Concussion Management Protocols Research Articles

Return to play after head injury in adolescent sports: evaluating football versus other sports.

Increased adolescent sports participation has raised concerns about higher rates of concussions, a prevalent injury among young athletes with potential long-term effects. Discrepancies in concussion recovery and management protocols across various sports underscore a critical issue in youth athletics. This study aimed to examine the relationship between sport type and the number of games missed following a concussion to inform targeted management strategies. Data from 7445 postinjury ImPACT tests for athletes aged 12-22 years, collected from 2009 to 2019, were analyzed across different sports: baseball, basketball, cheerleading, football, ice hockey, lacrosse, soccer, softball, swimming, track and field, volleyball, and wrestling. The number of days and normalized missed games (NMG), a metric accounting for the different number of games in a season for different sports, were used to evaluate the effect of concussions across different sports. ANOVA, t-tests, and linear regression analyses were performed to model the effect of sport type on games missed in a season while controlling for sex, age, concussion history, diagnosed learning disability (DLD), and attention-deficit/hyperactivity disorder (ADHD). Multivariable linear regression analysis demonstrated that football participation significantly increased NMG (β 1.681, 95% CI 0.807-2.554; p < 0.001) and days missed (β 1.637, 95% CI 1.044-2.231; p < 0.001) after head injury. Concussion diagnoses were also found to significantly increase NMG (β 2.344, 95% CI 1.629-3.059; p < 0.001) and days missed (β 1.560, 95% CI 1.074-2.045; p < 0.001), as well as history of prior concussion (NMG: β 7.791, 95% CI 7.368-8.215; p < 0.001; days missed: β 5.232, 95% CI 4.945-5.520; p < 0.001). In contrast, factors such as age, sex, DLD, ADHD, and concussions causing loss of consciousness did not significantly affect NMG or days missed. ANOVA with Tukey Honest Significant Difference indicated that compared with football, ice hockey (mean difference [MD] 5.4 days, p = 0.011) and track and field (MD 4.1 days, p = 0.006) were associated with significantly more days being missed after head injury. Conversely, basketball (MD -3.0, p < 0.001) and volleyball (MD -2.6, p = 0.005) were associated with fewer missed games. Adolescents playing football missed fewer days and games after concussion than other contact and noncontact sports, including ice hockey and track and field, raising questions about variations in return-to-play protocols and cultural attitudes within sports. Further research is needed to determine the factors affecting games missed across sport types in adolescent athletics and return-to-play protocols.

Match official experiences with the Blue Card protocol in amateur rugby: implementing Rowan’s Law for concussion management

ABSTRACT The Blue Card protocol was introduced to domestic amateur rugby competitions to bring Rugby Canada into compliance with provincial concussion legislation. The Blue Card protocol formalises how match officials can remove an athlete with a suspected concussion from play and prevents athletes from returning to sport without medical clearance. This exploratory study examined the experiences of Canadian rugby match officials with the novel Blue Card process. Semi-structured interviews conducted with six Canadian rugby match officials were subjected to Interpretive Phenomenological Analysis. Findings revealed interpersonal (e.g. stakeholder collaboration and peer support) and intrapersonal (e.g. concerns about personal liability and comfort with the administration of the Blue Card) factors related to the successful implementation of concussion management protocols. Match officials distinguished actions from members of the rugby community as either supporting (e.g. information sharing) or actively resisting (e.g. questioning match official decisions regarding the Blue Card) efforts to implement the Blue Card protocol. Those who had personal experience removing an athlete from play due to a suspected concussion or who administered a Blue Card during the 2019 season reported feeling more comfortable with the process than less experienced peers. However, in this early policy implementation phase, 50% of participants expressed concerns about their personal liability associated with the Blue Card process. Implications for the design and implementation of sport-related concussion research and policy at the amateur level are discussed.

