Concussion Training Research Articles

Provision of Concussion Information From Coaches and the Presence of Athletic Trainers: Findings From the 2021 YouthStyles Survey.

Coaches play an important role in concussion safety, and their views on concussion influence those of their athletes and the athletes' reporting behaviors. In this 2021 survey of youth, we examined how often coaches provide concussion safety information to their athletes and the association between coaches' provision of concussion information to athletes and the presence of athletic trainers (ATs) at a team's games and practices. More than 4 in 10 youth who played sports reported that their coaches did not provide any sort of concussion education or information to them in the past 12 months. Among those youth who always or sometimes had ATs at practices or games, 76.3% received some type of coach education on concussion in the past 12 months, compared with 31.9% of those who rarely or never had ATs at practices or games (P < .0001). Increasing access to ATs and adapting current concussion training and educational materials for coaches to increase coach-athlete communication may be beneficial.

A-08 Understanding the relationship between knowledge, beliefs, actions and confidence surrounding concussions among youth hockey coaches

Abstract Purpose To investigate the effectiveness of mandatory concussion education among youth hockey coaches and to understand if increased knowledge correlates with confidence. Identification of facilitators and barriers to coaches’ beliefs and actions were also assessed. Methods Prospective, cross-sectional descriptive pilot study using an electronic survey via REDCap sent to youth coaches within the Minnesota Hockey organization. Quantitative questions were used to investigate knowledge and attitudes, while qualitative questions explored the facilitators and barriers to concussion management in youth hockey. Results 98.8% of the 177 participants (M=150; F=22, NB=5), aged 18–65+ years completed the mandatory concussion training, with majority completing it in the last year (79%). 95% endorsed concussion education as beneficial with only 8 coaches reporting it was not helpful and 10 coaches requesting more educational materials. Over half of the participants (96; 54%) denied legislation impacting their attitude toward concussion. Confidence in concussion knowledge (3.07±1.09; 77%) and attitudes towards concussions (7.62±1.63; 85%) were positive. 39 (26%) coaches considered athlete and parent input most valuable for return to play. This may be related 72% of participants who reported no trained medical staff were present at games or practices. Concerningly, 20% of coaches may not encourage an athlete with loss of consciousness to seek emergent care. Conclusions Current mandatory concussion education produces increased knowledge, confidence, and appropriate action among majority of youth coaches. Coach reliance on athlete and parent report for clearance to play increases with no medical staff present for practices and games, which could have negative consequences.

Developing and Implementing a Concussion Curriculum in Enhancing Competency

<h3>Research Objectives</h3> Research has identified knowledge gaps among medical trainees on the topic of concussion, but it is still unclear whether such activities affect patient outcomes and knowledge transfer (Provvidenza, 2009). With the shift to competency-based medical education in Canada, there is a need to systematically review and evaluate the effects of concussion curriculum. We conducted a systematic review to determine the most effective concussion curriculum for enhancing medical trainees' competency. <h3>Design</h3> A study protocol was developed and registered in the National Institute of Health Research PROSPERO registry. The report followed the PRISMA guidelines. The studies' quality was evaluated using the MINORS score, an assessment tool to evaluate non-randomized control trials. We used program evaluation models (Kirkpatrick's and Miller's models) to evaluate concussion programs. A comprehensive search strategy utilized 5 bibliographic databases and 11 medical education journals. To be included, studies were required to report on concussion training received by medical trainees at any point during their medical education or career. Studies examining concussion curriculum or formal training were included. Two reviewers screened unique citations for relevance and reviewed the full texts of relevant articles. Two independent researchers extracted data and assessed methodologic quality. At all stages, a third independent reviewer adjudicated discrepancies. <h3>Setting</h3> N/A. <h3>Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> Overall, 6 studies were included from 1177 references and 4 out of 6 of the studies met 80% quality criteria. All studies reflected a Competency Miller's Pyramid level 1, which was very different from the traditional program evaluation model. <h3>Conclusions</h3> All studies identified a low level of competency demonstrated the limited attention given to competency-focused training. The current evidence in concussion curriculum development suggests longitudinal repetitive learning experiences with a focus on social workplace learning.

