Definition Of Concussion Research Articles

Mild Traumatic Brain Injury (Concussion) During Combat

To determine whether screening for a blast mechanism of concussion identifies individuals at higher risk of persistent postconcussive symptoms (PCS). United States Army post. 3952 US Army infantry soldiers were administered anonymous surveys 3 to 6 months after returning from a yearlong deployment to Iraq. Self-reported concussion (defined as an injury that resulted in being "dazed, confused, or 'seeing stars'"; "not remembering the injury"; or "losing consciousness [knocked out]): Patient Health Questionnaire 15-item scale for physical symptoms and PCS; Posttraumatic Stress Disorder Checklist; and Patient Health Questionnaire depression module. Of the 587 soldiers (14.9% of the total sample) who met criteria for concussion, 201 (34.2%) reported loss of consciousness, and 373 (63.5%) reported only an alteration of consciousness without loss of consciousness; 424 (72.2%) reported a blast mechanism, and 150 (25.6%) reported a nonblast mechanism. Among soldiers who lost consciousness, blast mechanism was significantly associated with headaches and tinnitus 3 to 6 months postdeployment compared with a nonblast mechanism. However, among the larger group of soldiers reporting concussions without loss of consciousness, blast was not associated with adverse health outcomes. Blast mechanism of concussion was inconsistently associated with PCS, depending on the definition of concussion utilized. A self-reported history of blast mechanism was not associated with persistent PCS for the majority of US soldiers with concussions.

Consensus Statement on Concussion in Sport: The 3rd International Conference on Concussion in Sport Held in Zurich, November 2008

This paper is a revision and update of the recommendations developed following the 1st (Vienna) and 2nd (Prague) International Symposia on Concussion in Sport.1 2 The Zurich Consensus statement is designed to build on the principles outlined in the original Vienna and Prague documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document. This document is developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving and therefore management and return to play decisions remain in the realm of clinical judgement on an individualised basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document and/or the Sports Concussion Assessment Tool (SCAT2) card and neither is subject to any copyright restriction. The authors request, however that the document and/or the SCAT2 card be distributed in their full and complete format. The following focus questions formed the foundation for the Zurich concussion consensus statement: ### Acute simple concussion ### Return to play (RTP) issues

Let's Standardize the Definition of Concussion and Get Reliable Incidence Data

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Is protective equipment useful in preventing concussion? A systematic review of the literature

Objective:To determine if there is evidence that equipment use reduces sport concussion risk and/or severity.Data sources:12 electronic databases were searched using a combination of Medical Subject Headings and text words...

Consensus statement on Concussion in Sport—The 3rd International Conference on Concussion in Sport held in Zurich, November 2008

This paper is a revision and update of the recommendations developed following the 1st (Vienna) and 2nd (Prague) International Symposia on Concussion in Sport.1 2 The Zurich Consensus statement is designed to build on the principles outlined in the original Vienna and Prague documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document. This document is developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving and therefore management and return to play decisions remain in the realm of clinical judgement on an individualised basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document and/or the Sports Concussion Assessment Tool (SCAT2) card and neither is subject to any copyright restriction. The authors request, however that the document and/or the SCAT2 card be distributed in their full and complete format. The following focus questions formed the foundation for the Zurich concussion consensus statement: ### Acute simple concussion ### Return to play (RTP) issues

The Role of a School Psychologist in Concussion

School psychologists historically have received little training on topics such as mild traumatic brain injury or concussion, yet they could play a significant role in assessment, consultation, and intervention with students who have sustained a concussion. The purpose of this article is to educate school psychologists with regard to definition, prevalence, characteristics, and management of concussion in children, especially the various services that a school could provide to assist these students with their recovery. The article includes a case study that highlights the personal challenges faced by a student with concussion.

Review of sports-related concussion: Potential for application in military settings

This article reviews current issues and practices in the assessment and clinical management of sports-related concussion. An estimated 300,000 sports-related concussions occur annually in the United States. Much of what has been learned about concussion in the sports arena can be applied to the diagnosis and management of concussion in military settings. Current military guidelines for assessing and managing concussion in war zones incorporate information and methods developed through sports-concussion research. We discuss the incidence, definition, and diagnosis of concussion; concussion grading scales; sideline evaluation tools; neuropsychological assessment; return-to-action criteria; and complications of concussion.

