Assessment Of Sports-related Concussion Research Articles

The Adolescent Patient Perspective on Activity Limitations Following Sport-Related Concussion.

Assessment of sport-related concussion (SRC) has begun to include patient- reported outcome measures (PROMs). However, there is a limited understanding of which health limitations are most meaningful to adolescents following SRC. To explore patient-perceived activity limitations following SRC and throughout recovery to return-to-play (RTP) and mapped according to the International Classification of Functioning, Disability, and Health (ICF) model. Longitudinal. Secondary school athletic training facilities. Fifty patients (41 males, 5 females, 4 sex not reported, age=14.9±3.5 years, grade=10.2±0.93 level) with a medically diagnosed SRC. The Patient Specific Functional Scale (PSFS) was used to assess changes in the patient's condition and the impact the injury posed on their ability to perform activities. The PSFS is a self-reported assessment of health used to identify activity limitations and rate the difficulty of performing those tasks. The PSFS was administered to patients on days 3 (D3) and 10 (D10) following SRC and at RTP. Activities impacted by injury were coded into common categories and themes by a three-person research team for subsequent analysis. The coded themes were also mapped to the ICF domains, chapters, and categories. The dependent variables were the PSFS themes, number of activities endorsed, PSFS scores, ICF domains, chapters, and categories. Descriptive analyses and frequencies were reported for the dependent variables. A total of 157 different activities were identified at D3 and coded into 28 categories that fit into six themes: activities of daily living (ADLs), cognitive and school (COG), sports and physical activity (SPA), screen time (SCR), sleep (SLP) and social (SOC). On D3, all patients (50/50) identified at least one activity limitation. The majority related to SPA (37.6%) and COG (31.2%). Sixty percent of patients endorsed activity limitations at D10, primarily in COG (38.6%) and SPA (36.6%). All (100%) response categories were mapped to the ICF, with most (75%) fitting the activities and participation (AP) domain. Our primary findings suggest that sport-related concussion influences many facets of the lives of adolescent athletes. Specifically, adolescent athletes identified activity restrictions primarily related to physical activity and sports participation.

Assessment and management of sport-related concussion in general practice.

Sport-related concussion (SRC) is a traumatic brain injury that occurs during sport or exercise activity. SRC is a growing health concern in Australia, withincreasing public awareness and presentations to general practitioners being increasingly common. This article will focus on the assessment and management of SRC in general practice, including guidance for returning patients to sport. Concussion prevention, potential long-term complications, and the decision-making process regarding retirement from sport are beyond the scope of this article. Recognising concussion can be difficult, asclinical symptoms and signs of SRC can evolve over a period of hours to days. General practitioners should be aware of the range of clinical concussion presentations. The key principles of management include relative rest, followed by a graduated return to cognitive and physical activity. Involvement of a multidisciplinary team can improve symptoms for those patients whose concussion symptoms are prolonged.

Are Sex Differences in Collegiate and High School Sports-Related Concussion Reflected in the Guidelines? A Scoping Review.

Background: Sport-related concussion (SRC) is a common sport injury. Females are participating in sports at increasing rates, and there is growing awareness that female athletes may be more vulnerable to SRC. Objectives: We aimed to identify sex differences in epidemiology, clinical manifestation and assessment of SRC and examine how these relate to the 6th International Conference on Concussion in Sport (ICCS). Methods: We conducted a scoping review of the Medline database and identified 58 studies examining the effects of sex on SRC in collegiate and high school athletes that were written in English and published in a peer-reviewed journal between March 2012 and March 2022. Results: We found that female athletes suffer higher rates of concussion in sex-comparable sports, in particular soccer. Female athletes experience more somatic symptoms-headache/migraine/sleep disturbance-and may take longer to recover from concussion. Sex differences were also identified regarding some aspects of sideline concussion assessment with the Sport Concussion Assessment Tool. Conclusions: Females are at greater risk and experience SRC differently than males; this is mostly likely due to a combination of biomechanical factors, differences in neck musculature and hormonal and social factors. Sex differences are not widely addressed by the 6th ICSS, which informs many sports' concussion protocols.