US physical therapist practice patterns evaluating concussion and clinical practice guideline adherence

ObjectivesTo assess the influence of contemporary physical therapy clinical practice guidelines (CPG) on concussion evaluation practice patterns and barriers/facilitators for CPG adherence. DesignElectronic cross-sectional survey. SettingOnline survey platform. ParticipantsUS licensed physical therapists that manage concussion. Main outcome measures1) practice patterns 2) knowledge/use of CPG 3) barriers/facilitations to CPG adherence. ResultsKnowledge/use of CPG categories significantly predicted the model (χ2(1) = 10.966, p < .001) of total vignette scores/practice patterns with a statistically significant effect. A Kruskal-Wallis test indicated significant differences in total vignette score means based on knowledge/use between “not aware of the concussion CPG” and “integrated concussion CPG into practice” groups (p < .001, ES = .21). Knowledge/use of the CPG predicted the perceived barriers/facilitators model for three questions: investment in specialized concussion training (χ2(1) = 39.52, p < .001), necessary equipment to complete concussion evaluation (χ2(1) = 16.01, p < .001), and confidence around concussion evaluation knowledge (χ2(1) = 27.46, p < .001) with a significant effect. ConclusionThe results of this study provide support for guiding documents like the CPG to positively influence concussion practice patterns and insight into facilitators for guideline adherence.

Imposing Compulsory Rugby Union on Schoolchildren: An Analysis of English State-Funded Secondary Schools.

ObjectiveTo establish the extent to which Rugby Union was a compulsory physical education activity in state-funded secondary schools in England and to understand the views of Subject Leaders for Physical Education with respect to injury risk.MethodA cross-sectional research study using data obtained under the Freedom of Information Act (2000) from 288 state-funded secondary schools.ResultsRugby Union was delivered in 81% (n = 234 of 288) of state-funded secondary school physical education curricula, including 83% (n = 229 of 275) of state-funded secondary school boys' and 54% (n = 151 of 282) of girls' physical education curricular. Rugby Union was compulsory in 91% (n = 208 of 229) of state-funded secondary schools that delivered it as part of the boys' physical education curriculum and 54% (n = 82 of 151) of state-funded secondary schools that delivered contact Rugby Union as part of the girls' physical education curriculum. Subject Leaders for Physical Education also perceived Rugby Union to have the highest risk of harm of the activities they delivered in their school physical education curriculum.ConclusionNotwithstanding discussions of appropriate measures (i.e., mandatory concussion training, Rugby Union specific qualifications and CPD) to reduce injury risk, it is recommended that Rugby Union should not be a compulsory activity given that it has a perceived high risk of injury and is an unnecessary risk for children in physical education.

Outlining the Invisible: Experiences and Perspectives Regarding Concussion Recovery, Return-to-Work, and Resource Gaps.

Appropriate supports and accommodations are necessary to ensure full concussion recovery and return-to-work (RTW). This research investigated barriers and facilitators to concussion recovery and RTW, and resource gaps reported by adults with concussion (‘workers’) and workplace and healthcare professionals (‘workplaces’). Semi-structured interviews and focus groups were conducted with workers (n = 31) and workplaces (n = 16) across British Columbia. Data were analyzed using inductive content analysis. Facilitators to workers’ concussion recovery and RTW included treatment, social support, and workplace and lifestyle modifications. To address barriers, both groups recommended: (a) widespread concussion and RTW education and training (b) standardized concussion recovery guidelines; (c) changing attitudes toward concussion; (d) mental health supports; and (e) increasing awareness that every concussion is unique. Findings can inform best practice for concussion recovery and RTW among professionals in workplaces, healthcare, occupational health and safety, and workers’ compensation boards.

Youth sport parents’ familiarity and perceptions of concussion legislation

Objectives In an effort to reduce the negative health consequences often associated with concussions among young athletes, all U.S. states and the District of Columbia enacted youth concussion legislation between 2009 and 2014. This study explored youth sport parents’ (1) familiarity with their state's concussion legislation, and (2) perceptions about the need for additional legislative provisions not currently found in such laws. Methods Cross-sectional online survey data were obtained from parents ( n = 430) of youth sport athletes from 22 U.S states. Results Primary findings suggest that 67% of parents were moderately to extremely familiar with the removal from play requirement; 69.9% were moderately to extremely familiar with mandatory concussion training for coaches; and 75.1% were moderately to extremely familiar with the medical clearance requirement for athletes to return to play. In regard to perceptions, approximately half (50.2%) believed it is essential to mandate parent/guardian notification when a child suffers a potential concussion; and 42.8% believed it is essential to include a penalty/sanction for violating the statute. Based on the results of a multivariable logistic regression model, a significantly greater familiarity of concussion legislation was found among parents who were White/Caucasian, had advanced degrees, had higher household incomes, or were urban residents. Conclusions Our findings suggest that most youth sport parents have a sound understanding of concussion legislation and believe that the laws should be revised to improve best practices in preventing and managing concussions. Parents who face socio-cultural and economic barriers can benefit most from having access to credible information about their state's concussion law.

