion changed the expression of β-APP and tau protein in chronic alcoholic rat medulla oblongata, suggesting that chronic alcoholism can lead to severe axonal injury following a concussion blow. (c) The effect of chronic alcoholism may be synergistic the concussion blow to promote animal injury and death.

Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review.

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Howell, David R; Lynall, Robert C; Buckley, Thomas A; Herman, Daniel C

2018-05-01

An emerging area of research has identified that an increased risk of musculoskeletal injury may exist upon returning to sports after a sport-related concussion. The mechanisms underlying this recently discovered phenomenon, however, remain unknown. One theorized reason for this increased injury risk includes residual neuromuscular control deficits that remain impaired despite clinical recovery. Thus, the objectives of this review were: (1) to summarize the literature examining the relationship between concussion and risk of subsequent injury and (2) to summarize the literature for one mechanism with a theorized association with this increased injury risk, i.e., neuromuscular control deficits observed during gait after concussion under dual-task conditions. Two separate reviews were conducted consistent with both specified objectives. Studies published before 9 December, 2016 were identified using PubMed, Web of Science, and Academic Search Premier (EBSCOhost). Inclusion for the objective 1 search included dependent variables of quantitative measurements of musculoskeletal injury after concussion. Inclusion criteria for the objective 2 search included dependent variables pertaining to gait, dynamic balance control, and dual-task function. A total of 32 studies were included in the two reviews (objective 1 n = 10, objective 2 n = 22). According to a variety of study designs, athletes appear to have an increased risk of sustaining a musculoskeletal injury following a concussion. Furthermore, dual-task neuromuscular control deficits may continue to exist after patients report resolution of concussion symptoms, or perform normally on other clinical concussion tests. Therefore, musculoskeletal injury risk appears to increase following a concussion and persistent motor system and attentional deficits also seem to exist after a concussion. While not yet experimentally tested, these motor system and attentional deficits may contribute to the risk of sustaining a

A novel approach to sports concussion assessment: Computerized multilimb reaction times and balance control testing.

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Vartiainen, Matti V; Holm, Anu; Lukander, Jani; Lukander, Kristian; Koskinen, Sanna; Bornstein, Robert; Hokkanen, Laura

2016-01-01

Mild traumatic brain injuries (MTBI) or concussions often result in problems with attention, executive functions, and motor control. For better identification of these diverse problems, novel approaches integrating tests of cognitive and motor functioning are needed. The aim was to characterize minor changes in motor and cognitive performance after sports-related concussions with a novel test battery, including balance tests and a computerized multilimb reaction time test. The cognitive demands of the battery gradually increase from a simple stimulus response to a complex task requiring executive attention. A total of 113 male ice hockey players (mean age = 24.6 years, SD = 5.7) were assessed before a season. During the season, nine concussed players were retested within 36 hours, four to six days after the concussion, and after the season. A control group of seven nonconcussed players from the same pool of players with comparable demographics were retested after the season. Performance was measured using a balance test and the Motor Cognitive Test battery (MotCoTe) with multilimb responses in simple reaction, choice reaction, inhibition, and conflict resolution conditions. The performance of the concussed group declined at the postconcussion assessment compared to both the baseline measurement and the nonconcussed controls. Significant changes were observed in the concussed group for the multilimb choice reaction and inhibition tests. Tapping and balance showed a similar trend, but no statistically significant difference in performance. In sports-related concussions, complex motor tests can be valuable additions in assessing the outcome and recovery. In the current study, using subtasks with varying cognitive demands, it was shown that while simple motor performance was largely unaffected, the more complex tasks induced impaired reaction times for the concussed subjects. The increased reaction times may reflect the disruption of complex and integrative cognitive

Return to rugby after brain concussion: a prospective study in 35 high level rugby players.