Sports-Related Concussion Assessment: A New Physiological, Biomechanical, and Cognitive Methodology Incorporating a Randomized Controlled Trial Study Protocol.

Taking part in moderate-to-vigorous exercise in contact sports on a regular basis may be linked to an increase in cerebrovascular injury and head trauma. Validated objective measures are lacking in the initial post-event diagnosis of head injury. The exercise style, duration, and intensity may also confound diagnostic indicators. As a result, we propose that the new Interdisciplinary Group in Movement & Performance from Acute & Chronic Head Trauma (IMPACT) analyze a variety of functional (biomechanical and motor control) tests as well as related biochemistry to see how they are affected by contact in sports and head injury. The study's goal will be to look into the performance and physiological changes in rugby players after a game for head trauma and injury. This one-of-a-kind study will use a randomized controlled trial (RCT) utilizing a sport participation group and a non-participation control group. Forty male rugby 7 s players will be recruited for the study and allocated randomly to the experimental groups. The intervention group will participate in three straight rugby matches during a local 7 s rugby event. At the pre-match baseline, demographic and anthropometric data will be collected. This will be followed by the pre-match baseline collection of biochemical, biomechanical, and cognitive-motor task data. After three consecutive matches, the same measures will be taken. During each match, a notational analysis will be undertaken to obtain contact information. All measurements will be taken again 24, 48, and 72 h after the third match. When the number of games increases owing to weariness and/or stressful circumstances, we expect a decline in body movement, coordination, and cognitive-motor tasks. Changes in blood biochemistry are expected to correspond to changes in biomechanics and cognitive-motor processes. This research proposal will generate considerable, ecologically valid data on the occurrence of head trauma events under game conditions, as well as the influence of these events on the biological systems of the performers. This will lead to a greater understanding of how sports participants react to exercise-induced injuries. This study's scope will have far-reaching ramifications for doctors, coaches, managers, scientists, and sports regulatory bodies concerned with the health and well-being of athletic populations at all levels of competition, including all genders and ages.

A-59 Sport-related concussion in para athletes: A scoping review of concussion assessment and management

Abstract Purpose Current guidelines have lagged in addressing sport-related concussion (SRC) in athletes with disabilities, or para athletes. Concussion assessments may not accurately capture symptoms in para athletes or be appropriately accessible, resulting in challenges managing SRCs in these athletes. The objective of this scoping review was to summarize the current literature on SRC in para athletes, including assessment procedures and management of SRC. Data Selection This review was registered with Open Science Framework and adhered to PRISMA-ScR guidelines. Searches of electronic databases (CINAHL, Google Scholar, MEDLINE, SPORTDiscus, and Web of Science) were conducted from database inception to 02/01/2023. Articles selected examined SRC assessment and management in adaptive sports. Data Synthesis Reviewers screened 202 title-abstracts and 32 articles qualified for full-text review, with 9 articles qualifying for data extraction for information on SRC assessment and management. Most articles addressed baseline assessment (N=6), some addressed both assessment and management (N=2), and only one article addressed SRC management (N=1). Results identified discrepancies in the results of baseline data in para athletes. Differences in baseline composite scores and symptom reporting in para vs. non-adaptive athletes were also found. The literature acknowledged lack of validated assessment tools and SRC management guidelines for para athletes. Conclusions There is limited literature on the assessment and management of SRC in para athletes at both elite and non-elite levels, indicating a lag in research on para athletes as compared to non-adaptive athletes. Development or standardization of current baseline assessment procedures for SRC and subsequent management guidelines for para athletes is needed.

Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children

ObjectivesTo systematically review the scientific literature regarding the assessment of sport-related concussion (SRC) in the subacute phase (3–30 days) and provide recommendations for developing a Sport Concussion Office Assessment Tool...