Assessment of Argentine Health Care Providers' Knowledge on Sports-Related Concussion: A Cross-sectional Study

To assess the current experience, beliefs and knowledge of survey respondents in the diagnosis and management of sports-related concussion and their relationship to formal concussion training. Athletes who have had a concussion may be at risk of a wide range of short- or long-term complications. The experience with and knowledge about concussion may be the most important factors for an effective concussion management. A cross-sectional survey was conducted in July and August 2020 all over Buenos Aires, Argentina among health care professionals involved in the training and care of the competitive or recreational athletes. The survey covered: (i) the socio-demographic characteristics; (ii) experience; (iii) beliefs; and (iv) assessment of knowledge on sports concussion. A total of 626 participants completed and returned the questionnaire (response rate 86%). The majority of the health care professionals were physicians (n = 429; 68.5%). Nearly two-thirds (72%) of the respondents were related to rugby. Soccer was the second sport (6.2%). Seventy 4 percent of the respondents (n = 463) reported having concussion training. Respondents correctly answered on average 6.23 ± 2.16 (out of 10) concussion knowledge questions. The largest gaps were related to the topics of clinical interpretation of severity symptoms scales and neuroimaging. The smallest gaps were identified for young athletes (<18 years of age) management after a concussion. There was a significant difference in mean survey respondents' knowledge scores about concussion (F [1,622] = 109.479, p < 0.001) between who had received the formal concussion training and those who had not, whilst adjusting for age and years the participant reported having had experience in sport. Knowledge gaps exist in the clinical practice when dealing with professionals who are involved in the care of athletes. Our findings confirm the need for training and education on sport-related concussion.

Video analysis of potential concussions in elite male Hurling: are players being assessed according to league guidelines?

BackgroundHurling is a fast-paced contact sport that places players at risk of concussion. Given the consequences of repeated concussive impacts, it is imperative that concussion management guidelines are followed.Hypothesis/Purpose.The aim of this study is to determine if potential concussive events (PCEs) in elite Hurling are assessed in accordance with league management guidelines. The secondary objective is to investigate the effectiveness of current concussion training programs.MethodsInvestigators used a video analysis approach to identify PCEs throughout the 2018 and 2019 inter-county Hurling seasons and championships. Subsequent assessment, return to play (RTP) decision, and signs of concussion were evaluated based on previously validated methods. The results were then compared year-over-year with previous research in Gaelic Football (GF).ResultsA total of 183 PCEs were identified over 82 matches. PCEs were frequently assessed (86.3%, n = 158) by medical personnel. The majority of assessments were less than 1 min in duration (81.0%, n = 128). Thirteen (7.1%) players were removed following a PCE. There were 43 (23.5%) PCEs that resulted in one or more signs of concussion, of which 10 (23.3%) were removed from play. There was no difference in rate of assessment, duration of assessment, or rate of RTP between 2018 and 2019 in both Hurling and GF, suggesting that current concussion training programs have had limited success.ConclusionIn Hurling, players suspected of having sustained a concussion are frequently subject to a brief assessment, and are rarely removed from play. Affirmative action is needed to ensure the consistent application of standardized concussion assessment across the Gaelic Games.

Collaboration, Training and Resources to Support School Policy Development and Recovery from Concussion

Objective: Concussion is a public health concern across all ages, yet there is little research on providing concussion education and training within the educational context. The Concussion Awareness Training Tool for School Professionals (CATT SP) was developed to provide the necessary concussion education and resources for school professionals to support a student with concussion while integrating back to school. Methods: The CATT SP module underwent a 2016 pre/post-intervention evaluation to determine if knowledge and attitudes significantly improved among educators and administrators following completion of the CATT SP, as well as a 2018-19 pilot study within a school district in British Columbia with an accompanying Quality Assurance/ Quality Improvement assessment. Results: A statistically significant positive change in knowledge (p = .027) was found among those who indicated that they had accessed CATT SP. Results of the pilot study and QA/QI assessment found support of the use of CATT within the school district. Conclusions: Evidence-based concussion training and resources are key components for school professionals who are collaboratively supporting a student’s individualized return to school and learning following a concussion, and when developing and implementing a concussion policy within districts and school.