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Chermann, Jean Francois; Klouche, Shahnaz; Savigny, Alexis; Lefevre, Nicolas; Herman, Serge; Bohu, Yoann

2014-12-01

Although guidelines based on expert opinions have been developed for the immediate management and return to play of athletes after a concussion, data are lacking on this issue. Evaluate a standardized management of brain concussion among rugby players to prevent the recurrence. A prospective study was performed from September 2009 to June 2012. All rugby players who had a concussion when playing rugby were included. Patients were managed by a specialized hospital team with a specific protocol developed in collaboration with the medical staff of the rugby clubs included in the study. The series included 35 rugby players, with 23 professionals and 12 high-level players, 30 men and 5 women, mean age 23.1 ± 5.5 years old. The median number of previous concussions was 2 (0-30) episodes. According to the Cantu concussion severity classification, 3 athletes were grade 1, 12 were grade 2 and 20 were grade 3. None of the injured athletes was lost to follow-up. The primary endpoint was the occurrence of a new concussion within 3 months after the first in patients who returned to rugby. Thirty-three patients returned to rugby after a mean 22.1 ± 10 days. The recurrence rate within 3 months was 2/33 (6.1%). The median delay before returning to rugby was 21 (7-45) days. Factors associated with a delayed return to play were young age, initial loss of consciousness, severity Cantu grade 3 and post-concussive syndrome of more than 5 days. Analysis of two failures showed that the initial injury was grade 3 and that both were professional athletes and had a history of concussion. This prospective study validated the study protocol for the management of concussion in rugby players.

Concussion Incidence and Return-to-Play Time in National Basketball Association Players: Results From 2006 to 2014.

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Padaki, Ajay S; Cole, Brian J; Ahmad, Christopher S

2016-09-01

Various research efforts have studied concussions in the National Football League, Major League Baseball, and the National Hockey League. However, no study has investigated the incidence and return-to-play trends in the National Basketball Association (NBA), which this study aims to do. Increased media scrutiny and public awareness, in addition to the institution of a league-wide concussion protocol, may have resulted in more conservative return-to-play practices. Descriptive epidemiology study. All concussions to NBA players that were publicly reported in the media from the beginning of the 2006 NBA season to the end of the 2014 season were included. The incidence and return-to-play statistics were generated by synthesizing information from publicly available records. There were 134 publicly reported concussions to NBA players from the beginning of the 2006 season to the conclusion of the 2014 season, resulting in an average of 14.9 concussions per season. The incidence has not changed significantly during this time span. The average games missed after a concussion from 2006 to 2010 was 1.6, significantly less than the 5.0 games missed from 2011 to 2014, following the institution of the NBA concussion protocol (P = .023). Although the incidence of publicly reported concussions in the NBA has not changed appreciably over the past 9 seasons, the time missed after a concussion has. While players often returned in the same game in the 2006 season, the combination of implemented policy, national coverage, medical staff awareness, and player education may have contributed to players now missing an average of 4 to 6 games after a concussion. A multitude of factors has resulted in more conservative return-to-play practices for NBA players after concussions. © 2016 The Author(s).

Acupuncture for treating acute ankle sprains in adults.

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Kim, Tae-Hun; Lee, Myeong Soo; Kim, Kun Hyung; Kang, Jung Won; Choi, Tae-Young; Ernst, Edzard

2014-06-23

An acute ankle sprain is a sudden-onset injury of one or more of the ankle ligaments. It is one of the most common musculoskeletal injuries in the general population as well as in athletes. In some countries, such as China and Korea, acupuncture is frequently used in the treatment of ankle sprains, either as a single treatment or a secondary intervention accompanied by standard medical treatment. To assess the effects (benefits and harms) of acupuncture for the treatment of ankle sprains in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 4), MEDLINE (1948 to May week 2 2013), EMBASE (1980 to May week 2 2013), China National Knowledge Infrastructure databases (1994 to August week 4 2013), the Cumulative Index to Nursing and Allied Health Literature (1937 to May 2013), the Allied and Complementary Medicine Database (1985 to May 2013), Science Links Japan (1996 to August week 4 2013), several Korean medical databases (August week 4 2013), the World Health Organization International Clinical Trials Registry Platform (August week 4 2013), the bibliographic references of included trials and conference proceedings. We included randomised and quasi-randomised controlled trials involving adults with acute ankle sprains. We included all types of acupuncture practices, such as needle acupuncture, electroacupuncture, laser acupuncture, pharmacoacupuncture, non-penetrating acupuncture point stimulation (e.g. acupressure and magnets) and moxibustion. Acupuncture could be compared with control (no treatment or placebo) or another standard non-surgical intervention. Two review authors independently screened the search results, assessed trial eligibility, assessed risk of bias and extracted data from the included trials. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences for continuous outcomes. We conducted meta