12 Measuring effort on a continuum provides improved insight into concussion baseline cognitive assessments

Objective:Baseline assessment of cognitive performance is common practice under many concussion management protocols and is required for collegiate athletes by the NCAA. The purpose of baseline cognitive assessment is to understand an athlete’s individual uninjured cognitive performance, as opposed to using population normative data. This baseline can then serve as a reference point for recovery after concussion and can inform return-to-play decisions. However, multiple factors, including lack of effort, can contribute to misrepresentation of baseline results which raises concern for reliability during return-to-play decision-making. Measuring effort across a continuum, rather than as a dichotomous variable (good versus poor effort) may provide informative insight related to cognitive performance at baseline.Participants and Methods:Collegiate athletes (n = 231) completed the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) as part of their baseline pre-participation concussion evaluation. ImPACT creates composite scores of Verbal Memory, Visual Memory, Visual-Motor Speed, and Reaction Time. Baseline self-reported symptoms and total hours of sleep the night prior to testing are also collected through ImPACT. ImPACT has one embedded indicator within the program to assess effort, and research has identified an additional three embedded indicators. Athletes were also administered one stand-alone performance validity test, either the Medical Symptom Validity Test (n = 130) or the Rey Dot Counting Test (n = 101), to independently measure effort. Effort was estimated across a continuum (zero, one, two, or three or more failed effort indicators) with both stand-alone and embedded effort indicators. We evaluated the relationship between effort, symptoms, self-reported sleep, Reaction Time composite score and Visual-Motor Speed composite score using a linear regression model.Results:We found that 121 athletes passed all effort indicators, while 39 athletes failed only one effort indicator, 40 athletes failed two effort indicators, and 31 athletes failed three or four (three+) effort indicators. Self-reported symptoms and total hours of sleep were not related to effort, but Reaction Time and VisualMotor Speed composites were. Specifically, performance on the Visual-Motor Speed composite was significantly worse for athletes who failed two or three+ effort indicators compared to athletes who did not fail any, and performance on the Reaction Time composite was significantly worse only for athletes who failed three+ effort indicators. Additionally, athletes who failed one or more effort indicators and reported less sleep performed worse on both the Visual-Motor Speed and Reaction Time composites, compared to those who reported less sleep and did not fail any effort indicators.Conclusions:Athletes who failed one effort indicator did not perform significantly worse on Reaction Time and Visual-Motor Speed composites compared to those who passed all effort indicators. However, 31% of athletes failed two or more effort indicators and these athletes performed worse on cognitive tests, likely due to factors impacting their ability to put forth good effort. These results suggest that effort is more complex than a previously used dichotomous variable and highlights the importance of using several indicators of effort throughout baseline assessments. In addition, the importance of sleep should be emphasized during baseline assessments, especially when effort is questionable.

Concussion Management Among National Collegiate Athletic Association Swim Programs

The nuances of swimming make the application of traditional return-to-play progressions following concussion challenging. Our purpose was to describe athletic training services and concussion management protocols among National Collegiate Athletic Association swim programs and compare them between the National Collegiate Athletic Association divisions. We surveyed 228 athletic trainers assigned to or with knowledge of their institution’s swim programs from a convenience sample of 539 (response rate = 42.3%) athletic trainers. Athletic training services were provided to 98.6% (214/217) of the programs. Nearly 80% (164/207) of the programs administered baseline concussion testing to swimmers, with differences observed between divisions (p &lt; .001). No differences (p = .108) in the number of concussions sustained by swimmers in the past academic year were noted between divisions. Specific return-to-swim protocols were reported by 51.8% (115/222) of respondents with no differences in the presence of a specific return-to-swim protocol between divisions (p = .790). While concussions are reported less frequently in swimming than other sports, appropriate medical care, including a specific return-to-swim protocol, is warranted and provided for future use.

Assessment of a collaborative concussion management strategy in a school-based sport program: Prospective cohort study.

To analyze the implementation of a concussion management protocol in which a team physiotherapist is involved in the identification of concussions and return-to-play (RTP) decisions. A prospective injury surveillance cohort study in a school-based Canadian football program (4 teams; grades 8 to 12) over 4 years. For years 1 to 2, the team physician made all RTP decisions; over years 3 to 4, the team physiotherapist was allowed to make some RTP decisions using pre-established criteria defined in the protocol. A high school in Québec, Que. Male student athletes between 11 and 17 years old. Same-season recurrence (SSR) of concussion symptoms following RTP. A total of 119 concussions were identified (55 during the first 2 years and 64 during the last 2 years) during 27,741 athlete-exposures in 672 athlete-years for an incidence rate of 4.3 per 1000 athlete-exposures. During years 1 to 3, no SSR was observed following RTP clearance. During year 4 there was 1 case of SSR that occurred 11 days after clearance. The overall SSR rate of concussion symptoms following RTP clearance was 0.8%. A very low rate of SSR was achieved whether the team physician made all RTP decisions or the team physiotherapist was allowed to make some of the RTP decisions through the terms of the protocol.