Delivering Evidence-Based Online Concussion Education to Medical and Healthcare Professionals: The Concussion Awareness Training Tool (CATT).

Background Medical and healthcare professionals report an important gap in their training and knowledge on concussion diagnosis and management. The Concussion Awareness Training Tool (CATT) for medical professionals provides evidenced-based training and resources, representing an important effort to fill this gap. The goal of the current article was to summarize and describe the general uptake of the 2018 relaunch of the CATT for medical professionals and to present results of a quality assurance/quality improvement (QA/QI) assessment including qualitative feedback from medical and healthcare professionals. Methodology. Tracking completions via certificates and Google Analytics were used to measure uptake over the first two years following the 2018 relaunch and promotion of CATT for medical professionals. Medical and healthcare professionals who had completed the CATT from the time of the relaunch on June 11, 2018, to July 31, 2019, were invited via e-mail to participate in the survey-based QA/QI assessment. Both quantitative and qualitative data were collected. Results Year 1 saw 8,072 pageviews for the CATT for medical professionals landing page, increasing to 9,382 in Year 2. Eighty-nine medical and healthcare professionals who had completed the CATT for medical professionals participated in the QA/QI assessment. Results showed that 85% of respondents reported learning new information about concussion; 73% reported changing the way they diagnose, treat, or manage concussion; and 71% reported recommending the CATT to colleagues. Qualitative data also indicated highly favourable opinions and experiences. Conclusions The CATT for medical professionals has demonstrated promise as a tool to promote knowledge translation practice and help fill the gap in concussion training and knowledge reported by medical and healthcare professionals.

High School Athletic Directors Report Poor Compliance With Concussion Reporting and Medical Clearance in Massachusetts

PurposeTo assess statewide prevalence of medical access, concussion reporting, and concussion clearance rates of high school athletic departments in Massachusetts after the implementation of state-wide concussion legislation.MethodsA random sample of 50 athletic directors (ADs) from Massachusetts high schools with an enrollment of >150 students was selected. A 10-minute electronic survey about access to athletic trainers and physicians, and concussion reporting and clearance practices was administered. Responses were anonymous.ResultsThe response rate was 80% (n = 40). In total, 90% of respondents were male. Median age and experience of respondents was 52 years old and 10 years, respectively. The median school size was 637 students, represented from all Massachusetts geographic athletic districts. ADs disclosed that on average, 12% (95% confidence interval 7%-20%) of concussions go unreported at their schools. In total, 16% of respondents reported that at least 1 in 4 of concussed athletes at their school returned to play without appropriate medical clearance, and 5% of ADs reported that not all of their coaches had undergone any form of concussion training. Overall, 55% of high schools do not have access to a full-time athletic trainer and 50% do not have a team physician; 20% have affiliations with an orthopaedic surgeon and 8% with a neurologist.ConclusionsDespite new regulations in Massachusetts, high school ADs report concussion reporting and clearance that are less than 100%. Less than one half of all Massachusetts high schools report access to a full-time athletic trainer or formal relationship with a school physician.Clinical RelevanceInvestigating compliance with Massachusetts school athletics safety regulations could help identify a need for reform of policies designed to help schools keep student athletes safer in situations where a concussion may have occurred.