Role of biomarkers and emerging technologies in defining and assessing neurobiological recovery after sport-related concussion: a systematic review

ObjectiveDetermine the role of fluid-based biomarkers, advanced neuroimaging, genetic testing and emerging technologies in defining and assessing neurobiological recovery after sport-related concussion (SRC).DesignSystematic review.Data sourcesSearches of seven databases from 1...

Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review

ObjectivesTo systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6).Data sourcesSystematic searches of seven databases...

Sport-Related Concussion: A Cognitive Perspective.

The incidence of sport-related concussion (SRC) has been increasing in different sports and its impact on long-term cognitive function is increasingly recognized. In this study, we review the epidemiology, neuropathophysiology, clinical symptoms, and long-term consequences of SRC with a specific focus on cognition. Repeated concussions are associated with an increased risk of several neurologic diseases and long-term cognitive deficits. To improve cognitive outcomes in athletes with SRC, standardized guidelines for the assessment and management of SRC are vital. However, current concussion management guidelines lack procedures for rehabilitating acute and long-term cognitive symptoms. Increased awareness for the management and rehabilitation of cognitive symptoms in SRC is needed in all clinical neurologists treating professional and amateur athletes. We propose cognitive training as a prehabilitation tool to alleviate the severity of cognitive symptoms and as a rehabilitative tool to improve cognitive recovery postinjury.

'It's All Downhill from Here': A Scoping Review of Sports-Related Concussion (SRC) Protocols in Downhill Mountain Biking (DHI), with Recommendations for SRC Policy in Professional DMB.

Introduction: Downhill mountain biking (DHI) is a form of cycling and does not currently have a specific sports-related concussion (SRC) assessment. Objective: To review the extent, range and nature of research investigating SRC in DMB, provide a summary of key literature findings relating to its identification and management, and then develop a SRC protocol specific to DMB. Design: Scoping review as per recognised methods. Setting: Literature-based. The following databases were searched: MEDLINE, EMBASE, Scopus and Web of Science, with no restrictions on date. Results were limited to the English language. Participants: Six articles were included in the review from 64 identified articles. The article had to specifically include an analysis of adult downhill riders for inclusion. Outcome measures: Study type, study group (amateur/professional), concussion incidence, concussion assessment and recommendations. Main Results: Concussion incidence was identified as between 5–23%. No study outlined a trackside assessment of cyclists or a protocol for return to play where SRC was identified. Several authors identified that riders often continued to participate despite the presence of a concussion. No sport-specific SRC assessment was determined for DHI, and a SRC assessment was therefore developed. Conclusions: This review illustrates the lack of studies and formal protocol in SRC assessment for DHI. In light of this, we propose a three-stage framework specific to the sport to best identify a concussion and act where appropriate while minimising disruption to competition. This framework involves assessing the cyclist on the ‘sideline’, a second assessment post-event in the medical room and a third assessment the following day. A SRC consensus meeting specific for DHI is suggested with an identified need for updated guidance from UCI, requiring possible rule changes for the sport.

Exploring Inertial-Based Wearable Technologies for Objective Monitoring in Sports-Related Concussion: A Single-Participant Report.