Controversies in the evaluation and management of minor blunt head trauma in children

We present data from recently conducted research regarding controversial aspects of the evaluation and management of children with minor blunt head trauma. Clinicians frequently but at times indiscriminately perform computed tomography scans for children with minor blunt head trauma resulting in potentially harmful radiation exposure. Recent guidelines recognize the limited but increasing data available to make strong recommendations regarding appropriate neuroimaging decisions. Investigators have derived and validated clinical prediction models to accurately identify patients with substantial traumatic brain injury, though no clear definitive rule exists. Children younger than 2 years appear to have a higher risk of intracranial injury following minor head trauma. These patients can be difficult to assess, with the evidence suggesting the need for a more conservative approach to diagnostic imaging. We present current and accepted definitions of concussion along with risk factors and treatment for postconcussion syndrome. Current return-to-play guidelines suggest that athletes who have sustained concussion should not resume play until symptoms have resolved because of the possibility, though rare, of second impact syndrome. Research in the management of children with minor head trauma is actively evolving. We present a review of recent developments that can influence current clinical practice.

Poster 60: Challenges in the Diagnosis of Concussion in the Emergency Department

Objective: To determine the frequency of undiagnosed concussion in the emergency department (ED) in persons meeting the U.S. Centers for Disease Control and Prevention (CDC) operational definition of concussion. Design: Retrospective review of medical records of patients identified in the ED by study personnel as meeting CDC concussion criteria. Charts were reviewed for clinical diagnosis of concussion and key terms used in concussion epidemiologic studies. Setting: Urban academic level I trauma center ED.

Reflections on 40 years as a sideline physician

In this study the author presents his personal observations concerning football injuries in a historical perspective with additional literature citations. Aspects of brachial plexus and cervical spine injuries, neurapraxia, face mask infractions, concussion, acute subdural hematoma (SDH), and the so-called second-impact syndrome are addressed. The list of conclusions presented in this paper is as follows: there is more than one kind of brachial plexus injury; wedging of cervical vertebrae may be normal; neurapraxia presents a problem for return to play; face mask injuries are rarely serious; definitions of concussion vary; acute SDH requires immediate transfer to a hospital; and the second-impact syndrome may be a myth to some.

Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004

In November 2001, the 1st International Symposium on Concussion in Sport was held in Vienna, Austria to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, football (soccer), and other sports. The 2nd International Symposium on Concussion in Sport was organised by the same group and held in Prague, Czech Republic in November 2004. It resulted in a revision and update of the Vienna consensus recommendations, which are presented here.

Proximal myotonic dystrophy mimicking progressive muscular atrophy

Sir, I read the article, A controlled prospective inception cohort study on the postconcussion syndrome outside the medicolegal context, by Mickeviciene et al. in the June 2004 issue with interest. Although the results are intriguing, they may not be generalizable to other patients with sequelae from mild head injuries. As the authors note, they arbitrarily defined mild head injury as loss of consciousness of up to 15 min. In other studies, a duration of up to 30 min has been used. In addition, 66% of the cases were the result of assaults and 16% as a result of car accidents. This contrasts with the relative causes of head trauma in industrialized countries such as the USA or Western Europe: motor vehicle accidents, 45%; falls, 30%; occupational accidents, 10%; recreational accidents, 10%; and assaults, 5% (Jennett and Frankowski, 1990). Different external causes of head trauma may have different sequelae. The authors conclude that the most important observation in the study was that the prevalence, frequency, and VAS scores of headache of head injured and controls did not differ at 3 months and 1 year. However, the prevalence of headaches more than 14 days in controls (6% at 3 months and 8% at 1 year) was higher than reported in other countries. Although I am not aware of any prevalence studies in Lithuania, compare this to population-based studies revealing the prevalence of chronic daily headache in 2.98% (4.18% in females and 1.62% in males) in France (Lanteri-Minet et al., 2003) and 4.1% in the USA (5% in females and 2.8% in males; Scher et al., 1998). The prevalence of headaches in controls in this study is especially high when you consider that 66% of both head injured and controls were males. In summary, the results may not be generalizable because of the following: the definition of concussion used; the predominant male population; assault was the most common cause of injury; and the inordinately high prevalence of headache in the control population.