Leadership Lessons in Concussion Management for Team Physicians.

Over the last decade, with emphasis on concussion awareness and potential long-term deficits, concussions have become a public health concern. Although common, concussions are complex in nature and often require a collaborative treatment approach across multiple disciplines. In an athletic setting, the Team Physician plays a critical leadership role in the organization, management, and provision of care for concussed athletes. However, leadership strategies for the provision of concussion care utilized by the Team Physician have not been adequately described. This manuscript intends to describe advanced planning for concussion management and highlight best practices for the provision of care for the concussed athlete, to assist the Team Physician in coordinating optimal care. Specific emphasis will be placed on outlining a concussion management protocol aligned with evidence-based best practices.

A-137 Role of Neuropsychology in Framing and Assisting the Development of Recovery Efforts: Education for Providers across Disciplines

Abstract Objective Information regarding differences in concussion and mild TBI recovery management protocols and recovery expectations vary across disciplines. This often leads to imprecise expectations for prognosis and adverse impacts on effective treatment and recovery. National groups and institutions provide training regarding concussion by neuropsychologists and rehabilitation psychologists to psychologists; however, broadband cross-discipline training is limited. Clinically, psychoeducation and clarification fall on Neuropsychologists and Rehabilitation psychologists. The purpose of this poster is to highlight the importance of the role of neuropsychologists in the education of concussion versus TBI recovery to support medical providers, teachers, and educators to facilitate appropriate care. Data Selection The current literature was review and obtained through the search within various databases such as PsycInfo, Google Scholar, and OhioLink. Keywords such as concussion, mild traumatic brain injury, psychoeducation, and neuropsychology were utilized to provide an inclusive review of the current research (2016–2021). Data Synthesis The focus of existing literature supports the education of concussions for patients and their families. Much of the literature supports the role of many disciplines to aid in recovery. There is limited research to support neuropsychology/Rehabilitation psychology’s efficacy to provide didactic training for providers of different fields supporting this population. Conclusion Through research, advocacy, and program development, the field of Neuropsychology and Rehabilitation psychology can utilize the holistic framework of the brain–body relationship to further facilitate the discussion of concussion and TBI recovery for providers of other disciplines serving these populations. Since treatment is multi-disciplinary for this clinical population, further programmatic evaluation provides interdisciplinary didactics to improve patient care.

Available supports and resources for postsecondary students with traumatic brain injury: A systematic review of the literature

BACKGROUND: Postsecondary students with traumatic brain injuries (TBI) are a rapidly growing population, encompassing those who sustained injuries prior to attending postsecondary education and those who endure injuries during their postsecondary studies. Not only do these individuals face a broad range of symptoms, all of which can affect academic achievement, but they also do not achieve comparable academic outcomes to their peers without disabilities. OBJECTIVE: There is a need to develop and examine the effectiveness of available supports and resources to meet the needs of these students. METHODS: Twenty-three articles were systematically reviewed to illustrate what supports are currently described in the literature for postsecondary students with TBI and what research methods were used to assess the effectiveness of these supports. RESULTS: Three categories of supports emerged, including concussion management protocols, typical study/learning strategies and accommodations, and interventions developed specifically for this population. Findings also indicated a lack of rigorous research methods used to assess these interventions’ effects. CONCLUSIONS: Implications for future research include a need for additional study of all supports and resources described in this review, and assessment of whether or not education professionals, including postsecondary disability services professionals, are aware of and using the tools and strategies addressed in this review.

