Management Of Acute Concussion Research Articles

Smartphone Technology to Facilitate Remote Postural Balance Assessment in Acute Concussion Management: Pilot Study.

Impaired balance is a key symptom following acute concussion. Unfortunately, the recommended clinical balance assessment lacks sensitivity and discriminative ability, relying on the experience of the clinician for interpretation. The aim of this pilot study is to explore smartphone technology to remotely assess balance impairment in people with acute concussion. A smartphone app was developed to allow the clinician to connect remotely using their personal web browser to the participant's smartphone and collect motion data while instructing the participant to perform the following balance tests: standing on firm and foam surface with eyes opened and closed (FIRMEO, FIRMEC, FOAMEO, and FOAMEC). Outcome measures were processed from the raw acceleration to calculate the average acceleration magnitude from the mean and the root-mean square, with greater values indicating more sway. Eleven healthy controls (HCs) and 11 people with concussion (CON) participated. In all sway measurements, the CON group had significantly (p < 0.05) greater values when standing on a firm surface. In the FOAMEC condition, the CON group had significantly (p < 0.05) greater sway measures only in the AP direction, while significantly greater sway in all directions were found in the CON group in the FOAMEO condition. This study shows that remote balance assessment using a smartphone can discriminate between healthy controls and people with acute concussion. This technology could play an important role in concussion management to assist with determining recovery from concussions and the optimal timing for return to sport.

Circadian therapy interventions for glymphatic dysfunction in concussions injuries: A narrative review.

There are two primary threats to the brain after concussion. The first is a buildup of neurotoxic proteins in the brain. The second, a partial consequence of the first, is a sustained neuroinflammatory response that may lead to central sensitization and the development of persistent post-concussive symptoms. These threats make neurotoxin clearance a high clinical priority in the acute period after injury. The glymphatic system is the brain's primary mechanism for clearing neurotoxic waste. The glymphatic system is intimately tied to the sleep cycle and circadian dynamics. However, glymphatic dysfunction and sleep disturbances are nearly ubiquitous in the acute period after concussion injury. Because of this, sleep optimization via circadian therapy is a time-sensitive and critical tool in acute concussion management.

Clinical application of the Buffalo Concussion Treadmill Test and the Buffalo Concussion Bike Test: A systematic review

Objective To identify and synthesise research evidence regarding psychometric properties and clinical utility of the Buffalo Concussion Treadmill Test (BCTT) and Buffalo Concussion Bike Test (BCBT) for use with patients with acute concussion, post-concussion syndrome (PCS) or physiological post-concussion disorder (PPCD). Data sources ProQuest (ProQuest Central), PEDro, Medline (Ovid), Emcare (Ovid), EBSCOhost (Health collection) and Google Scholar, searched September 8th-12th, 2020. Study selection Two authors independently selected studies that met eligibility criteria. Studies were selected if they were original research of any design, that investigated the properties of the testing protocols in either concussed or uninjured participants. Articles not published in English, that were not original research or that used significantly different testing protocols were excluded. The search yielded 250 articles, 11 of which were eligible and included in this review. Data extraction Included studies were critically appraised independently by two authors, using the Mixed Methods Appraisal Tool (MMAT). Data relating to study characteristics and key findings were extracted from the studies, documented in tables, and used to inform a critical narrative synthesis of findings. Data synthesis To provide recommendations relating to each aim of the review, a strength of evidence scoring system was used. Available evidence supported use of the BCTT, with strong evidence supporting the safety and construct validity of the test and moderate evidence supporting its prognostic value. There has been very limited research investigating use of the BCBT. Conclusion The findings support a recommendation for use of the BCTT in clinical settings for management of acute concussion, PCS and PPCD. There is limited evidence available for the BCBT. Additional studies are needed of both tests to further establish their clinical value.

Preliminary Safety and Efficacy of Head and Neck Cooling Therapy After Concussion in Adolescent Athletes: A Randomized Pilot Trial.