ObjectiveChallenges remain in sports-related concussion (SRC) assessment to better inform return to play. Reliance on self-reported symptoms within the Sports Concussion Assessment Tool means that there are limited data on the effectiveness of novel methods to assess a player’s readiness to return to play. Digital methods such as wearable technologies may augment traditional SRC assessment and improve objectivity in making decisions regarding return to play.MethodsThe participant was a male university athlete who had a recent history of SRC. The single-participant design consisted of baseline laboratory testing immediately after SRC, free-living monitoring, and follow-up supervised testing after 2 months. The primary outcome measures were from traditional assessment (eg, Sports Concussion Assessment Tool and 2-minute instrumented walk/gait test; secondary outcome measures were from remote (free-living) assessment with a single wearable inertial measurement unit (eg, for gait and sleep).ResultsThe university athlete (age = 20 years, height = 175 cm, weight = 77 kg [176.37 lb]) recovered and returned to play 20 days after SRC. Primary measures returned to baseline levels after 12 days. However, supervised (laboratory-based) wearable device assessment showed that gait impairments (increased step time) remained even after the athlete was cleared for return to play (2 months). Similarly, a 24-hour remote gait assessment showed changes in step time, step time variability, and step time asymmetry immediately after SRC and at return to play (1 month after SRC). Remote sleep analysis showed differences in sleep quality and disturbance (increased movement between immediately after SRC and once the athlete had returned to play [1 month after SRC]).ConclusionThe concern about missed or delayed SRC diagnosis is growing, but methods to objectively monitor return to play after concussion are still lacking. This report showed that wearable device assessment offers additional objective data for use in monitoring players who have SRC. This work could better inform SRC assessment and return-to-play protocols.ImpactDigital technologies such as wearable technologies can yield additional data that traditional self-report approaches cannot. Combining data from nondigital (traditional) and digital (wearable) methods may augment SRC assessment for improved return-to-play decisions.Lay SummaryInertia-based wearable technologies (eg, accelerometers) may be useful to help augment traditional, self-report approaches to sports-related concussion assessment and management by better informing return-to-play protocols.

Impact of Psychiatric Illnesses and Selective Serotonin Reuptake Inhibitor Medications on Baseline Neurocognitive Testing.

Neurocognitive tests are an integral component of sport-related concussion (SRC) workup. A history of psychiatric illness (HPI) is common among young athletes. Investigations of factors that influence athletes' baseline neurocognitive function are crucial for an accurate assessment of SRC. In this study, we aim to elucidate the effect of HPI and selective-serotonin reuptake inhibitor (SSRI) medication use on baseline neurocognitive performance in young athletes. We conducted a retrospective cross-sectional study of Immediate Post-Concussion Assessment and Cognitive Testing assessments. A total of 268 athletes with HPI and a control group of 6,364 athletes were included. The outcomes were total symptom score based on post-concussion symptom scale, verbal memory, visual memory, visual motor, reaction time, and impulse control scores with self-reported HPI status and SSRI use. Athletes with HPI had an elevated symptom score in both univariate analysis (p < .0001) and multivariate analysis (p < .0001). HPI influence on visual memory score was not robust to multivariate analysis (p = .24). Athletes with HPI who reported SSRI medication use had the same baseline neurocognitive performance as other athletes with HPI. HPI influences athletes' baseline neurocognitive performance by elevating symptom scores. HPI does not alter any of the objective neurocognitive composite scores in contrast to previous work. Clinicians should consider the impact of HPI on baseline neurocognitive performance during the assessment of a suspected SRC. Additional research is required to bolster our findings on SSRI use and ascertain the effects of other drug classes on baseline neurocognitive performance.