Brain smart – Let's play safely: Evaluation of a concussion education program in schools

Objectives There are two objectives for this paper. First, to determine effects of a concussion education program in a local school board in terms of concussion-specific knowledge in children and confidence in identifying and managing concussion in adults. Second, to identify differences and similarities in concussion knowledge between children who participate in sports and those who do not and between children with a history of one or more concussions and those without. Design A cross sectional survey regarding concussion knowledge was distributed randomly to students and adults at both pre- and posteducation timepoints. A concussion education program was disseminated across the school board for students between the distribution survey timepoints. Following the education program, adults and students completed their respective post-test surveys. Chi-squared tests in SPSS determined the significance of between-group differences. Results All 17 adults (100.0%) who had received concussion education recently reported confidence in their knowledge of concussion management, compared to 35.7% adults who had not received education for over a year (p = 0.020). For students, all of whom completed the concussion education training between the pre- and post-tests, there were no significant differences in concussion knowledge scores between athletes and non-athletes (either in or outside of school) or between those with a history of concussion and those without. There were no significant changes in concussion knowledge between the pre- and post-tests, except for one question. Conclusion Concussion education programs increase confidence of concussion management protocols in adults involved in sport, but they require improvements to better support knowledge amelioration, particularly for target groups that are at high risk of sustaining another injury.

Medical Supervision of Illinois Public and Private High School Athletics

ABSTRACT Background High-school sports participation in the United States has increased over the years with a corresponding increase in the number of injuries. Leading medical and sports organizations nationwide advocate for an increase in proper medical supervision of athletes. Objectives To analyze athletic medical coverage in Illinois high schools and compare differences between public and private Illinois high school. Methods A survey addressing various components of sports medical coverage was distributed in 2018 to all 810 Illinois High School Association (IHSA) high schools to be completed electronically. Results The response rate was 50% (407/810 schools). Of the responding schools, 14% were private high schools and 86% public high schools. An orthopedic surgeon, family doctor, pediatrician, or another type of physician were present on sidelines in 9.2% of private high schools and 8.5% of public high schools. Athletic trainers (ATs) were present on sidelines in 91% of private high schools and in 79% of public high schools. There was 68% of private high schools reporting coaches trained in CPR versus 85% in public high schools. Both private and public high schools had high rates of having written emergency action plans (89% vs 91%), AED on site (100% vs 99%), written concussion management protocols (96% vs 97%). Conclusion Our study found similar rates of high school medical coverage as compared to national studies, with some significant differences found between private and public high schools. Most Illinois high schools had high rates of having written EAPs, concussion management protocols and AEDs on site. Overall, an increase of medical supervision and emergency preparedness is needed, which should come in the form of increasing AT and physician presence alongside community and school engagement for improved implementation of coverage.

Evaluation of Concussion Management Protocol in Adaptive Sports: The Guidelines for Conducting Proper Baselines

To discuss current concussion management guidelines in Adaptive Sports and educate clinicians on our Concussion Management Protocol (CMP).

Incidence reporting via online high school concussion surveillance by certified athletic trainers and school nurses, 2015\u20132018

BackgroundThere is an increasing concern over adolescent concussions in sports due to risks of long-term negative effects. This study analyzed data over three school years on reported concussion incidence rates by season, high school grade levels and gender, and reported symptoms by school nurses versus athletic trainers, from New Jersey student-athlete concussion data available from an online school-based surveillance system.MethodsSchool nurses and athletic trainers reported 300 concussions within five days from when each occurred over three school years, 2015–2018, in team sports and physical education in New Jersey high schools. Analysis was further conducted on symptoms and number of symptoms reported by school nurses versus school athletic trainers for each documented student-athlete concussion. Estimated concussion incidence rates were calculated using state agency verified school enrollment data.FindingsConcussions most commonly occurred during fall, followed by spring, then winter. Concussion incidence rates ranged from 6.3/1000 (4.99, 7.55) – 9.1/1000 (7.27, 10.98) students over the three school years of the study. Athletic trainers completed 86% of the reports while nurses completed 11% (position or title of 3%, or n = 7, were not disclosed); the values were similar when considering only fall pre-season and regular season sports (88, 10, 2%, respectively). On average, across the three school years, athletic trainers reported about 3.5 symptoms per report while nurses reported 2.7 (values in fall seasons only were 3.7 and 3.1, respectively.)ConclusionsCertified athletic trainers, compared to school nurses, more often completed concussion report forms and reported more symptoms per injured student, perhaps due partly to closer contact and immediate care provided after injury. Additionally, this study had a higher concussion incidence rate during fall sports seasons compared to winter and spring. Future research can further improve our understanding of concussions among adolescent student-athletes to better inform concussion identification, management and recovery protocols.

Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion.

The need to have a pediatric-specific concussion management protocol on Return to School (RTS) and Return to Activity (RTA) after concussion has been recognized internationally. The first step to evaluate the protocol effectiveness is to establish whether children and youth are adhering to these recommendations. The objective of this study was to explore the prevalence and predictors of adherence to RTS and RTA concussion management protocols for children/youth. A prospective cohort of children/youth with concussion. Childhood Disability Research Centre. One hundred thirty-nine children/youth aged 5 to 18 years, diagnosed with concussion and symptomatic upon enrollment, were followed for up to 6 months. Primary recruitment occurred from a Children's Hospital Emergency Department. Provision of RTS/RTA guidelines. Measurement of adherence came from multiple sources, including the child's and parent's knowledge of protocols, research personnel evaluations, and self-reported stages of RTS/RTA and Post-Concussion Symptom Scale (PCSS) scores. Spearman correlations and logistic regression were used, investigating the relationship between PCSS and progression of protocols and determining predictors of adherence. Significant negative associations between total PCSS score and stage of RTS/RTA protocols were found. Fifty-three percent and 56% of the participants adhered to the RTS and RTA protocols, respectively. Children's knowledge of protocols and total PCSS scores significantly predicted adherence to RTS/RTA and may be the most important factors in predicting adherence during recovery from concussion.

Nonverbal hand movement durations indicate post-concussion symptoms of athletes

ObjectiveConcussions are common in sports and appear to be a risk factor for cognitive impairment and mental health problems. Methods of post-concussion diagnosis are still of debate, regarding sensitivity, objectivity, reliability, and costs. Spontaneous displays of nonverbal hand movement behavior during interaction are indicative of psychopathology and relatively simple to record and analyze.BackgroundIncreased durations of continuous (/irregular) body-focused hand movement activity in particular indicates psychopathology that overlaps in symptomatology with that of sport related concussions (SRC). We therefore hypothesized that the duration of irregular, on body, and act on each other hand movements is increased in athletes with SRC who suffer from post-concussion symptoms.Design/MethodsThree matched groups were investigated: 14 symptomatic athletes with a concussion, 14 asymptomatic athletes with a concussion, and 12 non-concussed athletes. Four certified raters analyzed with the NEUROGES analysis system all nonverbal hand movements that were displayed during a videotaped standardized anamnesis about concussion history, incidence, course of action, and post-concussion symptoms.ResultsIrregular Structure units of symptomatic athletes are significantly longer when compared to asymptomatic athletes. Hand movement durations of irregular, on body, and act on each other correlate positively with post-concussion symptoms. The duration of irregular units significantly predicts the PCS score.ConclusionsIncreased durations of irregular hand movement units indicate post-concussion symptoms in athletes with sport-related concussions. Because the recording of spontaneous displays of nonverbal hand movement behavior is relatively simple and cost-efficient, we suggest using the neuropsychological analysis of hand movement behavior as a future diagnostic parameter of concussion management protocols.

Medical Supervision of High School Athletics in Chicago: A Follow-up Study.