Objective:To determine the safety and efficacy of head and neck cooling when applied up to 8 days after concussion among adolescent athletes.Design:A randomized nonblinded pilot trial.Setting:Sports Medicine Clinic in a tertiary hospital.Patients:Adolescent athletes aged 12 to 17 years diagnosed with a concussion within 1 week of injury.Interventions and Main Outcome Measures:The control group (n = 27) received standard treatment (short term brain rest), whereas the treatment group (n = 28) received standard treatment and head and neck cooling. Head and neck cooling treatment was applied to patients at the postinjury assessment visit and at 72 hours post-injury. The SCAT5 (Sport Concussion Assessment Tool) total symptom severity score was collected at postinjury assessment visit, pre- and post-treatment at 72 hours, and at 10 days, and 4 weeks post-treatment.Results:Athletes who received head and neck cooling had a faster symptom recovery (P = 0.003) and experienced significant reduction in symptom severity scores after treatment (P < 0.001). Sport type and gender did not influence the treatment outcome (P = 0.447 and 0.940, respectively).Conclusions:This pilot study demonstrates feasibility of head and neck cooling for the management of acute concussion in adolescent athletes.

ADOLESCENTS REPORT SLEEP QUALITY IMPAIRMENTS ACUTELY POST-CONCUSSION

Background:Recently, the association between concussion and sleep has been explored. Few studies have used validated patient-reported outcome measures to examine how sleep quality differs between adolescents who have recently sustained a concussion compared to healthy adolescents.Hypothesis/Purpose:Our purpose was to evaluate the effect of acute concussion on sleep quality using the Pittsburgh Sleep Quality Index (PSQI). We hypothesized that adolescents with acute concussion symptoms would report worse sleep quality compared to healthy adolescent athletes undergoing a pre-participation evaluation.Methods:Patients seen for initial evaluation at a sports medicine clinic within 14 days of sustaining a concussion were matched with healthy control subjects undergoing a pre-participation evaluation based on age, sex and concussion history at a 3:1 control:concussion subject ratio. Controls with history of concussion were included if fully recovered at their evaluation. Both groups completed the PSQI and Post-Concussion Symptom Inventory (PCSI). Those with concussion reported sleep quality since their injury, while controls reported sleep quality over the past month. The primary outcome was global PSQI score, where higher scores indicate worse sleep quality. We compared sleep quality ratings between groups using independent samples t-test, and proportion of poor sleep ratings using Chi-square analysis. We then constructed a multivariable regression model to assess the effect of acute concussion on global PSQI scores while adjusting for sex, age and concussion history.Results:We evaluated 17 patients with concussion (mean 8±3 days post-injury) who were matched with 51 controls. Demographic variables did not differ significantly between concussion and control groups (Table 1). The concussion group reported higher PCSI symptom rating (Table 1), and worse overall sleep quality (Table 2). Specifically, the concussion group reported longer time to fall asleep, later morning awakening, longer sleep duration and longer time in bed, compared to controls. The concussion group was also less likely to rate their sleep as “very good” compared to controls (Table 2). After adjusting for the independent effect of sex, age, and concussion history, concussion was significantly associated with higher PSQI scores (β=2.01, 95% CI= 0.35, 3.68; p= 0.019).Conclusion:Adolescents assessed within 14 days of concussion reported worse overall sleep quality, longer sleep duration, and decreased sleep efficiency compared to healthy adolescents. These results, obtained utilizing a validated measure, highlight the negative impact of acute concussion on sleep quality and provide additional support that assessment of sleep characteristics is an important component of acute concussion management.Table 1.Group characteristics between concussion and control groups. Data are presented as mean (sd) or n (%).VariableConcussion Group(n=17)Control Group(n=51)P valueFemale Sex11 (65%)33 (65%)1.00Age (years)16.0 (1.4)16.0 (1.3)0.94Post-Injury Evaluation Time (days)7.6 (3.7)--Past history of concussion7 (41%)14 (27%)0.37Current PCSI Score57.2 (30.8)5.4 (8.5)< 0.001Table 2.Sleep characteristics from the PSQI for both participant groups. Data are presented as mean (standard deviation) or n (%).VariableConcussion GroupControl GroupP valueGlobal PSQI score6.77 (3.47)4.30 (2.64)0.007Poor sleep quality (PSQI score > 5)9 (69%)23 (45%)0.14Usual bed time10:01 PM (0:35)10:19 PM (0:56)0.42Usual wakeup time7:39 AM (1:39)6:15 AM (0:42)0.004Time to fall asleep (minutes)34.5 (40.8)18.3 (14.9)0.02Sleep per night (hours)8.6 (2.8)7.4 (1.0)0.009Time in bed per night (hours)10.1 (2.6)7.9 (1.1)< 0.001Self-rated overall sleep qualityVery good: 1 (6%)Fairly good: 12 (71%)Fairly bad: 3 (18%)Very bad: 1 (6%)Very good: 14 (28%)Fairly good: 33 (66%)Fairly bad: 3 (6%)Very bad: 0 (0%)0.04