Refinement of saliva microRNA biomarkers for sports-related concussion

BackgroundRecognizing sport-related concussion (SRC) is challenging and relies heavily on subjective symptom reports. An objective, biological marker could improve recognition and understanding of SRC. There is emerging evidence that salivary micro-ribonucleic acids (miRNAs) may serve as biomarkers of concussion; however, it remains unclear whether concussion-related miRNAs are impacted by exercise. We sought to determine whether 40 miRNAs previously implicated in concussion pathophysiology were affected by participation in a variety of contact and non-contact sports. Our goal was to refine a miRNA-based tool capable of identifying athletes with SRC without the confounding effects of exercise. MethodsThis case-control study harmonized data from concussed and non-concussed athletes recruited across 10 sites. Levels of salivary miRNAs within 455 samples from 314 individuals were measured with RNA sequencing. Within-subjects testing was used to identify and exclude miRNAs that changed with either (a) a single episode of exercise (166 samples from 83 individuals) or (b) season-long participation in contact sports (212 samples from 106 individuals). The miRNAs that were not impacted by exercise were interrogated for SRC diagnostic utility using logistic regression (172 samples from 75 concussed and 97 non-concussed individuals). ResultsTwo miRNAs (miR-532-5p and miR-182-5p) decreased (adjusted p < 0.05) after a single episode of exercise, and 1 miRNA (miR-4510) increased only after contact sports participation. Twenty-three miRNAs changed at the end of a contact sports season. Two of these miRNAs (miR-26b-3p and miR-29c-3p) were associated (R > 0.50; adjusted p < 0.05) with the number of head impacts sustained in a single football practice. Among the 15 miRNAs not confounded by exercise or season-long contact sports participation, 11 demonstrated a significant difference (adjusted p < 0.05) between concussed and non-concussed participants, and 6 displayed moderate ability (area under curve > 0.70) to identify concussion. A single ratio (miR-27a-5p/miR-30a-3p) displayed the highest accuracy (AUC = 0.810, sensitivity = 82.4%, specificity = 73.3%) for differentiating concussed and non-concussed participants. Accuracy did not differ between participants with SRC and non-SRC (z = 0.5, p = 0.60). ConclusionSalivary miRNA levels may accurately identify SRC when not confounded by exercise. Refinement of this approach in a large cohort of athletes could eventually lead to a non-invasive, sideline adjunct for SRC assessment.

Virtual Reality Application For The Vestibular Ocular Motor Screen: A Comparison With A Novel Prototype.

Clinical assessment of sport related concussion (SRC) involves a multifaceted test battery reliant upon accurate baseline measures. Advances in technology have prompted the use of virtual reality (VR) platforms to improve enjoyment of baseline and post-injury assessments. Possible influence of VR sickness for some users may deter the use symptom provocation tests like the Vestibular/Ocular Motor Screening (VOMS) exam in VR. It is important to understand baseline performance of the VOMS in VR as it might influence overall symptom provocation. PURPOSE: The purpose of this study was to examine differences in the VOMS using a clinical prototype (PRO) versus using a virtual reality (VR) stimulus with respect to symptom provocation change score (SPCS) and near point convergence (NPC) average score in a healthy population. METHODS: Data was collected from 15 healthy subjects (Female = 9, male = 6, avg. age = 20.86 years) who completed the VOMS assessment using the PRO and VR method in the same sitting. Symptoms assessed consisted of headache, nausea, dizziness, and fogginess. Subjects were asked to state the severity of each symptom based upon a scale of 0-10. After a 5-minute break, the same subjects completed the VOMS with an HTC Vive Pro Eye HMD (90 Hz; 2880x1600 pixels). The headset was powered by an Acer Predator gaming laptop with a 7th Generation Intel Core i7 Quad-Core processor with 16GB of memory and NVIDIA GeForce GTX 1070 graphics card. The VOMS stimuli was created with the Unity Software package (Unity3D engine version 2019.1.6) in which the VOMS protocol was simulated in a VR environment. Mann-Whitney U tests assessed the differences in total SPCS and NPC average score from baseline between both methods. RESULTS: For SPCS, the results indicate that the PRO method (avg = 1.4 ± 1.77 symptoms) and the VR method (avg = 0.9 ± 1.18 symptoms) of administering the VOMS were not significantly different (p = 0.33, Cohen’s d = 0.33). With respect to NPC average, there was no significant difference (p = 0.19, Cohen’s d = 0.22) between the PRO method (avg = 2.33 ± 1.74 cm) and the VR method (avg = 3.08 ± 4.42 cm). CONCLUSION: These data suggests that using a VR system to administer the VOMS may not elicit additional symptoms and it may be a viable tool for the collection of baseline symptom provocation data in a healthy population.

Internal (Factorial) Validity of the ANAM using a Cohort of Woman High-School Soccer Players.