Adult cognitive ability and educational level in relation to concussions in childhood and adolescence: a population study of young men.

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Teasdale, Thomas W; Frøsig, Anna J; Engberg, Aase W

2014-01-01

To investigate the relationship of concussion(s) suffered through childhood and adolescence with completed level of school education and cognitive ability in young adulthood. Educational level and scores on a test of cognitive ability were obtained for a cohort of 130,298 young men processed by the Danish draft board. Of these, 6146 had, at some age from birth onwards, been briefly admitted to hospital with a main discharge diagnosis of concussion. A further 402 had two such concussions and 48 had three or more. Educational level and cognitive ability test scores were negatively associated with the number of concussions and the age at concussion(s). Most markedly, compared to the 123,684 non-concussed men, those with two or more concussions had lower educational levels (OR = 0.48; 95% CI = 0.26-0.89), as also did those sustaining one concussion between the age of 13 up to the time of testing (OR = 0.47: 0.42-0.52). Since concussions do not generally have long-term effects, the results suggest that lower educational level is primarily a risk factor for sustaining a concussion at all ages, but in particular in adolescence more than in childhood and in the case of multiple concussions. It should, however, be recognized that, in some proportion of cases, the educational deficits have probably arisen as a consequence of the persistent symptoms of a lengthy post-concussional syndrome.

Concussion Education in U.S. Collegiate Sport: What Is Happening and What Do Athletes Want?

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Kroshus, Emily; Baugh, Christine M.

2016-01-01

Concussion education for athletes has the potential to play a role in reducing the health burden of concussions from sport by modifying individual risk-related behaviors. In U.S. collegiate sport, decisions about content and delivery of concussion education are left up to the individual institution. This may result in a high degree of variability…

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial

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Fisher Beth E

2010-10-01

Full Text Available Abstract Background Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle sprains. However, these interventions have yet to be longitudinally compared against a placebo study condition. Methods/Design We developed a randomized, placebo-controlled clinical trial designed to test the hypotheses that hands-on treatment procedures administered to individuals following ankle sprains during the post-acute injury period can improve short-, intermediate-, and long-term disablement, as well as reduce the risk for re-injury. Discussion This study is designed to measure the clinical effects of hands-on passive stretching treatment procedures directed to the talocrural joint that vary in treatment speed during the post-acute injury period, compared to hands-on placebo control intervention. Trial Registration http://www.clinicaltrials.gov identifier NCT00888498.

A case matched study examining the reliability of using ImPACT to assess effects of multiple concussions.

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Barker, Trevor; Russo, Stephen A; Barker, Gaytri; Rice, Mark A; Jeffrey, Mary G; Broderick, Gordon; Craddock, Travis J A