One-year test-retest reliability of ten vision tests in Canadian athletes

Background: Vision tests are used in concussion management and baseline testing. Concussions, however, often occur months after baseline testing and reliability studies generally examine intervals limited to days or one week. Our objective was to determine the one-year test-retest reliability of these tests. Methods: We assessed one-year test-retest reliability of ten vision tests in elite Canadian athletes followed by the Institut National du Sport du Quebec. We included athletes who completed two baseline (preseason) annual evaluations by one clinician within 365±30 days. We excluded athletes with any concussion or vision training in between the annual evaluations or presented with any factor that is believed to affect the tests (e.g. migraines). Data were collected from clinical charts. We evaluated test-retest reliability using Intraclass Correlation Coefficient (ICC) and 95% limits of agreement (LoA). Results: We examined nine female and seven male athletes with a mean age of 22.7 (SD 4.5) years. Among the vision tests, we observed excellent test-retest reliability in Positive Fusional Vergence at 30cm (ICC=0.93) but this dropped to 0.53 when an outlier was excluded in a sensitivity analysis. There was good to moderate reliability in Negative Fusional Vergence at 30cm (ICC=0.78), Phoria at 30cm (ICC=0.68), Near Point of Convergence break (ICC=0.65) and Saccades (ICC=0.61). The ICC for Positive Fusional Vergence at 3m (ICC=0.56) also decreased to 0.45 after removing two outliers. We found poor reliability in Near Point of Convergence (ICC=0.47), Gross Stereoscopic Acuity (ICC=0.03) and Negative Fusional Vergence at 3m (ICC=0.0). ICC for Phoria at 3m was not appropriate because scores were identical in 14/16 athletes. 95% LoA of the majority of tests were ±40% to ±90%. Conclusions: Five tests had good to moderate one-year test-retest reliability. The remaining tests had poor reliability. The tests would therefore be useful only if concussion has a moderate-large effect on scores.

One-year test-retest reliability of ten vision tests in Canadian athletes

Background: Vision tests are used in concussion management and baseline testing. Concussions, however, often occur months after baseline testing and reliability studies generally examine intervals limited to days or one week. Our objective was to determine the one-year test-retest reliability of these tests. Methods: We assessed one-year test-retest reliability of ten vision tests in elite Canadian athletes followed by the Institut National du Sport du Quebec. We included athletes who completed two baseline (preseason) annual evaluations by one clinician within 365±30 days. We excluded athletes with any concussion or vision training in between the annual evaluations or presented with any factor that is believed to affect the tests (e.g. migraines). Data were collected from clinical charts. We evaluated test-retest reliability using Intraclass Correlation Coefficient (ICC) and 95% limits of agreement (LoA). Results: We examined nine female and seven male athletes with a mean age of 22.7 (SD 4.5) years. Among the vision tests, we observed excellent test-retest reliability in Positive Fusional Vergence at 30cm (ICC=0.93) but this dropped to 0.53 when an outlier was excluded in a sensitivity analysis. There was good to moderate reliability in Negative Fusional Vergence at 30cm (ICC=0.78), Phoria at 30cm (ICC=0.68), Near Point of Convergence break (ICC=0.65) and Saccades (ICC=0.61). The ICC for Positive Fusional Vergence at 3m (ICC=0.56) also decreased to 0.21 after removing one outlier. We found poor reliability in Near Point of Convergence (ICC=0.47), Gross Stereoscopic Acuity (ICC=0.03) and Negative Fusional Vergence at 3m (ICC=0.0). ICC for Phoria at 3m was not appropriate because scores were identical in 14/16 athletes. 95% LoA of the majority of tests were ±40% to ±90%. Conclusions: Five tests had good to moderate one-year test-retest reliability. The remaining tests had poor reliability. The tests would therefore be useful only if concussion has a moderate-large effect on scores.

One-year test-retest reliability of ten vision tests in Canadian athletes

Background: Vision tests are used in concussion management and baseline testing. Concussions, however, often occur months after baseline testing and reliability studies generally examine intervals limited to days or one week. Our objective was to determine the one-year test-retest reliability of these tests. Methods: We assessed one-year test-retest reliability of ten vision tests in elite Canadian athletes followed by the Institut National du Sport du Quebec. We included athletes who completed two baseline (preseason) annual evaluations by one clinician within 365±30 days. We excluded athletes with any concussion or vision training in between the annual evaluations or presented with any factor that is believed to affect the tests (e.g. migraines). Data were collected from clinical charts. We evaluated test-retest reliability using Intraclass Correlation Coefficient (ICC) and 95% limits of agreement (LoA). Results: We examined nine female and seven male athletes with a mean age of 22.7 (SD 4.5) years. Among the vision tests, we observed excellent test-retest reliability in Positive Fusional Vergence at 30cm (ICC=0.93) but this dropped to 0.55 when an outlier was excluded in a sensitivity analysis. There was good to moderate reliability in Negative Fusional Vergence at 30cm (ICC=0.78), Phoria at 30cm (ICC=0.68), Near Point of Convergence break (ICC=0.65) and Saccade (ICC=0.56). The ICC for Positive Fusional Vergence at 3m (ICC=0.56) also decreased to 0.21 after removing one outlier. We found poor reliability in Near Point of Convergence (ICC=0.47), Gross Stereoscopic Acuity (ICC=0.03) and Negative Fusional Vergence at 3m (ICC=0.0). ICC for Phoria at 3m was not appropriate because scores were identical in 14/16 athletes. 95% LoA of the majority of tests were ±40% to ±90%. Conclusions: Five tests had good to moderate one-year test-retest reliability. The remaining tests had poor reliability. The tests would therefore be useful only if concussion has a moderate-large effect on scores.