Computerized neuropsychological testing is a cornerstone of sport-related concussion assessment. Female soccer players are at an increased risk for concussion as well as exposures to repetitive head impacts from heading a soccer ball. Our primary aim was to examine factorial validity of the Automated Neuropsychological Assessment Metrics (ANAM) neuropsychological test battery in computing the multiple neurocognitive constructs it purports to measure in a large cohort of interscholastic female soccer players. Study participants included 218 interscholastic female soccer players (age = 17.0±0.7year; mass = 55.5±6.8kg; height = 164.7±6.6cm) drawn from a large (850+) prospective database examining purposeful heading from four area high schools over a 10-year period. The ANAM-2001 measured neurocognitive performance. Three methods were used to identify integral constructs underlying the ANAM: (a) exploratory factor analysis (EFA), (b) first-order confirmatory factor analysis (CFA), and (c) hierarchical CFA. Neuropsychological phenomena measured by the ANAM-2001 were best reproduced by a hierarchical CFA organization, composed of two lower level factors (Simple Reaction Time, Mental Efficiency) and a single, general composite. Although the ANAM was multidimensional, only the composite was found to possess sufficient construct dimensionality and reliability for clinical score interpretation. Findings failed to uphold suppositions that the ANAM measures seven distinct constructs, or that any of its seven tests provide unique information independent of other constructs, or the composite, to support individual interpretation. Outcomes infer the ANAM possesses factorial-validity evidence, but only scores from the composite appear to sufficiently internally valid, and reliable, to support applied use by practitioners.

Practice effect associated with the serial administration of the switch task and its implications in the assessment of sports-related concussion

ABSTRACT In the context of return to play assessment following a sports concussion, athletes may have to complete a cognitive task several times within days. The current longitudinal study aimed to examine the practice effect associated with the serial administration of the switch task. We hypothesized that the practice effect would be the greatest between the first and second assessments and that a plateau would be obtained by the third assessment. Forty healthy university students completed the switch task four times at an interval of 48-hour, with half of them doing version A on all visits (AA group), while the others alternated between A and B every other assessment (AB group). For response accuracy, performance generally improved from V1 to V2, and from V2 to V3 (ps ≤.001), irrespective of group. For reaction time, a significant interaction of Visit × Group was observed. Specifically, AA group performance improved from V1 to V2, and from V2 to V3, while the AB group only improved from V2 to V3 (ps ≤.01). Performance improved over the first three assessments and stabilized with no statistically significant change between the third and fourth testing sessions. Although the use of an alternative version has helped reduce the practice effect, it did not help in eliminating it. The current results highlight the need for further examination of the practice effect and its implication in clinical decision-making. Clinicians working in the sports concussion field must take the practice effect into account when they use the switch task for serial testing.

Diversifying sport-related concussion measures with baseline balance and ocular-motor scores in professional Zambian football athletes

ABSTRACT Purpose Normative values of common sport-related concussion assessment tools may assist clinical diagnosis and management. However, current baseline normative values are not representative of athletic participants across international domains. This study develops healthy baseline norms on the Balance Error Scoring System (BESS), and King-Devick (K-D), providing baseline reference values for professional Zambian football athletes. Methods Of the 125 male participants (aged 24.48 ± 5.41 years) screened for this study, 9 (7.2%) reported a previous history of concussion, 98 (78.4%) completed the Balance Error Scoring System and 88 (70.4%) completed the King-Devick. Descriptive statistics calculated for the BESS and the K-D test included mean, standard deviation, median, interquartile range (IQR), and percentiles ranks. Main findings Participants scored a mean ± standard deviation of 10.15 ± 5.6 and a median [IQR] of 9 [6–12.25] errors on the total BESS and completed the K-D test in a mean ± standard deviation 56.85 ± 10.55 seconds and a median [IQR] 55.28 [48.7–64.8] seconds. Conclusions Cross-cultural awareness and management of sport-related concussion are continuously improving the safety and well-being of athletic participants around the world. The diverse representation in these data may aid in interpretation of post-injury performance during sport-related concussion management in Zambia. This study develops baseline reference values currently lacking within African cultures and demonstrates the feasibility and global clinical utility of two sport-related concussion assessment resources.