2017-04-28

Approximately 3.8 million sport and recreational concussions occur per year, creating a need for accurate diagnosis and management of concussions. Researchers and clinicians are exploring the potential dose-response cumulative effects of concussive injuries using computerized neuropsychological exams, however, results have been mixed and/or contradictory. This study starts with a large adolescent population and applies strict inclusion criteria to examine how previous mild traumatic brain injuries affect symptom reports and neurocognitive performance on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) computerized tool. After applying exclusion criteria and case matching, 204 male and 99 female participants remained. These participants were grouped according to sex and the number of previous self-reported concussions and examined for overall differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. In an effort to further reduce confounding factors due to the varying group sizes, participants were then case matched on age, sex, and body mass index and analyzed for differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. Case matched analysis demonstrated males with concussions experience significantly higher rates of dizziness (p = .027, η 2  = .035), fogginess (p = .038, η 2  = .032), memory problems (p = .003, η 2  = .055), and concentration problems (p = .009, η 2  = .046) than males with no reported previous concussions. No significant effects were found for females, although females reporting two concussions demonstrated a slight trend for experiencing higher numbers of symptoms than females reporting no previous concussions. The results suggest that male adolescent athletes reporting multiple concussions have lingering concussive symptoms well after the last concussive event; however, these symptoms were found to

Epidemiology of Snow Skiing- Versus Snowboarding-Related Concussions Presenting to the Emergency Department in the United States from 2010 to 2014.

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Gil, Joseph A; DeFroda, Steven F; Kriz, Peter; Owens, Brett D

2017-09-01

To examine the trend of concussions in skiers and snowboarders from 2010 to 2014; and to quantify and compare the incidence of concussions injuries in skiers and snowboarders who presented to emergency departments in the United States in 2014. Cross-sectional study of concussions in skiers and snowboarders who were evaluated in emergency departments in the United States. Incidence of concussions. The trend of the annual incidence of concussions for skiers and snowboarders remained stable from 2010 to 2014. An estimated total of 5388 skiing-related concussions and 5558 snowboarding-related concussions presented to emergency departments in the United States between January 1st, 2014, and December 31st, 2014. This represented an incidence of 16.9 concussions per 1 000 000 person-years for skiers and 17.4 concussions per 1 000 000 person-years for snowboarders. The incidence of concussions in the pediatric and young adult population of skiers was significantly higher than the incidence in the adult population. Similarly, the incidence of concussions in the pediatric and young adult population of snowboarders was significantly higher than the incidence in the adult population. The incidence of concussions was significantly higher in males compared with females in both skiing and snowboarding. The incidence of concussions from 2010 to 2014 plateaued in both skiers and snowboarders. Pediatric and young adult skiers and snowboarders had significantly higher incidences of concussion than the adult population. In contrast to the higher incidence of concussions in females in several sports including ice hockey, soccer, and basketball, the incidence of concussions was higher in males compared with females in both skiing and snowboarding.

Spontaneous nervous system concussion in dogs: a description of two cases and a review of terminology in veterinary medicine

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Angelo Pasquale Giannuzzi

2017-11-01

Full Text Available In human medicine, central nervous system (CNS concussion is defined as a transient neurological dysfunction following a traumatic event, without evidence of structural abnormalities of the affected region on advanced diagnostic imaging. Depending on the anatomical region involved, three forms of concussive syndromes are described: brain concussion, spinal concussion and cerebellar concussion. Although major textbooks of veterinary neurology admit the existence of canine brain concussion, spontaneous cases of this pathological condition have not been reported in small animals so far. This report describes two cases of concussion in dogs: a 9-month-old, intact male, shih-tzu with brain concussion; and a 10-month-old, intact male, poodle with cerebellar concussion. In addition, a brief review of the definition of the term “concussion” in the veterinary medical literature is provided, in comparison to its meaning in the human medical literature. Finally, this paper proposes an appropriate definition of “concussion” in dogs, that may facilitate clinicians in the recognition of such an elusive syndrome.

What is the definition of sports-related concussion: a systematic review.