Background:High school sports participation in the United States has increased dramatically over the past 25 years. A corresponding increase in the number of injuries has been noted, particularly in contact sports such as football. This has led medical and sports organizations nationwide to advocate for proper medical supervision of athletes at games and practices.Purpose:To gather information from Chicago public high schools to gauge how medical supervision for high school sports has changed in 2017 compared with 2003.Study Design:Cross-sectional study.Methods:Survey questionnaires were sent to the athletic directors of all 99 Chicago public high schools to complete via email. The questionnaire survey contained the same questions as in a survey conducted in 2003 by Tonino and Bollier, with the addition of 4 novel questions relating to emergency action plans (EAPs), automated external defibrillators, concussion management policy, and tackling progression drills.Results:The response rate was 66.67% (66/99 schools). Of the 66 responding schools, all with football programs, no school had a physician on the sideline at home games (decrease from 10.6% in 2003), 37.9% had an athletic trainer present (increase from 8.5% in 2003), and 63.6% had a paramedic available (decrease from 89.4% in 2003). In 2017, 65.6% of responding schools had a coach certified in cardiopulmonary resuscitation (CPR) available at practice to handle medical problems, compared with 89.4% in 2003 (P < .001). Regarding the 4 novel questions, 93.9% of the responding schools had proper tackling progression drills in place, followed by 89.1% who had appropriate EAPs and 93.9% with concussion management protocols, including return-to-play and return-to-learn protocols.Conclusion:Although significant improvement was found in athletic trainer coverage, especially at games, physician coverage was lacking and fewer coaches were certified in CPR in 2017 compared with 2003. EAPs and concussion management protocols were present in most Chicago public high schools. Overall, greater medical supervision is needed, which we believe should come in the form of increased athletic training and physician involvement and coverage, given that expert, expedited medical care saves lives.

Nonverbal Hand Movement Durations Indicate Post-Concussion Symptoms of Athletes.

Methods of post-concussion diagnosis are still under debate with regard to sensitivity, objectivity, reliability, and costs. Spontaneous displays of nonverbal hand movement behavior during interaction are indicative of psychopathology and are relatively simple to record and analyze. Increased continuous (irregular) body-focused hand movement activity in particular indicates psychopathologies that overlap in symptomatology with those of sport-related concussions (SRCs). We therefore hypothesized that the duration of "irregular," "on body," and "act on each other" hand movements is increased in athletes with SRC who suffer from post-concussion symptoms. Three matched groups of 40 athletes were investigated: 14 symptomatic athletes with a concussion, 14 asymptomatic athletes with a concussion, and 12 non-concussed athletes. Using the Neuropsychological Gesture (NEUROGES)-Elan analysis system, four certified raters analyzed all nonverbal hand movements that were displayed during a videotaped standardized anamnesis about concussion history, incidence, course of action, and post-concussion symptoms. The duration of irregular Structure units among symptomatic athletes was significantly longer compared with asymptomatic athletes. Irregular, on body, and act on each other hand movement durations correlated with post-concussion symptoms. Whereas the duration of irregular units significantly predicted the post-concussion symptom score, working memory performances showed only marginal effects. Increased duration of irregular hand movement units indicates post-concussion symptoms in athletes with SRC. Because the recording of spontaneous displays of nonverbal hand movement behavior is relatively simple and cost efficient, we suggest using the neuropsychological analysis of hand movement behavior as a future diagnostic parameter of concussion management protocols.

Biomechanical comparison of concussions with and without a loss of consciousness in elite American football: implications for prevention

ABSTRACT Loss of consciousness (LOC) associated with concussion is no longer considered an indicator of severity of injury in concussion management protocols. Studies investigating the association between LOC and recovery time or neurophysiological performance have reported ambiguous findings and resulted in a limited understanding of the severity of LOC-inducing head impacts. Concussive injuries with and without LOC from helmet-to-helmet and shoulder collisions and falls in elite American football were reconstructed in laboratory using a hybrid III headform and finite element model to obtain peak linear and rotational acceleration and brain tissue deformation metrics in the cerebral cortex, the cerebral white matter, the corpus callosum, the thalamus and the brainstem. Impact velocity, peak linear and rotational acceleration were significantly greater in the LOC group than the no LOC group. The brain tissue deformation metrics were greater in the LOC group than the no LOC group. The best overall predictor for LOC was impact velocity. Concussions with LOC are characterised by greater magnitudes of brain tissue deformation. This was mainly the result of higher impact velocities in the LOC group providing league decision-makers with an understanding of the importance of managing impact velocity through athlete education and rule enforcement or change.