An Introduction to Sports Concussion for the Sport Psychology Consultant

This paper was designed to introduce the sport psychology consultant (SPC) to the relevant practical and theoretical information pertaining to sports concussion. The paper discusses four key areas related to sports concussion: 1) recognition, 2) management, 3) psychological issues following a concussion, and 4) prevention and education. Throughout the paper, the authors emphasize the role of the SPC in each of these four areas. An integrated review of the sport concussion literature and current research and guidelines regarding the definition, pathophysiology, symptoms, neuropsychological testing, and risk factors for concussion is presented. The SPC's roles in educating and helping athletes deal with post-concussion issues such as the pressure to return to play and fear of reinjury are examined. The authors highlight the need for baseline neuropsychological testing of athletes; and advocate a multidimensional team approach to sport concussion, involving the SPC as a key member of that team.

Heading and head injuries in soccer.

In the world of sports, soccer is unique because of the purposeful use of the unprotected head for controlling and advancing the ball. This skill obviously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even the ball. Such impacts can lead to contusions, fractures, eye injuries, concussions or even, in rare cases, death. Coaches, players, parents and physicians are rightly concerned about the risk of head injury in soccer. Current research shows that selected soccer players have some degree of cognitive dysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that focus on heading has revealed methodological concerns that question the validity of blaming purposeful heading of the ball. The player's history and age (did they play when the ball was leather and could absorb significant amounts of water), alcohol intake, drug intake, learning disabilities, concussion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a player's history of concussive episodes is a more likely explanation for cognitive deficits. While it is likely that the subconcussive impact of purposeful heading is a doubtful factor in the noted deficits, it is unknown whether multiple subconcussive impacts might have some lingering effects. In addition, it is unknown whether the noted deficits have any affect on daily life. Proper instruction in the technique is critical because if the ball contacts an unprepared head (as in accidental head-ball contacts), the potential for serious injury is possible. To further our understanding of the relationship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the head, verify the exposure to heading at all ages and competitive levels, determine stable estimates of concussive injury rates across the soccer spectrum, conduct prospective longitudinal studies on soccer players focusing on exposure, injury and cognition, and determine the minimum safe age to begin instruction on the skill of heading. Only then will we be able to speak with some authority on the issue of heading and head injuries in soccer.

Cerebral concussion in athletes: evaluation and neuropsychological testing.

To conduct a topic review of studies related to cerebral concussion in athletes, as an aid to improving decision-making and outcomes. We review the literature to provide an historical perspective on the incidence and definition of and the management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide additional principles for decision-making. Neuropsychological testing, as it applies to athletes, is discussed in detail, to delineate baseline assessments, the characteristics of the neuropsychological evaluation, the neuropsychological tests used, and the methods for in-season identification of cerebral concussion. Future directions in the management of concussions are presented. The incidence of cerebral concussions has been reduced from approximately 19 per 100 participants in football per season to approximately 4 per 100, i.e., 40,000 to 50,000 concussions per year in football alone. The most commonly used definitions of concussion are those proposed by Cantu and the American Academy of Neurology. Each has associated management guidelines. Concussion or loss of consciousness occurs when the extracellular potassium concentration increases beyond the upper normal limit of approximately 4 to 5 mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma. Neuropsychological testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of neuropsychological testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries.

Stalning af amyloid percursor protein to study axonal damage in mild head Injury

The most common definition of cerebral concussion is that of a transient loss of neurological function without macroscopic or microscopic abnormality in the brain. However, some patients have persistent symptoms and subtle neuropsychological deficits, particularly affecting memory. We have studied five patients aged 59-89 years who sustained mild concussive head injury and died of other causes (2-99 days post-injury). Immunostaining with an antibody to amyloid precursor protein, a marker of fast axonal transport, showed multifocal axonal injury in all five. All had axonal damage in the fornices, which are important in memory function.

HEAD INJURIES

The postconcussional syndrome is being recognized more and more frequently as an oft occurring sequela of concussion of the brain. It is usually characterized by triad of symptoms which includes headache, dizziness and emotional disturbances. To gain clear conception of this common condition it is first necessary to define concussion. One of the better definitions of concussion was presented by Strauss and Savitsky 1 as a series of events resulting from blow to the head severe enough to cause disruption of intracranial equilibrium. This statement is broad enough to allow for many of the theories of its pathophysiology. 2 A general discussion of this disorder and its treatment seems timely, since undoubtedly there will soon be many more patients with this condition owing to the increased frequency of concussion resulting from war injuries. Unfortunately great number of these patients are labeled neurotic. This is because