Editorial: How do you diagnosis and manage sports-related concussion (SRC) in road cycling? A Plan for developing SRC-assessment and management protocols within road cycling

Abstract: Sports-related concussion (SRC) is a common injury within elite road cycling and SRC is typically assessed and managed with a SCAT5. However the SCAT5 cannot be applied to road cycling in its current format and the cycling community therefore need to consider modifications or indeed alternatives to the SCAT5 to allow adequate assessment and management of SRC within road cycling. Potential solutions to consider to improve SRC assessment and management in road cycling include: 1) a SRC consensus meeting to allow modification of the SCAT5 for road cycling; 2) rule alterations to allow ‘pitch-side’ SRC assessment during races; 3) epidemiological injury surveillance within road cycling to better understand the issues around SRC; and, 4) better use of technologies to help diagnose SRC. We hope that these solutions can go some way to bridging the gap between SRC assessment and management between our own sport of road cycling and those with maturing SRC protocols, such as rugby union.

A-04 One Size Fits None: Neurobiologic-Specific Modifications For The Assessment, Diagnosis, and Treatment of Sport-Related Concussion

Abstract Objective The primary objective of this review paper is to introduce the underlying neurobiology of concussion symptoms, including relevant neuroanatomy, and to discuss these findings relative to the traditional homogenous model and a newer clinical profile model for sport-related concussion (SRC) assessment, conceptualization, and treatment. Method Empirical studies, meta-analyses, and consensus statements relevant to the assessment, conceptualization, and treatment of SRC were identified via systematic, but informal, procedures. This literature review focused on papers discussing the neuroanatomy and neurobiology of concussion symptoms and sequelae, as well as the exploration of new clinical treatment models for SRC. Results Exploration of the literature further supports the use of a clinical profiles-based SRC assessment and treatment protocol. Comparisons of traditional and new protocols show that a traditional assessment, conceptualization, and treatment model of SRC as a homogenous injury inadequately captures the individual injury experience and recovery trajectory. Conclusions This review confirms existing literature that the clinical profiles-based model best addresses the heterogeneous nature of sport-related concussion using a neurobiological and neuroanatomical approach to understanding SRC. Utilizing this model, clinicians can provide an individualized assessment, conceptualization, and treatment plan for SRC, leading to an improved clinical experience for athletes and better clinical outcomes.

Postexercise Slowing on the King-Devick Test and Longer Recovery From Sport-Related Concussion in Adolescents: A Validation Study.

The King-Devick (KD) test is a rapid number-reading test that has emerging use in the assessment of sport-related concussion (SRC). Previous research suggested that healthy individuals and patients with acute concussions who had shorter recovery times (<3 weeks) demonstrated a learning effect on the KD test after mild to moderate exertion, whereas patients with longer recovery times did not. To assess if the absence of postexertional improvement on the KD test within 10 days of concussive head injury was associated with a longer duration of recovery. Prospective cohort study. University concussion-management clinics. Male and female adolescent athletes (n = 99, aged 13-18 years) presenting within 10 days of SRC. The KD test was administered before and after the Buffalo Concussion Treadmill Test (BCTT). Days from injury to recovery, with recovery defined as being asymptomatic, confirmed by the assessment of a physician who was blinded to the treatment group, and the return of normal exercise tolerance on the BCTT were recorded. Participants with postexertional slowing (PES group, n = 33) had a longer duration of recovery (17 days versus 13.5 days, P = .033) than participants without PES (no-PES group, n = 66). At any clinic visit, PES was also associated with a relative risk of 2.36 (95% confidence interval = 1.55, 3.61; P < .001) of not recovering within the following week. The current study validates our prior work showing that acutely concussed adolescents who did not display the typical learning effect on the KD test after the BCTT took longer to recover from SRC than those who exhibited the typical learning effect.