Concussion history influences sleep disturbances, symptoms, and quality of life in collegiate student-athletes

ObjectivesImmediately after experiencing a concussion, many will report the presence of a variety of symptoms, which may include disturbances in sleep. It is possible that these symptoms and other resulting quality of life (QOL) disturbances may persist for some time following a concussion. The purpose of this study was to determine if a history of concussions was related to ongoing sleep disturbances, symptoms, and changes in QOL. MethodsEighty-two student-athletes (club and varsity) completed an online survey to determine concussion history, sleep disturbances, concussion symptoms, and QOL dysfunctions. Separate analyses of variance were performed to determine if sleep disturbances, symptoms, and QOL dysfunctions were related and if they differed based on concussion history (0, 1-2, 3+). ResultsThose with no concussion history reported fewer sleep disturbances (P = .028), symptoms (P = .029), symptom severity (P = .014), QOL dysfunctions (P = .003), and QOL severity (P = .011) than those who self-reported having had a previous concussion(s). Additionally, the number of sleep disturbances was found to positively correlate with symptoms (P < .001), symptom severity (P < .001), QOL dysfunctions (P = .001), and severity of QOL dysfunctions (P = .002). ConclusionsThe results of the current study demonstrate that concussion history is related to persistent changes in sleep, ongoing symptoms, and QOL dysfunctions and should be considered in concussion management protocols even after return to play and academics has occurred.

Evaluation of Concussion Incidence and Modulating Factors in the 2013-2017 Australian Football League.

IntroductionThe increasing awareness and popularization of concussions in the research realm over the last few years have begun to shed more light on the detrimental effects associated with repetitive head trauma. While the majority of the current literature focuses on the National Football League (NFL) and National Hockey League (NHL), several other high-impact sports have been implementing concussion management protocols to protect their players. The Australian Football League (AFL) is a prime example of a major contact sport that has undertaken recent changes to its concussion assessment and management modalities. We recognize the benefit of reporting potential changes in concussion rates over the 2013-2017 AFL seasons. We were interested in some of the factors not yet evaluated before, which may contribute to the overall concussion incidence such as “style-of-play” factors” (home/away, win/loss, points scored, time of season). We hope the results of this analysis shed light on the mechanisms by which concussion rates can be mitigated across major contact sports.MethodsData were obtained from the weekly injury list published by the AFL, a publicly available website. Details of players listed with concussions were collected from regular season games (890 games total) of 18 AFL teams from 2013 to 2017. Weekly injury lists were retrospectively compared using THE AGE, a publicly available newspaper published and owned by Fairfax Media. Data were analyzed utilizing GraphPad Prism 6 (GraphPad Software Inc., CA, US). In addition to descriptive statistics, Fisher's exact tests, Welch’s two-tailed t-tests, and correlation tests were used. Alpha level < 0.05 was considered significant for all tests.ResultsThe dataset comprised 236 total concussions between the 2013 and 2017 AFL seasons. We noted a significant increase in the concussion rate (p = 0.0010) between the 2013 and 2017 seasons. This result was complemented by a significant increase in average games missed between the 2014 and 2015 seasons (p = 0.0002); however, this trend was not significant when evaluating the 2013 and 2017 seasons directly (p = 0.0951). Further analysis into the "style of play" factors on concussion incidence, such as average points scored, win/loss, home/away, and time of season, produced non-significant results.ConclusionOur study identified a significant increasing trend in concussion rate and average games missed that correlate to the data analysis in other high-impact sports such as the NFL and NHL. However, further research is necessary to determine if these findings indicate the improvement in concussion management and player safety measures beginning to develop in high-impact sports. We also noted that certain “style of play” factors (points scored, win/loss, home/away, and time of season) have no significant implication on concussion rate during the 2013-2017 AFL seasons. While we consider our data source to be reliable in the reporting of concussions from the AFL, the ideal data set would comprise a medical diagnosis from the team of doctors. It may be possible that our data set is underreporting the total amount of concussions between the 2013 and 2017 AFL seasons. Return-to-play times were not ascertained directly from the team doctor for the clearance date. It may be possible that this data collection modality led to missed cases of head injury or return to play times, which could impact the reliability of our dataset.

Perceptual-cognitive three-dimensional multiple-object tracking task can help the monitoring of sport-related concussion

ObjectivesWhile the rate of sport-related concussion is increasing, more effective tools are needed to help monitor the diagnosis and return to play of athletes. The three-dimensional multiple-object tracking (3D-MOT) exercise...