Examining Changes in Sleep Between Concussed and Healthy Individuals Across Recovery

Abstract Purpose To examine changes and the relationship between Pittsburgh Sleep Quality Index (PSQI) scores and the Sport Concussion Assessment Tool–5th Edition (SCAT5) sleep symptom across recovery between concussed and healthy individuals. Methods Sixty-eight (18.12±2.6 years; male:n=47, female:n=21; concussed:n=38, healthy:n=30) individuals completed the PSQI and SCAT5 at three times across recovery (≤72 hours of injury, return-to-play (RTP), &gt;one-month after RTP). Two mixed between-within subjects analysis of variance (ANOVAs) evaluated changes in PSQI scores and SCAT5 sleep symptom across recovery between concussed and healthy individuals. Spearman’s rho correlations were used to examine the relationships between the two sleep measures. Significance was set at p≤.05. Results There was no significant groupXtime interaction for PSQI scores (Wilks λ=.96, F(2,65)=1.50, p=.23, η2=.04) or SCAT5 sleep symptom (Wilks λ=.93, F(2,65)=2.42, p=.10, η2=.07). There was a significant main effect for time for PSQI scores (Wilks λ=.65, F(2,65)=17.2, p&lt;.001, η2=.35) and SCAT5 sleep symptom (Wilks λ=.88, F(2,65)=4.25, p=.02, η2=.12) with PSQI scores and SCAT5 sleep symptom improving over time. For the SCAT5 sleep symptom there was a significant main effect for group (F(1,66)=13.41, p&lt;.001, η2=.17), with concussed individuals reporting higher SCAT5 sleep symptom (M=0.59, SE=0.1) than healthy controls (M=0.09, SE=0.1). There was no significant correlation between PSQI scores and SCAT5 sleep symptom ≤72 hours (r=.15, p=.36), but there were significant correlations at RTP (r=.38, p=.02) and &gt;one-month (r=.43, p=.01). Conclusion Global sleep quality changes throughout recovery and may influence post-concussion outcomes. Utilizing a specialized sleep measure along with sleep-related symptoms may be beneficial to healthcare professionals, specifically during acute concussion management.

Pediatric Patient Compliance With Recommendations for Acute Concussion Management

Emerging evidence supports an active approach for acute pediatric concussion management. The current practices of pediatric emergency providers following acute concussions has not been well studied. We prospectively enrolled 134 pediatric patients with an acute concussion. Providers completed a real-time survey to assess their recommendations for time off from school and sports. Seven to 10 days post-injury, patient compliance with provider recommendations was assessed. Forty-seven (35.1%) providers recommended moderate time off from school. In this cohort (n = 44), 14 (31.8%) patients took more than 2 days off from school. When minimal rest was prescribed (n = 80), 26 (32.5%) patients took more than 2 days off from school, P = .94. One third of our pediatric emergency providers are still recommending moderate time off from school. Regardless of physician prescriptions, patients took a similar amount of time off from school. Our study questions the influence of physician recommendations on management of acute pediatric concussions.

Acute concussion: making the diagnosis and state of the art management.

Concussion is an increasingly common injury in children. We aim to review the basic epidemiology and management of acute concussion and highlight recent studies that have contributed to our understanding of care for this injury. While concussion is considered a 'mild' form of traumatic brain injury, recent evidence suggests that as many as 30% of children are still symptomatic 1 month after injury. Although there is increasing interest in finding objective measures of injury and recovery, emerging imaging and serum biomarkers are not ready for routine clinical use. Identification of children at risk for prolonged symptoms is vital. Prolonged rest after injury may worsen outcomes. Concussion is a common injury in children. Objective measures of injury and recovery are needed, as are targeted therapies to mitigate the risk of prolonged recovery after injury.