Assessment of HEADS UP online training as an educational intervention for sports officials/athletic trainers

Background: Sports- and recreation-related concussions are a common injury among children. Sports officials (SOs) and athletic trainers (ATs) are integral to setting the stage for safe play and managing concussions when they occur, and significant numbers of both groups have completed the Centers for Disease Control and Prevention’s HEADS UP online concussion training course. However, the utility of the course for these audiences has not been assessed. We hypothesized that sports officials’ and athletic trainers’ concussion-related knowledge, attitudes, and behavioral intentions will improve from pre- and post-test after completing CDC’s HEADS UP online concussion training course. Method: Respondents’ concussion-related knowledge, attitudes, and behavioral intentions were assessed both before and after taking the training course. Differences between pre- and post-test scores were calculated based on the Wilcoxon Signed Rank Test Z-score or McNemar’s test. Effect sizes were interpreted. Results: The SOs and ATs who participated in the HEADS UP online training had a high level of concussion knowledge before taking the course: 90% or more of respondents could identify the correct response for at least seven of the 13 knowledge questions in the pre-test. Still, the course was effective at improving the respondents’ knowledge about return-to-play protocols and concussion reporting. Further, SOs and ATs demonstrated improvement in their concussion-related attitudes and behavioral intentions between the pre- and post-test. Conclusion: SOs’ and ATs’ concussion knowledge, attitudes, and behavioral intentions improved immediately following completion of the CDC HEADS UP online training. Future research could also focus on the long-term retention of this type of training. Practical Applications: This study provides insight into how to better focus concussion-related educational programs to fit SOs’ and ATs’ needs.

KNOWLEDGE OF VESTIBULAR OCULAR DYSFUNCTION AND UTILIZATION OF VESTIBULAR OCULAR MOTOR SCREENING (VOMS) TOOL COMPONENTS AMONG PROFESSIONAL SPORTS LEAGUE ATHLETIC TRAINERS

The Vestibular Ocular Motor Screen (VOMS) is a relatively new measurement tool intended for the non-vestibular practitioner to identify vestibular ocular dysfunction (VOD) following sport related concussion (SRC). Specific knowledge of VOD and usage of the VOMS among athletic trainers in professional sports leagues is currently unknown. The purpose of this study was to examine knowledge of VOD following SRC and utilization of the VOMS tool and other vestibular ocular tests and measures among athletic trainers in professional sports. Cross Sectional Study. A total of 117 athletic trainers from Major League Baseball, the National Basketball Association, the National Football League and Major League Soccer, with a mean of 17 ± 9 years in the athletic training profession were surveyed via Qualtrics™ with a response rate of 33%. The survey contained three primary sub-sections; demographics, knowledge of vestibular ocular deficits following SRC, and VOMS component utilization at baseline, acute and return-to-play phases of management. Total knowledge scores as well as percentage of utilization based on concussion management stages were calculated. The average percentage correct on the knowledge items was 56% (range of 30% to 65%). There was no difference in knowledge score among athletic trainers with formal post-professional concussion training (p = 0.29) compared to those with no formal training. There was no relationship found between total years practicing and total knowledge score, r = -.128, (p = 0.17). Smooth pursuit testing was the most commonly utilized (70%) in clinical practice and Visual Motion Sensitivity (VMS) was the least utilized (17%). Balance assessment measures to examine vestibular functioning remained the highest utilized examination technique at all-time points in management of SRC. The range of correct responses from 30% to 65% indicates that at the time of survey the participants had decreased knowledge of VOD following SRC. There was low overall utilization of all VOMS components despite recent evidence showing good sensitivity and low false positive rates in SRC. The results of this study identify an opportunity for future training specific to vestibular-ocular impairments and assessment following concussion injury. 2c.