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McCrory, Paul; Feddermann-Demont, Nina; Dvořák, Jiří; Cassidy, J David; McIntosh, Andrew; Vos, Pieter E; Echemendia, Ruben J; Meeuwisse, Willem; Tarnutzer, Alexander A

2017-06-01

Various definitions for concussion have been proposed, each having its strengths and weaknesses. We reviewed and compared current definitions and identified criteria necessary for an operational definition of sports-related concussion (SRC) in preparation of the 5th Concussion Consensus Conference (Berlin, Germany). We also assessed the role of biomechanical studies in informing an operational definition of SRC. This is a systematic literature review. Data sources include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Clinical Trials and SPORT Discus (accessed 14 September 2016). Eligibility criteria were studies reporting (clinical) criteria for diagnosing SRC and studies containing SRC impact data. Out of 1601 articles screened, 36 studies were included (2.2%), 14 reported on criteria for SRC definitions and 22 on biomechanical aspects of concussions. Six different operational definitions focusing on clinical findings and their dynamics were identified. Biomechanical studies were obtained almost exclusively on American football players. Angular and linear head accelerations linked to clinically confirmed concussions demonstrated considerable individual variation. SRC is a traumatic brain injury that is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces with several common features that help define its nature. Limitations identified include that the current criteria for diagnosing SRC are clinically oriented and that there is no gold/standard to assess their diagnostic properties. A future, more valid definition of SRC would better identify concussed players by demonstrating high predictive positive/negative values. Currently, the use of helmet-based systems to study the biomechanics of SRC is limited to few collision sports. New approaches need to be developed to provide objective markers for SRC. © Article author(s) (or their employer(s) unless otherwise

Functional, Structural, and Neurotoxicity Biomarkers in Integrative Assessment of Concussions

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Svetlana A Dambinova

2016-10-01

Full Text Available Concussion is a complex, heterogenous process affecting the brain. Accurate assessment and diagnosis and appropriate management of concussion are essential to ensure athletes do not prematurely return to play or others to work or active military duty, risking re-injury. To date, clinical diagnosis relies primarily on evaluating subjects for functional impairment using instruments that include neurocognitive testing, subjective symptom report, and neurobehavioral assessments, such as balance and vestibular-ocular reflex testing. Structural biomarkers, defined as advanced neuroimaging techniques and biomarkers assessing neurotoxicity and immunoexcitotoxicity may complement the use of functional biomarkers. We hypothesize that neurotoxicity AMPA, NMDA, and kainite receptor biomarkers might be utilized as a part of comprehensive approach to concussion evaluations, with the goal of increasing diagnostic accuracy and facilitating treatment planning and prognostic assessment.

Short-term Outcomes following Concussion in the NFL: An 11-year Retrospective Study of Player Release Rate and Financial Loss

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Ramkumar, Prem; Navarro, Sergio Michael

2017-01-01

Objectives: The primary goal of this study was to assess the short-term outcomes among National Football League (NFL) players following concussion in terms of: (1) DNP protocol activation, (2) release rate at one and three years, and (3) mean salary reduction. A secondary goal of the study was to stratify the post-concussive release rate by franchise and player position. Methods: NFL player transaction records and publicly available weekly injury reports from August 2005 to January 2016 for NFL players were analyzed. All players immediately sustaining recorded concussions were evaluated for a change to inactive or do-not-play (DNP) status. The one-year and three-year release rate following concussion was defined as any player transitioning to inactivation, retirement, free agency, or any failure to return for a successive season on the same team’s active roster after one or three years from the initial concussion. Student’s t-test was used to compare release rates between non-concussed and concussed players at one and three years. Mean salary reduction per year following concussion was calculated using publicly available player contracts. Additionally, franchise-level and position-based analyses of the release rate were performed. Results: Of the total 5,451 NFL players retrospectively analyzed over the 11-year period, 373 sustained publicly reported concussions resulting in DNP protocol activation. The release rate of the post-concussive versus non-concussive player was 26% vs. 20% at 1 year (pfranchise to release an athlete following concussion within one and three years. Table 1 reports a position-based analysis in terms of concussion rate, mean salary reduction, and NFL career longevity. Conclusion: Our retrospective study demonstrates that NFL concussions resulting in DNP protocol activation leads to a statistically greater release rate among concussed NFL players than non-concussed players. Released players suffered reduction in year-over-year accumulated

Recognizing and managing concussion in school sport.

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