Acute White-Matter Abnormalities in Sports-Related Concussion: A Diffusion Tensor Imaging Study from the NCAA-DoD CARE Consortium.

Sports-related concussion (SRC) is an important public health issue. Although standardized assessment tools are useful in the clinical management of acute concussion, the underlying pathophysiology of SRC and the time course of physiological recovery after injury remain unclear. In this study, we used diffusion tensor imaging (DTI) to detect white matter alterations in football players within 48 h after SRC. As part of the NCAA-DoD CARE Consortium study of SRC, 30 American football players diagnosed with acute concussion and 28 matched controls received clinical assessments and underwent advanced magnetic resonance imaging scans. To avoid selection bias and partial volume effects, whole-brain skeletonized white matter was examined by tract-based spatial statistics to investigate between-group differences in DTI metrics and their associations with clinical outcome measures. Mean diffusivity was significantly higher in brain white matter of concussed athletes, particularly in frontal and subfrontal long white matter tracts. In the concussed group, axial diffusivity was significantly correlated with the Brief Symptom Inventory and there was a similar trend with the symptom severity score of the Sport Concussion Assessment Tool. In addition, concussed athletes with higher fractional anisotropy performed better on the cognitive component of the Standardized Assessment of Concussion. Overall, the results of this study are consistent with the hypothesis that SRC is associated with changes in white matter tracts shortly after injury, and these differences are correlated clinically with acute symptoms and functional impairments.

221 Do Practitioners Still Recommend Rest for Acute Concussion Management?

221 Do Practitioners Still Recommend Rest for Acute Concussion Management?

Acute Concussion Management with Remove-Reduce/Educate/Adjust-Accommodate/Pace (REAP)

BackgroundWith increased concussion awareness and significantly increased numbers of emergency department (ED) visits for pediatric concussion, a seamless process of managing a patient with a concussion can begin in the ED. Case ReportThis article demonstrates the effectiveness of the Remove-Reduce/Educate/Adjust-Accommodate/Pace (REAP) concussion management program in the evaluation, management, and return to play of an acutely concussed pediatric patient. The REAP program was developed in Colorado and promotes a multidisciplinary team approach to concussion management. The team consists of parents, teachers, athletic personnel, and clinicians. The patient described in this case report had concussion management initiated in the ED. He was able to successfully return to sports, having recovered from his concussion with the guidance of the Center for Concussion (Centennial, Colorado) staff utilizing the REAP model of care and the currently recommended graduated return-to-play process. Why Should an Emergency Physician Be Aware of This?Busy EDs are often the initial point of contact for school-aged patients with concussion. We present a program that we believe represents a good model of patient care with concussion management implemented in the ED and carried through to clearance of the patient.

Diagnosis and management of acute concussion.

Mild traumatic brain injury (mTBI), or concussion, constitutes a significant percentage of the millions of TBIs sustained in the United States each year. Symptoms are typically short-lived, and may correlate to physiologic changes in the acute period after injury. There are many available tools that can be utilized on the sideline as well as in the clinical setting for assessment and diagnosis of concussion. It is important to use validated tests in conjunction with a thorough history and physical examination. Neurocognitive testing may be helpful in the subacute period. Management should begin with removal from risk if a concussion is suspected, and once diagnosis is made, education and reassurance should be provided. Once symptoms have resolved, a graded return-to-play protocol can be implemented with close supervision and observation for return of symptoms. Management should be tailored to the individual, and if symptoms are prolonged, further diagnostic evaluation may be necessary.

Management of acute concussion in a deployed military setting.

The DoD has established clinical guidelines and policies creating a system of care for the management of battlefield concussion. Within these instructions, medical providers have standardized guidance for screening and diagnosing concussion, along with guidelines for treating common concussion symptoms. Underlying these policies is the principle that concussion is an important injury, and SMs need to be removed from combat during the acute period to ensure full recovery before return to duty. As our understanding of concussion advances, the DoD will incorporate these advances into the current system of care, ensuring that SMs have the highest level of care possible for concussions sustained on the battlefield.

The evaluation and management of acute concussion differs in young children

BackgroundThere are many reasons why concussion in children needs to be considered different from adults. The Zurich (2008) recommendations on the management of concussion in children are restricted to children...