Perspective of United States Judo Coaches on Concussion: A National Survey

Concussions among athletes in contact sports are a prevalent health concern in the United States. There are few studies that have assessed concussion from the perspective of judo coaches. This is a descriptive study of a survey sent to 1,056 United States judo coaches assessing their attitudes, knowledge, and practices toward concussion. The survey had a response rate of 21%, with 215 total responses. Though most coaches could accurately identify common symptoms of concussion from a case presentation, many also misidentified nonconcussion and red flags (e.g., facial droop) as symptoms of concussion. A minority of coaches reported any formal training in concussion management. USA Judo coaches are receptive to and would benefit from a sport-specific standardized concussion training program.

One-year test-retest reliability of ten vision tests in Canadian athletes.

Background: Vision tests are increasingly being suggested for use in concussion management and baseline testing. Concussions, however, often occur months after baseline testing and reliability studies generally examine intervals limited to days or one week. Therefore, our objective was to determine the one-year test-retest reliability of these tests. Methods: We assessed one-year test-retest reliability of ten vision tests in elite Canadian athletes followed by the Institut National du Sport du Quebec. We included athletes who completed two baseline (preseason) annual evaluations by one clinician within 365±30 days. We excluded athletes with any concussion or vision training in between the annual evaluations or presented with any factor that is believed to affect the tests (e.g. migraines, etc.). Data were collected from clinical charts. We evaluated test-retest reliability using Intraclass Correlation Coefficient (ICC) and 95% limits of agreement (LoA). Results: We examined nine female and seven male athletes with a meanage of22.7 (SD 4.5) years. Among the vision tests, we observed excellent test-retest reliability in Positive Fusional Vergence at 30cm (ICC=0.93) but this dropped to 0.55 when an outlier was excluded in a sensitivity analysis. There was good to moderate reliability in Negative Fusional Vergence at 30cm (ICC=0.78), Phoria at 30cm (ICC=0.68), Near Point of Convergence break (ICC=0.65) and Saccade (ICC=0.56). The ICC for Positive Fusional Vergence at 3m (ICC=0.56) also decreased to 0.21 after removing one outlier. We found poor reliability in Near Point of Convergence (ICC=0.47), Gross Stereoscopic Acuity (ICC=0.03) and Negative Fusional Vergence at 3m (ICC=0.0). ICC for Phoria at 3m was not appropriate because scores were identical in 14/16 athletes. 95% LoA of the majority of tests were ±40% to ±90%. Conclusions: Four tests had moderate one-year test-retest reliability. The remaining tests had poor reliability. The tests would therefore be useful only if concussion has a moderate-large effect on scores.

One-year test-retest reliability of ten vision tests in Canadian athletes

Background: Vision tests are used in concussion management and baseline testing. Concussions, however, often occur months after baseline testing and reliability studies generally examine intervals limited to days or one week. Our objective was to determine the one-year test-retest reliability of these tests. Methods: We assessed one-year test-retest reliability of ten vision tests in elite Canadian athletes followed by the Institut National du Sport du Quebec. We included athletes who completed two baseline (preseason) annual evaluations by one clinician within 365±30 days. We excluded athletes with any concussion or vision training in between the annual evaluations or presented with any factor that is believed to affect the tests (e.g. migraines). Data were collected from clinical charts. We evaluated test-retest reliability using Intraclass Correlation Coefficient (ICC) and 95% limits of agreement (LoA). Results: We examined nine female and seven male athletes with a mean age of 22.7 (SD 4.5) years. Among the vision tests, we observed excellent test-retest reliability in Positive Fusional Vergence at 30cm (ICC=0.93) but this dropped to 0.53 when an outlier was excluded in a sensitivity analysis. There was good to moderate reliability in Negative Fusional Vergence at 30cm (ICC=0.78), Phoria at 30cm (ICC=0.68), Near Point of Convergence break (ICC=0.65) and Saccades (ICC=0.61). The ICC for Positive Fusional Vergence at 3m (ICC=0.56) also decreased to 0.45 after removing two outliers. We found poor reliability in Near Point of Convergence (ICC=0.47), Gross Stereoscopic Acuity (ICC=0.03) and Negative Fusional Vergence at 3m (ICC=0.0). ICC for Phoria at 3m was not appropriate because scores were identical in 14/16 athletes. 95% LoA of the majority of tests were ±40% to ±90%. Conclusions: Five tests had good to moderate one-year test-retest reliability. The remaining tests had poor reliability. The tests would therefore be useful only if concussion has a moderate-large effect on scores.